Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

LIDOCAINE INJ 1%/25G 5/8

Facility

$8.00

Hospital Charge Code	60634271
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% 30ML SDV

Facility

$86.45

Hospital Charge Code	60628271
Hospital Revenue Code	250
Min. Negotiated Rate	$12.97
Max. Negotiated Rate	$12.97
Rate for Payer: Qualcare PPO/HMO/WC	$12.97

LIDOCAINE INJ 1% 30ML SDV

Facility

$86.45

Hospital Charge Code	60628271
Hospital Revenue Code	250
Min. Negotiated Rate	$2.08
Max. Negotiated Rate	$43.23
Rate for Payer: Aetna Commercial	$32.85
Rate for Payer: Aetna Medicare Advantage	$25.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.04
Rate for Payer: Cigna Commercial	$43.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.93
Rate for Payer: Oxford Commercial	$17.29
Rate for Payer: Qualcare PPO/HMO/WC	$12.97
Rate for Payer: UnitedHealthcare Commercial	$17.29
Rate for Payer: UnitedHealthcare Community & State	$2.08
Rate for Payer: Wellpoint Medicaid Managed Care	$2.29

LIDOCAINEINJ 1% 548108100

Facility

$111.25

Hospital Charge Code	60628272
Hospital Revenue Code	250
Min. Negotiated Rate	$2.68
Max. Negotiated Rate	$55.62
Rate for Payer: Aetna Commercial	$42.27
Rate for Payer: Aetna Medicare Advantage	$33.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.37
Rate for Payer: Cigna Commercial	$55.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.38
Rate for Payer: Oxford Commercial	$22.25
Rate for Payer: Qualcare PPO/HMO/WC	$16.69
Rate for Payer: UnitedHealthcare Commercial	$22.25
Rate for Payer: UnitedHealthcare Community & State	$2.68
Rate for Payer: Wellpoint Medicaid Managed Care	$2.95

LIDOCAINEINJ 1% 548108100

Facility

$111.25

Hospital Charge Code	60628272
Hospital Revenue Code	250
Min. Negotiated Rate	$16.69
Max. Negotiated Rate	$16.69
Rate for Payer: Qualcare PPO/HMO/WC	$16.69

LIDOCAINE INJ 20ML 2% W/EPI

Facility

$25.46

Service Code	NDC 409014710
Hospital Charge Code	60629099
Hospital Revenue Code	250
Min. Negotiated Rate	$3.82
Max. Negotiated Rate	$3.82
Rate for Payer: Qualcare PPO/HMO/WC	$3.82

LIDOCAINE INJ 20ML 2% W/EPI

Facility

$25.46

Service Code	NDC 409014710
Hospital Charge Code	60629099
Hospital Revenue Code	250
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$12.73
Rate for Payer: Aetna Commercial	$9.67
Rate for Payer: Aetna Medicare Advantage	$7.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.49
Rate for Payer: Cigna Commercial	$12.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.64
Rate for Payer: Oxford Commercial	$5.09
Rate for Payer: Qualcare PPO/HMO/WC	$3.82
Rate for Payer: UnitedHealthcare Commercial	$5.09
Rate for Payer: UnitedHealthcare Community & State	$0.61
Rate for Payer: Wellpoint Medicaid Managed Care	$0.67

LIDOCAINE INJ/2%/25G 5/8

Facility

$8.00

Hospital Charge Code	60634272
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/2%/25G 5/8

Facility

$8.00

Hospital Charge Code	60634272
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 5ML 2% W/EPI

Facility

$17.95

Hospital Charge Code	60629098
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$8.97
Rate for Payer: Aetna Commercial	$6.82
Rate for Payer: Aetna Medicare Advantage	$5.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.58
Rate for Payer: Cigna Commercial	$8.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.38
Rate for Payer: Oxford Commercial	$3.59
Rate for Payer: Qualcare PPO/HMO/WC	$2.69
Rate for Payer: UnitedHealthcare Commercial	$3.59
Rate for Payer: UnitedHealthcare Community & State	$0.43
Rate for Payer: Wellpoint Medicaid Managed Care	$0.48

LIDOCAINE INJ 5ML 2% W/EPI

Facility

$17.95

Hospital Charge Code	60629098
Hospital Revenue Code	250
Min. Negotiated Rate	$2.69
Max. Negotiated Rate	$2.69
Rate for Payer: Qualcare PPO/HMO/WC	$2.69

LIDOCAINE JELLY 2%6ML GLYDO

Facility

$47.84

Service Code	NDC 25021067376
Hospital Charge Code	606390539
Hospital Revenue Code	250
Min. Negotiated Rate	$7.18
Max. Negotiated Rate	$7.18
Rate for Payer: Qualcare PPO/HMO/WC	$7.18

LIDOCAINE JELLY 2%6ML GLYDO

Facility

$47.84

Service Code	NDC 25021067376
Hospital Charge Code	606390539
Hospital Revenue Code	250
Min. Negotiated Rate	$1.15
Max. Negotiated Rate	$23.92
Rate for Payer: Aetna Commercial	$18.18
Rate for Payer: Aetna Medicare Advantage	$14.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.20
Rate for Payer: Cigna Commercial	$23.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.35
Rate for Payer: Oxford Commercial	$9.57
Rate for Payer: Qualcare PPO/HMO/WC	$7.18
Rate for Payer: UnitedHealthcare Commercial	$9.57
Rate for Payer: UnitedHealthcare Community & State	$1.15
Rate for Payer: Wellpoint Medicaid Managed Care	$1.27

LIDOCAINE JELLY UROJET

Facility

$9.00

Hospital Charge Code	6012777
Hospital Revenue Code	252
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$3.42
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.70
Rate for Payer: Oxford Commercial	$1.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.35
Rate for Payer: UnitedHealthcare Commercial	$1.80
Rate for Payer: UnitedHealthcare Community & State	$0.22
Rate for Payer: Wellpoint Medicaid Managed Care	$0.24

LIDOCAINE JELLY UROJET

Facility

$9.00

Hospital Charge Code	6012777
Hospital Revenue Code	252
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

LIDOCAINE JELY 2% 20MG/ML 11ML

Facility

$51.05

Service Code	NDC 25021067377
Hospital Charge Code	606390281
Hospital Revenue Code	250
Min. Negotiated Rate	$7.66
Max. Negotiated Rate	$7.66
Rate for Payer: Qualcare PPO/HMO/WC	$7.66

LIDOCAINE JELY 2% 20MG/ML 11ML

Facility

$51.05

Service Code	NDC 25021067377
Hospital Charge Code	606390281
Hospital Revenue Code	250
Min. Negotiated Rate	$1.23
Max. Negotiated Rate	$25.52
Rate for Payer: Aetna Commercial	$19.40
Rate for Payer: Aetna Medicare Advantage	$15.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.02
Rate for Payer: Cigna Commercial	$25.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.31
Rate for Payer: Oxford Commercial	$10.21
Rate for Payer: Qualcare PPO/HMO/WC	$7.66
Rate for Payer: UnitedHealthcare Commercial	$10.21
Rate for Payer: UnitedHealthcare Community & State	$1.23
Rate for Payer: Wellpoint Medicaid Managed Care	$1.35

LIDOCAINE MPF 5% W/GLUC 7.5%

Facility

$73.00

Hospital Charge Code	6006845
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 MPF 5% W/GLUC 7.5%

Facility

$73.00

Hospital Charge Code	6006845
Hospital Revenue Code	250
Min. Negotiated Rate	$10.95
Max. Negotiated Rate	$10.95
Rate for Payer: Qualcare PPO/HMO/WC	$10.95

LIDOCAINE ORAL 20MG/ML 120ML

Facility

$34.60

Hospital Charge Code	6003263
Hospital Revenue Code	251
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$17.30
Rate for Payer: Aetna Commercial	$13.15
Rate for Payer: Aetna Medicare Advantage	$10.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.82
Rate for Payer: Cigna Commercial	$17.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.38
Rate for Payer: Oxford Commercial	$6.92
Rate for Payer: Qualcare PPO/HMO/WC	$5.19
Rate for Payer: UnitedHealthcare Commercial	$6.92
Rate for Payer: UnitedHealthcare Community & State	$0.83
Rate for Payer: Wellpoint Medicaid Managed Care	$0.92

LIDOCAINE ORAL 20MG/ML 120ML

Facility

$34.60

Hospital Charge Code	6003263
Hospital Revenue Code	251
Min. Negotiated Rate	$5.19
Max. Negotiated Rate	$5.19
Rate for Payer: Qualcare PPO/HMO/WC	$5.19

LIDOCAINE PF 1% INJ (2ML)

Facility

$7.64

Service Code	NDC 409471332
Hospital Charge Code	6063943127
Hospital Revenue Code	250
Min. Negotiated Rate	$1.15
Max. Negotiated Rate	$1.15
Rate for Payer: Qualcare PPO/HMO/WC	$1.15

LIDOCAINE PF 1% INJ (2ML)

Facility

$7.64

Service Code	NDC 409471332
Hospital Charge Code	6063943127
Hospital Revenue Code	250
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$3.82
Rate for Payer: Aetna Commercial	$2.90
Rate for Payer: Aetna Medicare Advantage	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.95
Rate for Payer: Cigna Commercial	$3.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.29
Rate for Payer: Oxford Commercial	$1.53
Rate for Payer: Qualcare PPO/HMO/WC	$1.15
Rate for Payer: UnitedHealthcare Commercial	$1.53
Rate for Payer: UnitedHealthcare Community & State	$0.18
Rate for Payer: Wellpoint Medicaid Managed Care	$0.20

LIDOCAINE (PRE-MIX)

Facility

$70.40

Hospital Charge Code	6008155
Hospital Revenue Code	250
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$35.20
Rate for Payer: Aetna Commercial	$26.75
Rate for Payer: Aetna Medicare Advantage	$21.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.95
Rate for Payer: Cigna Commercial	$35.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.12
Rate for Payer: Oxford Commercial	$14.08
Rate for Payer: Qualcare PPO/HMO/WC	$10.56
Rate for Payer: UnitedHealthcare Commercial	$14.08
Rate for Payer: UnitedHealthcare Community & State	$1.70
Rate for Payer: Wellpoint Medicaid Managed Care	$1.87

LIDOCAINE (PRE-MIX)

Facility

$70.40

Hospital Charge Code	6008155
Hospital Revenue Code	250
Min. Negotiated Rate	$10.56
Max. Negotiated Rate	$10.56
Rate for Payer: Qualcare PPO/HMO/WC	$10.56

Know your out-of-pocket cost for care.

All Charges