Heights University Hospital

All Charges

Charge

Type

Setting

Price

LIDOCAINE 1% ABBOJECT 5ML

Facility

$59.83

Service Code	NDC 409490434
Hospital Charge Code	6063943311
Hospital Revenue Code	250
Min. Negotiated Rate	$7.78
Max. Negotiated Rate	$29.91
Rate for Payer: Aetna Commercial	$17.95
Rate for Payer: Aetna Medicare Advantage	$17.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.26
Rate for Payer: Cigna Commercial	$29.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.78
Rate for Payer: Oxford Commercial	$29.91
Rate for Payer: Qualcare PPO/HMO/WC	$8.97
Rate for Payer: UnitedHealthcare Commercial	$29.91

LIDOCAINE 1% ABBOJECT 5ML

Facility

$59.83

Service Code	NDC 409490434
Hospital Charge Code	6063943311
Hospital Revenue Code	250
Min. Negotiated Rate	$8.97
Max. Negotiated Rate	$8.97
Rate for Payer: Qualcare PPO/HMO/WC	$8.97

LIDOCAINE/1GM/DEXTROSE

Facility

$66.00

Hospital Charge Code	60634674
Hospital Revenue Code	250
Min. Negotiated Rate	$8.58
Max. Negotiated Rate	$33.00
Rate for Payer: Aetna Commercial	$19.80
Rate for Payer: Aetna Medicare Advantage	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.83
Rate for Payer: Cigna Commercial	$33.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.58
Rate for Payer: Oxford Commercial	$33.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.90
Rate for Payer: UnitedHealthcare Commercial	$33.00

LIDOCAINE/1GM/DEXTROSE

Facility

$66.00

Hospital Charge Code	60634674
Hospital Revenue Code	250
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$9.90
Rate for Payer: Qualcare PPO/HMO/WC	$9.90

LIDOCAINE 1% PF 5 ML AMP

Facility

$9.18

Service Code	NDC 409471302
Hospital Charge Code	606350966
Hospital Revenue Code	250
Min. Negotiated Rate	$1.38
Max. Negotiated Rate	$1.38
Rate for Payer: Qualcare PPO/HMO/WC	$1.38

LIDOCAINE 1% PF 5 ML AMP

Facility

$9.18

Service Code	NDC 409471302
Hospital Charge Code	606350966
Hospital Revenue Code	250
Min. Negotiated Rate	$1.19
Max. Negotiated Rate	$4.59
Rate for Payer: Aetna Commercial	$2.75
Rate for Payer: Aetna Medicare Advantage	$2.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.34
Rate for Payer: Cigna Commercial	$4.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.19
Rate for Payer: Oxford Commercial	$4.59
Rate for Payer: Qualcare PPO/HMO/WC	$1.38
Rate for Payer: UnitedHealthcare Commercial	$4.59

LIDOCAINE 1% SOL

Facility

$24.12

Service Code	NDC 409427001
Hospital Charge Code	60629316
Hospital Revenue Code	250
Min. Negotiated Rate	$3.62
Max. Negotiated Rate	$3.62
Rate for Payer: Qualcare PPO/HMO/WC	$3.62

LIDOCAINE 1% SOL

Facility

$24.12

Service Code	NDC 409427001
Hospital Charge Code	60629316
Hospital Revenue Code	250
Min. Negotiated Rate	$3.14
Max. Negotiated Rate	$12.06
Rate for Payer: Aetna Commercial	$7.24
Rate for Payer: Aetna Medicare Advantage	$7.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.15
Rate for Payer: Cigna Commercial	$12.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.14
Rate for Payer: Oxford Commercial	$12.06
Rate for Payer: Qualcare PPO/HMO/WC	$3.62
Rate for Payer: UnitedHealthcare Commercial	$12.06

LIDOCAINE1%WEPI 1,200,000 10ML

Facility

$59.36

Service Code	NDC 63323048717
Hospital Charge Code	606390272
Hospital Revenue Code	250
Min. Negotiated Rate	$8.90
Max. Negotiated Rate	$8.90
Rate for Payer: Qualcare PPO/HMO/WC	$8.90

LIDOCAINE1%WEPI 1,200,000 10ML

Facility

$59.36

Service Code	NDC 63323048717
Hospital Charge Code	606390272
Hospital Revenue Code	250
Min. Negotiated Rate	$7.72
Max. Negotiated Rate	$29.68
Rate for Payer: Aetna Commercial	$17.81
Rate for Payer: Aetna Medicare Advantage	$17.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.14
Rate for Payer: Cigna Commercial	$29.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.72
Rate for Payer: Oxford Commercial	$29.68
Rate for Payer: Qualcare PPO/HMO/WC	$8.90
Rate for Payer: UnitedHealthcare Commercial	$29.68

LIDOCAINE 2% 25G 5/8 SYR

Facility

$8.00

Hospital Charge Code	60635011
Hospital Revenue Code	250
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

LIDOCAINE 2% 25G 5/8 SYR

Facility

$8.00

Hospital Charge Code	60635011
Hospital Revenue Code	250
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna Commercial	$2.40
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	$1.04
Rate for Payer: Oxford Commercial	$4.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.20
Rate for Payer: UnitedHealthcare Commercial	$4.00

LIDOCAINE 2% 5ML INJ

Facility

$16.88

Service Code	NDC 63323020805
Hospital Charge Code	606350950
Hospital Revenue Code	250
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$2.53
Rate for Payer: Qualcare PPO/HMO/WC	$2.53

LIDOCAINE 2% 5ML INJ

Facility

$16.88

Service Code	NDC 63323020805
Hospital Charge Code	606350950
Hospital Revenue Code	250
Min. Negotiated Rate	$2.19
Max. Negotiated Rate	$8.44
Rate for Payer: Aetna Commercial	$5.06
Rate for Payer: Aetna Medicare Advantage	$5.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.30
Rate for Payer: Cigna Commercial	$8.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.19
Rate for Payer: Oxford Commercial	$8.44
Rate for Payer: Qualcare PPO/HMO/WC	$2.53
Rate for Payer: UnitedHealthcare Commercial	$8.44

LIDOCAINE 2.5% OINT

Facility

$2,613.87

Service Code	NDC 45861006130
Hospital Charge Code	60628416
Hospital Revenue Code	250
Min. Negotiated Rate	$339.80
Max. Negotiated Rate	$1,306.93
Rate for Payer: Aetna Commercial	$784.16
Rate for Payer: Aetna Medicare Advantage	$784.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$666.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$666.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$666.54
Rate for Payer: Cigna Commercial	$1,306.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$339.80
Rate for Payer: Oxford Commercial	$1,306.93
Rate for Payer: Qualcare PPO/HMO/WC	$392.08
Rate for Payer: UnitedHealthcare Commercial	$1,306.93

LIDOCAINE 2.5% OINT

Facility

$2,613.87

Service Code	NDC 45861006130
Hospital Charge Code	60628416
Hospital Revenue Code	250
Min. Negotiated Rate	$392.08
Max. Negotiated Rate	$392.08
Rate for Payer: Qualcare PPO/HMO/WC	$392.08

LIDOCAINE/2GM/DEXTROSE

Facility

$80.00

Hospital Charge Code	60634675
Hospital Revenue Code	250
Min. Negotiated Rate	$10.40
Max. Negotiated Rate	$40.00
Rate for Payer: Aetna Commercial	$24.00
Rate for Payer: Aetna Medicare Advantage	$24.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.40
Rate for Payer: Cigna Commercial	$40.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.40
Rate for Payer: Oxford Commercial	$40.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.00
Rate for Payer: UnitedHealthcare Commercial	$40.00

LIDOCAINE/2GM/DEXTROSE

Facility

$80.00

Hospital Charge Code	60634675
Hospital Revenue Code	250
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$12.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.00

LIDOCAINE 2% PF 2ML

Facility

$30.15

Service Code	NDC 55150016402
Hospital Charge Code	606390173
Hospital Revenue Code	250
Min. Negotiated Rate	$4.52
Max. Negotiated Rate	$4.52
Rate for Payer: Qualcare PPO/HMO/WC	$4.52

LIDOCAINE 2% PF 2ML

Facility

$30.15

Service Code	NDC 55150016402
Hospital Charge Code	606390173
Hospital Revenue Code	250
Min. Negotiated Rate	$3.92
Max. Negotiated Rate	$15.07
Rate for Payer: Aetna Commercial	$9.04
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	$3.92
Rate for Payer: Oxford Commercial	$15.07
Rate for Payer: Qualcare PPO/HMO/WC	$4.52
Rate for Payer: UnitedHealthcare Commercial	$15.07

LIDOCAINE 2% SOL

Facility

$4.00

Service Code	NDC 63323048627
Hospital Charge Code	60628273
Hospital Revenue Code	250
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.20
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	$0.52
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$2.00

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	$3.71
Max. Negotiated Rate	$14.27
Rate for Payer: Aetna Commercial	$8.56
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	$3.71
Rate for Payer: Oxford Commercial	$14.27
Rate for Payer: Qualcare PPO/HMO/WC	$4.28
Rate for Payer: UnitedHealthcare Commercial	$14.27

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	$13.69
Max. Negotiated Rate	$52.66
Rate for Payer: Aetna Commercial	$31.60
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	$13.69
Rate for Payer: Oxford Commercial	$52.66
Rate for Payer: Qualcare PPO/HMO/WC	$15.80
Rate for Payer: UnitedHealthcare Commercial	$52.66

Know your out-of-pocket cost for care.

All Charges