St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

LIDOCAINE HCL 1 % IJ SOLN

Facility

$1.56

Service Code	NDC 6332320102
Hospital Charge Code	6332320102
Hospital Revenue Code	250
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$0.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.78

LIDOCAINE HCL 1 % IJ SOLN

Facility

$0.20

Service Code	NDC 6332348527
Hospital Charge Code	6332348527
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.10
Rate for Payer: Aetna Government	$0.10
Rate for Payer: Brighton Health Commercial	$0.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.14
Rate for Payer: EmblemHealth Commercial	$0.10
Rate for Payer: Group Health Inc Commercial	$0.10
Rate for Payer: Group Health Inc Medicare	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.10
Rate for Payer: Hamaspik Choice Inc Medicare	$0.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.13

LIDOCAINE HCL 1 % IJ SOLN

Facility

$0.20

Service Code	NDC 6332348501
Hospital Charge Code	6332348501
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.10
Rate for Payer: Aetna Government	$0.10
Rate for Payer: Brighton Health Commercial	$0.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.14
Rate for Payer: EmblemHealth Commercial	$0.10
Rate for Payer: Group Health Inc Commercial	$0.10
Rate for Payer: Group Health Inc Medicare	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.10
Rate for Payer: Hamaspik Choice Inc Medicare	$0.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.13

LIDOCAINE HCL 1 % IJ SOLN

Facility

$0.10

Service Code	NDC 0409427601
Hospital Charge Code	0409427601
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05

LIDOCAINE HCL 1 % IJ SOLN

Facility

$0.20

Service Code	NDC 6332348501
Hospital Charge Code	6332348501
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.10

LIDOCAINE HCL 1 % IJ SOLN

Facility

$0.10

Service Code	NDC 0409427601
Hospital Charge Code	0409427601
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.05
Rate for Payer: Aetna Government	$0.05
Rate for Payer: Brighton Health Commercial	$0.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.06
Rate for Payer: EmblemHealth Commercial	$0.05
Rate for Payer: Group Health Inc Commercial	$0.05
Rate for Payer: Group Health Inc Medicare	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05
Rate for Payer: Hamaspik Choice Inc Medicare	$0.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.06

LIDOCAINE HCL 2 % EX GEL

Facility

$0.23

Service Code	NDC 6697710703
Hospital Charge Code	6697710703
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 HCL 2 % EX GEL

Facility

$0.23

Service Code	NDC 6697710703
Hospital Charge Code	6697710703
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.11

LIDOCAINE HCL 2 % EX GEL (WRAPPED)

Facility

$1.68

Service Code	NDC 1747871131
Hospital Charge Code	1747871131
Hospital Revenue Code	250
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$1.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.84
Rate for Payer: Aetna Government	$0.84
Rate for Payer: Brighton Health Commercial	$1.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.14
Rate for Payer: EmblemHealth Commercial	$0.84
Rate for Payer: Group Health Inc Commercial	$0.84
Rate for Payer: Group Health Inc Medicare	$0.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.84
Rate for Payer: Hamaspik Choice Inc Medicare	$0.84
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.09

LIDOCAINE HCL 2 % EX GEL (WRAPPED)

Facility

$1.68

Service Code	NDC 1747871131
Hospital Charge Code	1747871131
Hospital Revenue Code	250
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$0.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.84

LIDOCAINE HCL 2 % IJ SOLN

Facility

$0.47

Service Code	NDC 7075664887
Hospital Charge Code	7075664887
Hospital Revenue Code	250
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.23

LIDOCAINE HCL 2 % IJ SOLN

Facility

$0.25

Service Code	NDC 5515025520
Hospital Charge Code	5515025520
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.13

LIDOCAINE HCL 2 % IJ SOLN

Facility

$0.47

Service Code	NDC 7075664887
Hospital Charge Code	7075664887
Hospital Revenue Code	250
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.23
Rate for Payer: Aetna Government	$0.23
Rate for Payer: Brighton Health Commercial	$0.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.37
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.32
Rate for Payer: EmblemHealth Commercial	$0.23
Rate for Payer: Group Health Inc Commercial	$0.23
Rate for Payer: Group Health Inc Medicare	$0.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.23
Rate for Payer: Hamaspik Choice Inc Medicare	$0.23
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.30

LIDOCAINE HCL 2 % IJ SOLN

Facility

$0.25

Service Code	NDC 5515025520
Hospital Charge Code	5515025520
Hospital Revenue Code	250
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.13
Rate for Payer: Aetna Government	$0.13
Rate for Payer: Brighton Health Commercial	$0.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.17
Rate for Payer: EmblemHealth Commercial	$0.13
Rate for Payer: Group Health Inc Commercial	$0.13
Rate for Payer: Group Health Inc Medicare	$0.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.13
Rate for Payer: Hamaspik Choice Inc Medicare	$0.13
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.16

LIDOCAINE HCL 4 % EX SOLN

Facility

$0.96

Service Code	NDC 0054350547
Hospital Charge Code	0054350547
Hospital Revenue Code	250
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$0.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.53
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.48
Rate for Payer: Aetna Government	$0.48
Rate for Payer: Brighton Health Commercial	$0.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.77
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.65
Rate for Payer: EmblemHealth Commercial	$0.48
Rate for Payer: Group Health Inc Commercial	$0.48
Rate for Payer: Group Health Inc Medicare	$0.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.48
Rate for Payer: Hamaspik Choice Inc Medicare	$0.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.62

LIDOCAINE HCL 4 % EX SOLN

Facility

$0.96

Service Code	NDC 0054350547
Hospital Charge Code	0054350547
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.48

LIDOCAINE HCL (CARDIAC) 100 MG/5ML IV SOSY

Facility

$1.96

Service Code	NDC 7632933901
Hospital Charge Code	7632933901
Hospital Revenue Code	258
Min. Negotiated Rate	$0.98
Max. Negotiated Rate	$0.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.98

LIDOCAINE HCL (CARDIAC) 100 MG/5ML IV SOSY

Facility

$1.96

Service Code	NDC 7632933901
Hospital Charge Code	7632933901
Hospital Revenue Code	258
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$1.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.98
Rate for Payer: Aetna Government	$0.98
Rate for Payer: Brighton Health Commercial	$1.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.33
Rate for Payer: EmblemHealth Commercial	$0.98
Rate for Payer: Group Health Inc Commercial	$0.98
Rate for Payer: Group Health Inc Medicare	$0.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.98
Rate for Payer: Hamaspik Choice Inc Medicare	$0.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.27

LIDOCAINE HCL (CARDIAC) 100 MG/5ML IV SOSY

Facility

$1.37

Service Code	NDC 0409490334
Hospital Charge Code	0409490334
Hospital Revenue Code	258
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$1.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.68
Rate for Payer: Aetna Government	$0.68
Rate for Payer: Brighton Health Commercial	$1.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.93
Rate for Payer: EmblemHealth Commercial	$0.68
Rate for Payer: Group Health Inc Commercial	$0.68
Rate for Payer: Group Health Inc Medicare	$0.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.68
Rate for Payer: Hamaspik Choice Inc Medicare	$0.68
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.89

LIDOCAINE HCL (CARDIAC) 100 MG/5ML IV SOSY

Facility

$1.37

Service Code	NDC 0409490334
Hospital Charge Code	0409490334
Hospital Revenue Code	258
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$0.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.68

LIDOCAINE HCL (CARDIAC) PF 100 MG/5ML IV SOLN

Facility

$0.83

Service Code	NDC 6332320805
Hospital Charge Code	6332320805
Hospital Revenue Code	258
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$0.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.41

LIDOCAINE HCL (CARDIAC) PF 100 MG/5ML IV SOLN

Facility

$0.83

Service Code	NDC 6332320801
Hospital Charge Code	6332320801
Hospital Revenue Code	258
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$0.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.41

LIDOCAINE HCL (CARDIAC) PF 100 MG/5ML IV SOLN

Facility

$0.83

Service Code	NDC 6332320801
Hospital Charge Code	6332320801
Hospital Revenue Code	258
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.41
Rate for Payer: Aetna Government	$0.41
Rate for Payer: Brighton Health Commercial	$0.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.56
Rate for Payer: EmblemHealth Commercial	$0.41
Rate for Payer: Group Health Inc Commercial	$0.41
Rate for Payer: Group Health Inc Medicare	$0.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.41
Rate for Payer: Hamaspik Choice Inc Medicare	$0.41
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.54

LIDOCAINE HCL (CARDIAC) PF 100 MG/5ML IV SOLN

Facility

$0.83

Service Code	NDC 6332320805
Hospital Charge Code	6332320805
Hospital Revenue Code	258
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.41
Rate for Payer: Aetna Government	$0.41
Rate for Payer: Brighton Health Commercial	$0.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.56
Rate for Payer: EmblemHealth Commercial	$0.41
Rate for Payer: Group Health Inc Commercial	$0.41
Rate for Payer: Group Health Inc Medicare	$0.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.41
Rate for Payer: Hamaspik Choice Inc Medicare	$0.41
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.54

LIDOCAINE HCL (CARDIAC) PF 100 MG/5ML IV SOSY

Facility

$1.31

Service Code	NDC 0409132315
Hospital Charge Code	0409132315
Hospital Revenue Code	258
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$1.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.66
Rate for Payer: Aetna Government	$0.66
Rate for Payer: Brighton Health Commercial	$0.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.89
Rate for Payer: EmblemHealth Commercial	$0.66
Rate for Payer: Group Health Inc Commercial	$0.66
Rate for Payer: Group Health Inc Medicare	$0.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.66
Rate for Payer: Hamaspik Choice Inc Medicare	$0.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.85

Know your out-of-pocket cost for care.

All Charges