Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

LIDOCAINE 2% PF 2ML

Facility

$30.15

Service Code	NDC 55150016402
Hospital Charge Code	606390173
Hospital Revenue Code	250
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$15.07
Rate for Payer: Aetna Commercial	$11.46
Rate for Payer: Aetna Medicare Advantage	$9.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.69
Rate for Payer: Cigna Commercial	$15.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.04
Rate for Payer: Oxford Commercial	$6.03
Rate for Payer: Qualcare PPO/HMO/WC	$4.52
Rate for Payer: UnitedHealthcare Commercial	$6.03
Rate for Payer: UnitedHealthcare Community & State	$0.73
Rate for Payer: Wellpoint Medicaid Managed Care	$0.80

LIDOCAINE 2% SOL

Facility

$4.00

Service Code	NDC 63323048627
Hospital Charge Code	60628273
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

LIDOCAINE 2% SOL

Facility

$4.00

Service Code	NDC 63323048627
Hospital Charge Code	60628273
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

LIDOCAINE 2% UROJET GEL

Facility

$28.54

Service Code	NDC 76329301305
Hospital Charge Code	60635902
Hospital Revenue Code	250
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$14.27
Rate for Payer: Aetna Commercial	$10.85
Rate for Payer: Aetna Medicare Advantage	$8.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.28
Rate for Payer: Cigna Commercial	$14.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.56
Rate for Payer: Oxford Commercial	$5.71
Rate for Payer: Qualcare PPO/HMO/WC	$4.28
Rate for Payer: UnitedHealthcare Commercial	$5.71
Rate for Payer: UnitedHealthcare Community & State	$0.69
Rate for Payer: Wellpoint Medicaid Managed Care	$0.76

LIDOCAINE 2% UROJET GEL

Facility

$28.54

Service Code	NDC 76329301305
Hospital Charge Code	60635902
Hospital Revenue Code	250
Min. Negotiated Rate	$4.28
Max. Negotiated Rate	$4.28
Rate for Payer: Qualcare PPO/HMO/WC	$4.28

LIDOCAINE 2% W/ EPI

Facility

$105.32

Service Code	NDC 63323048921
Hospital Charge Code	60629138
Hospital Revenue Code	250
Min. Negotiated Rate	$2.54
Max. Negotiated Rate	$52.66
Rate for Payer: Aetna Commercial	$40.02
Rate for Payer: Aetna Medicare Advantage	$31.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.86
Rate for Payer: Cigna Commercial	$52.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.60
Rate for Payer: Oxford Commercial	$21.06
Rate for Payer: Qualcare PPO/HMO/WC	$15.80
Rate for Payer: UnitedHealthcare Commercial	$21.06
Rate for Payer: UnitedHealthcare Community & State	$2.54
Rate for Payer: Wellpoint Medicaid Managed Care	$2.79

LIDOCAINE 2% W/ EPI

Facility

$105.32

Service Code	NDC 63323048921
Hospital Charge Code	60629138
Hospital Revenue Code	250
Min. Negotiated Rate	$15.80
Max. Negotiated Rate	$15.80
Rate for Payer: Qualcare PPO/HMO/WC	$15.80

LIDOCAINE2% W/EPINEP-DENL1.8ML

Facility

$113.65

Hospital Charge Code	60628269
Hospital Revenue Code	250
Min. Negotiated Rate	$2.74
Max. Negotiated Rate	$56.83
Rate for Payer: Aetna Commercial	$43.19
Rate for Payer: Aetna Medicare Advantage	$34.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.98
Rate for Payer: Cigna Commercial	$56.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.09
Rate for Payer: Oxford Commercial	$22.73
Rate for Payer: Qualcare PPO/HMO/WC	$17.05
Rate for Payer: UnitedHealthcare Commercial	$22.73
Rate for Payer: UnitedHealthcare Community & State	$2.74
Rate for Payer: Wellpoint Medicaid Managed Care	$3.01

LIDOCAINE2% W/EPINEP-DENL1.8ML

Facility

$113.65

Hospital Charge Code	60628269
Hospital Revenue Code	250
Min. Negotiated Rate	$17.05
Max. Negotiated Rate	$17.05
Rate for Payer: Qualcare PPO/HMO/WC	$17.05

LIDOCAINE 4% 50ML TOPICAL (OR)

Facility

$321.60

Service Code	NDC 54350547
Hospital Charge Code	606390301
Hospital Revenue Code	250
Min. Negotiated Rate	$48.24
Max. Negotiated Rate	$48.24
Rate for Payer: Qualcare PPO/HMO/WC	$48.24

LIDOCAINE 4% 50ML TOPICAL (OR)

Facility

$321.60

Service Code	NDC 54350547
Hospital Charge Code	606390301
Hospital Revenue Code	250
Min. Negotiated Rate	$7.75
Max. Negotiated Rate	$160.80
Rate for Payer: Aetna Commercial	$122.21
Rate for Payer: Aetna Medicare Advantage	$96.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.01
Rate for Payer: Cigna Commercial	$160.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.48
Rate for Payer: Oxford Commercial	$64.32
Rate for Payer: Qualcare PPO/HMO/WC	$48.24
Rate for Payer: UnitedHealthcare Commercial	$64.32
Rate for Payer: UnitedHealthcare Community & State	$7.75
Rate for Payer: Wellpoint Medicaid Managed Care	$8.52

LIDOCAINE 4% 5GM L.M.X4

Facility

$56.28

Service Code	NDC 496088206
Hospital Charge Code	6060390471
Hospital Revenue Code	250
Min. Negotiated Rate	$1.36
Max. Negotiated Rate	$28.14
Rate for Payer: Aetna Commercial	$21.39
Rate for Payer: Aetna Medicare Advantage	$16.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.35
Rate for Payer: Cigna Commercial	$28.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.88
Rate for Payer: Oxford Commercial	$11.26
Rate for Payer: Qualcare PPO/HMO/WC	$8.44
Rate for Payer: UnitedHealthcare Commercial	$11.26
Rate for Payer: UnitedHealthcare Community & State	$1.36
Rate for Payer: Wellpoint Medicaid Managed Care	$1.49

LIDOCAINE 4% 5GM L.M.X4

Facility

$56.28

Service Code	NDC 496088206
Hospital Charge Code	6060390471
Hospital Revenue Code	250
Min. Negotiated Rate	$8.44
Max. Negotiated Rate	$8.44
Rate for Payer: Qualcare PPO/HMO/WC	$8.44

LIDOCAINE 4% 5ML AMP

Facility

$8.00

Hospital Charge Code	60635355
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna Commercial	$3.04
Rate for Payer: Aetna Medicare Advantage	$2.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.04
Rate for Payer: Cigna Commercial	$4.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.40
Rate for Payer: Oxford Commercial	$1.60
Rate for Payer: Qualcare PPO/HMO/WC	$1.20
Rate for Payer: UnitedHealthcare Commercial	$1.60
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.21

LIDOCAINE 4% 5ML AMP

Facility

$8.00

Hospital Charge Code	60635355
Hospital Revenue Code	250
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

LIDOCAINE 4% CREAM 5G

Facility

$46.75

Hospital Charge Code	60629077
Hospital Revenue Code	250
Min. Negotiated Rate	$1.13
Max. Negotiated Rate	$23.38
Rate for Payer: Aetna Commercial	$17.77
Rate for Payer: Aetna Medicare Advantage	$14.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.92
Rate for Payer: Cigna Commercial	$23.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.03
Rate for Payer: Oxford Commercial	$9.35
Rate for Payer: Qualcare PPO/HMO/WC	$7.01
Rate for Payer: UnitedHealthcare Commercial	$9.35
Rate for Payer: UnitedHealthcare Community & State	$1.13
Rate for Payer: Wellpoint Medicaid Managed Care	$1.24

LIDOCAINE 4% CREAM 5G

Facility

$46.75

Hospital Charge Code	60629077
Hospital Revenue Code	250
Min. Negotiated Rate	$7.01
Max. Negotiated Rate	$7.01
Rate for Payer: Qualcare PPO/HMO/WC	$7.01

LIDOCAINE 4% GEL PTCH SALONPAS

Facility

$14.54

Service Code	NDC 46581083006
Hospital Charge Code	606390402
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$7.27
Rate for Payer: Aetna Commercial	$5.53
Rate for Payer: Aetna Medicare Advantage	$4.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.71
Rate for Payer: Cigna Commercial	$7.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.36
Rate for Payer: Oxford Commercial	$2.91
Rate for Payer: Qualcare PPO/HMO/WC	$2.18
Rate for Payer: UnitedHealthcare Commercial	$2.91
Rate for Payer: UnitedHealthcare Community & State	$0.35
Rate for Payer: Wellpoint Medicaid Managed Care	$0.39

LIDOCAINE 4% GEL PTCH SALONPAS

Facility

$14.54

Service Code	NDC 46581083006
Hospital Charge Code	606390402
Hospital Revenue Code	250
Min. Negotiated Rate	$2.18
Max. Negotiated Rate	$2.18
Rate for Payer: Qualcare PPO/HMO/WC	$2.18

LIDOCAINE 4% MPF 5ML INJ

Facility

$50.59

Service Code	NDC 409428301
Hospital Charge Code	6063943213
Hospital Revenue Code	250
Min. Negotiated Rate	$1.22
Max. Negotiated Rate	$25.30
Rate for Payer: Aetna Commercial	$19.22
Rate for Payer: Aetna Medicare Advantage	$15.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.90
Rate for Payer: Cigna Commercial	$25.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.18
Rate for Payer: Oxford Commercial	$10.12
Rate for Payer: Qualcare PPO/HMO/WC	$7.59
Rate for Payer: UnitedHealthcare Commercial	$10.12
Rate for Payer: UnitedHealthcare Community & State	$1.22
Rate for Payer: Wellpoint Medicaid Managed Care	$1.34

LIDOCAINE 4% MPF 5ML INJ

Facility

$50.59

Service Code	NDC 409428301
Hospital Charge Code	6063943213
Hospital Revenue Code	250
Min. Negotiated Rate	$7.59
Max. Negotiated Rate	$7.59
Rate for Payer: Qualcare PPO/HMO/WC	$7.59

LIDOCAINE 4% SOL LARYNG-O-JET

Facility

$104.52

Service Code	NDC 76329630005
Hospital Charge Code	60628274
Hospital Revenue Code	250
Min. Negotiated Rate	$15.68
Max. Negotiated Rate	$15.68
Rate for Payer: Qualcare PPO/HMO/WC	$15.68

LIDOCAINE 4% SOL LARYNG-O-JET

Facility

$104.52

Service Code	NDC 76329630005
Hospital Charge Code	60628274
Hospital Revenue Code	250
Min. Negotiated Rate	$2.52
Max. Negotiated Rate	$52.26
Rate for Payer: Aetna Commercial	$39.72
Rate for Payer: Aetna Medicare Advantage	$31.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.65
Rate for Payer: Cigna Commercial	$52.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.36
Rate for Payer: Oxford Commercial	$20.90
Rate for Payer: Qualcare PPO/HMO/WC	$15.68
Rate for Payer: UnitedHealthcare Commercial	$20.90
Rate for Payer: UnitedHealthcare Community & State	$2.52
Rate for Payer: Wellpoint Medicaid Managed Care	$2.77

LIDOCAINE 5% GLUCOSE 7.5%

Facility

$46.45

Hospital Charge Code	6012769
Hospital Revenue Code	250
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$23.23
Rate for Payer: Aetna Commercial	$17.65
Rate for Payer: Aetna Medicare Advantage	$13.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.84
Rate for Payer: Cigna Commercial	$23.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.94
Rate for Payer: Oxford Commercial	$9.29
Rate for Payer: Qualcare PPO/HMO/WC	$6.97
Rate for Payer: UnitedHealthcare Commercial	$9.29
Rate for Payer: UnitedHealthcare Community & State	$1.12
Rate for Payer: Wellpoint Medicaid Managed Care	$1.23

LIDOCAINE 5% GLUCOSE 7.5%

Facility

$46.45

Hospital Charge Code	6012769
Hospital Revenue Code	250
Min. Negotiated Rate	$6.97
Max. Negotiated Rate	$6.97
Rate for Payer: Qualcare PPO/HMO/WC	$6.97

Know your out-of-pocket cost for care.

All Charges