Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

LIDOCAINE 5% OINT

Facility

$1,985.08

Service Code	NDC 168020437
Hospital Charge Code	60628417
Hospital Revenue Code	250
Min. Negotiated Rate	$47.84
Max. Negotiated Rate	$992.54
Rate for Payer: Aetna Commercial	$754.33
Rate for Payer: Aetna Medicare Advantage	$595.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$506.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$506.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$506.20
Rate for Payer: Cigna Commercial	$992.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$595.52
Rate for Payer: Oxford Commercial	$397.02
Rate for Payer: Qualcare PPO/HMO/WC	$297.76
Rate for Payer: UnitedHealthcare Commercial	$397.02
Rate for Payer: UnitedHealthcare Community & State	$47.84
Rate for Payer: Wellpoint Medicaid Managed Care	$52.60

LIDOCAINE 5% OINT

Facility

$1,985.08

Service Code	NDC 168020437
Hospital Charge Code	60628417
Hospital Revenue Code	250
Min. Negotiated Rate	$297.76
Max. Negotiated Rate	$297.76
Rate for Payer: Qualcare PPO/HMO/WC	$297.76

LIDOCAINE 5% PATCH

Facility

$69.68

Service Code	NDC 63481068706
Hospital Charge Code	60629189
Hospital Revenue Code	250
Min. Negotiated Rate	$10.45
Max. Negotiated Rate	$10.45
Rate for Payer: Qualcare PPO/HMO/WC	$10.45

LIDOCAINE 5% PATCH

Facility

$69.68

Service Code	NDC 63481068706
Hospital Charge Code	60629189
Hospital Revenue Code	250
Min. Negotiated Rate	$1.68
Max. Negotiated Rate	$34.84
Rate for Payer: Aetna Commercial	$26.48
Rate for Payer: Aetna Medicare Advantage	$20.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.77
Rate for Payer: Cigna Commercial	$34.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.90
Rate for Payer: Oxford Commercial	$13.94
Rate for Payer: Qualcare PPO/HMO/WC	$10.45
Rate for Payer: UnitedHealthcare Commercial	$13.94
Rate for Payer: UnitedHealthcare Community & State	$1.68
Rate for Payer: Wellpoint Medicaid Managed Care	$1.85

LIDOCAINE ABBOJECT/1000MG

Facility

$6.00

Hospital Charge Code	60634275
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

LIDOCAINE ABBOJECT/1000MG

Facility

$6.00

Hospital Charge Code	60634275
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$2.28
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.80
Rate for Payer: Oxford Commercial	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$1.20
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

LIDOCAINE ABBOJECT 1%/5ML

Facility

$7.00

Hospital Charge Code	60634273
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.66
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.10
Rate for Payer: Oxford Commercial	$1.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$1.40
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

LIDOCAINE ABBOJECT 1%/5ML

Facility

$7.00

Hospital Charge Code	60634273
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

LIDOCAINE ABBOJECT/2000MG

Facility

$15.00

Hospital Charge Code	60634276
Hospital Revenue Code	250
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$2.25

LIDOCAINE ABBOJECT/2000MG

Facility

$15.00

Hospital Charge Code	60634276
Hospital Revenue Code	250
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna Commercial	$5.70
Rate for Payer: Aetna Medicare Advantage	$4.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.83
Rate for Payer: Cigna Commercial	$7.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.50
Rate for Payer: Oxford Commercial	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.25
Rate for Payer: UnitedHealthcare Commercial	$3.00
Rate for Payer: UnitedHealthcare Community & State	$0.36
Rate for Payer: Wellpoint Medicaid Managed Care	$0.40

LIDOCAINE ABBOJECT 2%/5ML

Facility

$7.00

Hospital Charge Code	60634274
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.66
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.10
Rate for Payer: Oxford Commercial	$1.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$1.40
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

LIDOCAINE ABBOJECT 2%/5ML

Facility

$7.00

Hospital Charge Code	60634274
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

LIDOCAINE @ EPI 2%/100000 30ML

Facility

$14.00

Service Code	NDC 409318202
Hospital Charge Code	606350926
Hospital Revenue Code	250
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$7.00
Rate for Payer: Aetna Commercial	$5.32
Rate for Payer: Aetna Medicare Advantage	$4.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.57
Rate for Payer: Cigna Commercial	$7.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.20
Rate for Payer: Oxford Commercial	$2.80
Rate for Payer: Qualcare PPO/HMO/WC	$2.10
Rate for Payer: UnitedHealthcare Commercial	$2.80
Rate for Payer: UnitedHealthcare Community & State	$0.34
Rate for Payer: Wellpoint Medicaid Managed Care	$0.37

LIDOCAINE @ EPI 2%/100000 30ML

Facility

$14.00

Service Code	NDC 409318202
Hospital Charge Code	606350926
Hospital Revenue Code	250
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$2.10
Rate for Payer: Qualcare PPO/HMO/WC	$2.10

LIDOCAINE HCI 10MG/ML

Facility

$73.00

Hospital Charge Code	4800855
Hospital Revenue Code	250
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$36.50
Rate for Payer: Aetna Commercial	$27.74
Rate for Payer: Aetna Medicare Advantage	$21.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.61
Rate for Payer: Cigna Commercial	$36.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.90
Rate for Payer: Oxford Commercial	$14.60
Rate for Payer: Qualcare PPO/HMO/WC	$10.95
Rate for Payer: UnitedHealthcare Commercial	$14.60
Rate for Payer: UnitedHealthcare Community & State	$1.76
Rate for Payer: Wellpoint Medicaid Managed Care	$1.93

LIDOCAINE HCI 10MG/ML

Facility

$73.00

Hospital Charge Code	4800855
Hospital Revenue Code	250
Min. Negotiated Rate	$10.95
Max. Negotiated Rate	$10.95
Rate for Payer: Qualcare PPO/HMO/WC	$10.95

LIDOCAINE HYDROCHLORIDE 2% GEL

Facility

$28.68

Service Code	NDC 17478071130
Hospital Charge Code	6003289
Hospital Revenue Code	251
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$14.34
Rate for Payer: Aetna Commercial	$10.90
Rate for Payer: Aetna Medicare Advantage	$8.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.31
Rate for Payer: Cigna Commercial	$14.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.60
Rate for Payer: Oxford Commercial	$5.74
Rate for Payer: Qualcare PPO/HMO/WC	$4.30
Rate for Payer: UnitedHealthcare Commercial	$5.74
Rate for Payer: UnitedHealthcare Community & State	$0.69
Rate for Payer: Wellpoint Medicaid Managed Care	$0.76

LIDOCAINE HYDROCHLORIDE 2% GEL

Facility

$28.68

Service Code	NDC 17478071130
Hospital Charge Code	6003289
Hospital Revenue Code	251
Min. Negotiated Rate	$4.30
Max. Negotiated Rate	$4.30
Rate for Payer: Qualcare PPO/HMO/WC	$4.30

LIDOCAINE INJ 1% 10ML MDV

Facility

$13.13

Service Code	NDC 63323020110
Hospital Charge Code	60628270
Hospital Revenue Code	250
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$6.57
Rate for Payer: Aetna Commercial	$4.99
Rate for Payer: Aetna Medicare Advantage	$3.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.35
Rate for Payer: Cigna Commercial	$6.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.94
Rate for Payer: Oxford Commercial	$2.63
Rate for Payer: Qualcare PPO/HMO/WC	$1.97
Rate for Payer: UnitedHealthcare Commercial	$2.63
Rate for Payer: UnitedHealthcare Community & State	$0.32
Rate for Payer: Wellpoint Medicaid Managed Care	$0.35

LIDOCAINE INJ 1% 10ML MDV

Facility

$13.13

Service Code	NDC 63323020110
Hospital Charge Code	60628270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.97
Max. Negotiated Rate	$1.97
Rate for Payer: Qualcare PPO/HMO/WC	$1.97

LIDOCAINE INJ 1 % 10 ML VIAL

Facility

$5.00

Hospital Charge Code	60629316W
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

LIDOCAINE INJ 1 % 10 ML VIAL

Facility

$5.00

Hospital Charge Code	60629316W
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.50
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

LIDOCAINE INJ 1%/20ML VIA

Facility

$8.00

Hospital Charge Code	60634277
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 INJ 1%/20ML VIA

Facility

$8.00

Hospital Charge Code	60634277
Hospital Revenue Code	250
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

LIDOCAINE INJ 1%/25G 5/8

Facility

$8.00

Hospital Charge Code	60634271
Hospital Revenue Code	250
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

Know your out-of-pocket cost for care.

All Charges