St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

LIDOCAINE 5 % EX PTCH

Facility

$9.36

Service Code	NDC 0591352530
Hospital Charge Code	0591352530
Hospital Revenue Code	250
Min. Negotiated Rate	$3.28
Max. Negotiated Rate	$7.49
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.68
Rate for Payer: Aetna Government	$4.68
Rate for Payer: Brighton Health Commercial	$7.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.49
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.36
Rate for Payer: EmblemHealth Commercial	$4.68
Rate for Payer: Group Health Inc Commercial	$4.68
Rate for Payer: Group Health Inc Medicare	$3.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.68
Rate for Payer: Hamaspik Choice Inc Medicare	$4.68
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.08

LIDOCAINE 5 % EX PTCH

Facility

$10.28

Service Code	NDC 0378905516
Hospital Charge Code	0378905516
Hospital Revenue Code	250
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$8.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.14
Rate for Payer: Aetna Government	$5.14
Rate for Payer: Brighton Health Commercial	$7.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.99
Rate for Payer: EmblemHealth Commercial	$5.14
Rate for Payer: Group Health Inc Commercial	$5.14
Rate for Payer: Group Health Inc Medicare	$3.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.14
Rate for Payer: Hamaspik Choice Inc Medicare	$5.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.68

LIDOCAINE 5 % EX PTCH

Facility

$9.36

Service Code	NDC 0591352511
Hospital Charge Code	0591352511
Hospital Revenue Code	250
Min. Negotiated Rate	$3.28
Max. Negotiated Rate	$7.49
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.68
Rate for Payer: Aetna Government	$4.68
Rate for Payer: Brighton Health Commercial	$7.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.49
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.36
Rate for Payer: EmblemHealth Commercial	$4.68
Rate for Payer: Group Health Inc Commercial	$4.68
Rate for Payer: Group Health Inc Medicare	$3.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.68
Rate for Payer: Hamaspik Choice Inc Medicare	$4.68
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.08

LIDOCAINE 5 % EX PTCH

Facility

$10.28

Service Code	NDC 6516279104
Hospital Charge Code	6516279104
Hospital Revenue Code	250
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$8.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.14
Rate for Payer: Aetna Government	$5.14
Rate for Payer: Brighton Health Commercial	$7.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.99
Rate for Payer: EmblemHealth Commercial	$5.14
Rate for Payer: Group Health Inc Commercial	$5.14
Rate for Payer: Group Health Inc Medicare	$3.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.14
Rate for Payer: Hamaspik Choice Inc Medicare	$5.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.68

LIDOCAINE 5 % EX PTCH

Facility

$3.42

Service Code	NDC 8234705055
Hospital Charge Code	8234705055
Hospital Revenue Code	250
Min. Negotiated Rate	$1.71
Max. Negotiated Rate	$1.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.71

LIDOCAINE 5 % EX PTCH

Facility

$9.36

Service Code	NDC 0591352530
Hospital Charge Code	0591352530
Hospital Revenue Code	250
Min. Negotiated Rate	$4.68
Max. Negotiated Rate	$4.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.68

LIDOCAINE 5 % EX PTCH

Facility

$3.42

Service Code	NDC 8234705055
Hospital Charge Code	8234705055
Hospital Revenue Code	250
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$2.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.71
Rate for Payer: Aetna Government	$1.71
Rate for Payer: Brighton Health Commercial	$2.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.33
Rate for Payer: EmblemHealth Commercial	$1.71
Rate for Payer: Group Health Inc Commercial	$1.71
Rate for Payer: Group Health Inc Medicare	$1.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.71
Rate for Payer: Hamaspik Choice Inc Medicare	$1.71
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.22

LIDOCAINE 5 % EX PTCH

Facility

$10.28

Service Code	NDC 0378905593
Hospital Charge Code	0378905593
Hospital Revenue Code	250
Min. Negotiated Rate	$5.14
Max. Negotiated Rate	$5.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.14

LIDOCAINE 5 % EX PTCH

Facility

$9.36

Service Code	NDC 0591352511
Hospital Charge Code	0591352511
Hospital Revenue Code	250
Min. Negotiated Rate	$4.68
Max. Negotiated Rate	$4.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.68

LIDOCAINE 5 % EX PTCH

Facility

$10.28

Service Code	NDC 0378905516
Hospital Charge Code	0378905516
Hospital Revenue Code	250
Min. Negotiated Rate	$5.14
Max. Negotiated Rate	$5.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.14

LIDOCAINE 5 % EX PTCH

Facility

$10.28

Service Code	NDC 0378905593
Hospital Charge Code	0378905593
Hospital Revenue Code	250
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$8.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.14
Rate for Payer: Aetna Government	$5.14
Rate for Payer: Brighton Health Commercial	$7.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.99
Rate for Payer: EmblemHealth Commercial	$5.14
Rate for Payer: Group Health Inc Commercial	$5.14
Rate for Payer: Group Health Inc Medicare	$3.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.14
Rate for Payer: Hamaspik Choice Inc Medicare	$5.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.68

LIDOCAINE 5 % EX PTCH

Facility

$10.28

Service Code	NDC 0603188010
Hospital Charge Code	0603188010
Hospital Revenue Code	250
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$8.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.14
Rate for Payer: Aetna Government	$5.14
Rate for Payer: Brighton Health Commercial	$7.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.99
Rate for Payer: EmblemHealth Commercial	$5.14
Rate for Payer: Group Health Inc Commercial	$5.14
Rate for Payer: Group Health Inc Medicare	$3.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.14
Rate for Payer: Hamaspik Choice Inc Medicare	$5.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.68

LIDOCAINE 5 % EX PTCH

Facility

$10.28

Service Code	NDC 6516279104
Hospital Charge Code	6516279104
Hospital Revenue Code	250
Min. Negotiated Rate	$5.14
Max. Negotiated Rate	$5.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.14

LIDOCAINE 5 % EX PTCH

Facility

$10.28

Service Code	NDC 0603188016
Hospital Charge Code	0603188016
Hospital Revenue Code	250
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$8.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.14
Rate for Payer: Aetna Government	$5.14
Rate for Payer: Brighton Health Commercial	$7.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.99
Rate for Payer: EmblemHealth Commercial	$5.14
Rate for Payer: Group Health Inc Commercial	$5.14
Rate for Payer: Group Health Inc Medicare	$3.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.14
Rate for Payer: Hamaspik Choice Inc Medicare	$5.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.68

LIDOCAINE 5 % EX PTCH

Facility

$10.28

Service Code	NDC 0603188010
Hospital Charge Code	0603188010
Hospital Revenue Code	250
Min. Negotiated Rate	$5.14
Max. Negotiated Rate	$5.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.14

LIDOCAINE 5 % EX PTCH

Facility

$10.28

Service Code	NDC 0603188016
Hospital Charge Code	0603188016
Hospital Revenue Code	250
Min. Negotiated Rate	$5.14
Max. Negotiated Rate	$5.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.14

LIDOCAINE 5 % EX PTCH

Facility

$31.81

Service Code	NDC 6348168706
Hospital Charge Code	6348168706
Hospital Revenue Code	250
Min. Negotiated Rate	$15.90
Max. Negotiated Rate	$15.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.90

LIDOCAINE-COLLAGEN-ALOE VERA 2 % EX GEL

Facility

$0.23

Service Code	NDC 6697710003
Hospital Charge Code	6697710003
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.11

LIDOCAINE-COLLAGEN-ALOE VERA 2 % EX GEL

Facility

$0.23

Service Code	NDC 6697710003
Hospital Charge Code	6697710003
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.11
Rate for Payer: Aetna Government	$0.11
Rate for Payer: Brighton Health Commercial	$0.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.15
Rate for Payer: EmblemHealth Commercial	$0.11
Rate for Payer: Group Health Inc Commercial	$0.11
Rate for Payer: Group Health Inc Medicare	$0.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.11
Rate for Payer: Hamaspik Choice Inc Medicare	$0.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.15

LIDOCAINE-EPINEPHRINE 1 %-1:100000 IJ SOLN

Facility

$0.42

Service Code	NDC 6332348201
Hospital Charge Code	6332348201
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.33
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.23
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.21
Rate for Payer: Aetna Government	$0.21
Rate for Payer: Brighton Health Commercial	$0.31
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.33
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.28
Rate for Payer: EmblemHealth Commercial	$0.21
Rate for Payer: Group Health Inc Commercial	$0.21
Rate for Payer: Group Health Inc Medicare	$0.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.21
Rate for Payer: Hamaspik Choice Inc Medicare	$0.21
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.27

LIDOCAINE-EPINEPHRINE 1 %-1:100000 IJ SOLN

Facility

$0.30

Service Code	NDC 6332348203
Hospital Charge Code	6332348203
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.15
Rate for Payer: Aetna Government	$0.15
Rate for Payer: Brighton Health Commercial	$0.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.20
Rate for Payer: EmblemHealth Commercial	$0.15
Rate for Payer: Group Health Inc Commercial	$0.15
Rate for Payer: Group Health Inc Medicare	$0.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.15
Rate for Payer: Hamaspik Choice Inc Medicare	$0.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.19

LIDOCAINE-EPINEPHRINE 1 %-1:100000 IJ SOLN

Facility

$0.30

Service Code	NDC 6332348203
Hospital Charge Code	6332348203
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.15

LIDOCAINE-EPINEPHRINE 1 %-1:100000 IJ SOLN

Facility

$0.42

Service Code	NDC 6332348217
Hospital Charge Code	6332348217
Hospital Revenue Code	250
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.21

LIDOCAINE-EPINEPHRINE 1 %-1:100000 IJ SOLN

Facility

$0.42

Service Code	NDC 6332348217
Hospital Charge Code	6332348217
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.33
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.23
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.21
Rate for Payer: Aetna Government	$0.21
Rate for Payer: Brighton Health Commercial	$0.31
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.33
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.28
Rate for Payer: EmblemHealth Commercial	$0.21
Rate for Payer: Group Health Inc Commercial	$0.21
Rate for Payer: Group Health Inc Medicare	$0.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.21
Rate for Payer: Hamaspik Choice Inc Medicare	$0.21
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.27

LIDOCAINE-EPINEPHRINE 1 %-1:100000 IJ SOLN

Facility

$0.42

Service Code	NDC 6332348201
Hospital Charge Code	6332348201
Hospital Revenue Code	250
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.21

Know your out-of-pocket cost for care.

All Charges