Heights University Hospital

All Charges

Charge

Type

Setting

Price

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

LIDOCAINE2% W/EPINEP-DENL1.8ML

Facility

$113.65

Hospital Charge Code	60628269
Hospital Revenue Code	250
Min. Negotiated Rate	$17.05
Max. Negotiated Rate	$17.05
Rate for Payer: Qualcare PPO/HMO/WC	$17.05

LIDOCAINE2% W/EPINEP-DENL1.8ML

Facility

$113.65

Hospital Charge Code	60628269
Hospital Revenue Code	250
Min. Negotiated Rate	$14.77
Max. Negotiated Rate	$56.83
Rate for Payer: Aetna Commercial	$34.09
Rate for Payer: Aetna Medicare Advantage	$34.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.98
Rate for Payer: Cigna Commercial	$56.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.77
Rate for Payer: Oxford Commercial	$56.83
Rate for Payer: Qualcare PPO/HMO/WC	$17.05
Rate for Payer: UnitedHealthcare Commercial	$56.83

LIDOCAINE 4% 50ML TOPICAL (OR)

Facility

$321.60

Service Code	NDC 54350547
Hospital Charge Code	606390301
Hospital Revenue Code	250
Min. Negotiated Rate	$41.81
Max. Negotiated Rate	$160.80
Rate for Payer: Aetna Commercial	$96.48
Rate for Payer: Aetna Medicare Advantage	$96.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.01
Rate for Payer: Cigna Commercial	$160.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.81
Rate for Payer: Oxford Commercial	$160.80
Rate for Payer: Qualcare PPO/HMO/WC	$48.24
Rate for Payer: UnitedHealthcare Commercial	$160.80

LIDOCAINE 4% 50ML TOPICAL (OR)

Facility

$321.60

Service Code	NDC 54350547
Hospital Charge Code	606390301
Hospital Revenue Code	250
Min. Negotiated Rate	$48.24
Max. Negotiated Rate	$48.24
Rate for Payer: Qualcare PPO/HMO/WC	$48.24

LIDOCAINE 4% 5GM L.M.X4

Facility

$56.28

Service Code	NDC 496088206
Hospital Charge Code	6060390471
Hospital Revenue Code	250
Min. Negotiated Rate	$7.32
Max. Negotiated Rate	$28.14
Rate for Payer: Aetna Commercial	$16.88
Rate for Payer: Aetna Medicare Advantage	$16.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.35
Rate for Payer: Cigna Commercial	$28.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.32
Rate for Payer: Oxford Commercial	$28.14
Rate for Payer: Qualcare PPO/HMO/WC	$8.44
Rate for Payer: UnitedHealthcare Commercial	$28.14

LIDOCAINE 4% 5GM L.M.X4

Facility

$56.28

Service Code	NDC 496088206
Hospital Charge Code	6060390471
Hospital Revenue Code	250
Min. Negotiated Rate	$8.44
Max. Negotiated Rate	$8.44
Rate for Payer: Qualcare PPO/HMO/WC	$8.44

LIDOCAINE 4% 5ML AMP

Facility

$8.00

Hospital Charge Code	60635355
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 4% 5ML AMP

Facility

$8.00

Hospital Charge Code	60635355
Hospital Revenue Code	250
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

LIDOCAINE 4% CREAM 5G

Facility

$46.75

Hospital Charge Code	60629077
Hospital Revenue Code	250
Min. Negotiated Rate	$7.01
Max. Negotiated Rate	$7.01
Rate for Payer: Qualcare PPO/HMO/WC	$7.01

LIDOCAINE 4% CREAM 5G

Facility

$46.75

Hospital Charge Code	60629077
Hospital Revenue Code	250
Min. Negotiated Rate	$6.08
Max. Negotiated Rate	$23.38
Rate for Payer: Aetna Commercial	$14.03
Rate for Payer: Aetna Medicare Advantage	$14.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.92
Rate for Payer: Cigna Commercial	$23.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.08
Rate for Payer: Oxford Commercial	$23.38
Rate for Payer: Qualcare PPO/HMO/WC	$7.01
Rate for Payer: UnitedHealthcare Commercial	$23.38

LIDOCAINE 4% GEL PTCH SALONPAS

Facility

$14.54

Service Code	NDC 46581083006
Hospital Charge Code	606390402
Hospital Revenue Code	250
Min. Negotiated Rate	$2.18
Max. Negotiated Rate	$2.18
Rate for Payer: Qualcare PPO/HMO/WC	$2.18

LIDOCAINE 4% GEL PTCH SALONPAS

Facility

$14.54

Service Code	NDC 46581083006
Hospital Charge Code	606390402
Hospital Revenue Code	250
Min. Negotiated Rate	$1.89
Max. Negotiated Rate	$7.27
Rate for Payer: Aetna Commercial	$4.36
Rate for Payer: Aetna Medicare Advantage	$4.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.71
Rate for Payer: Cigna Commercial	$7.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.89
Rate for Payer: Oxford Commercial	$7.27
Rate for Payer: Qualcare PPO/HMO/WC	$2.18
Rate for Payer: UnitedHealthcare Commercial	$7.27

LIDOCAINE 4% MPF 5ML INJ

Facility

$50.59

Service Code	NDC 409428301
Hospital Charge Code	6063943213
Hospital Revenue Code	250
Min. Negotiated Rate	$7.59
Max. Negotiated Rate	$7.59
Rate for Payer: Qualcare PPO/HMO/WC	$7.59

LIDOCAINE 4% MPF 5ML INJ

Facility

$50.59

Service Code	NDC 409428301
Hospital Charge Code	6063943213
Hospital Revenue Code	250
Min. Negotiated Rate	$6.58
Max. Negotiated Rate	$25.30
Rate for Payer: Aetna Commercial	$15.18
Rate for Payer: Aetna Medicare Advantage	$15.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.90
Rate for Payer: Cigna Commercial	$25.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.58
Rate for Payer: Oxford Commercial	$25.30
Rate for Payer: Qualcare PPO/HMO/WC	$7.59
Rate for Payer: UnitedHealthcare Commercial	$25.30

LIDOCAINE 4% SOL LARYNG-O-JET

Facility

$104.52

Service Code	NDC 76329630005
Hospital Charge Code	60628274
Hospital Revenue Code	250
Min. Negotiated Rate	$15.68
Max. Negotiated Rate	$15.68
Rate for Payer: Qualcare PPO/HMO/WC	$15.68

LIDOCAINE 4% SOL LARYNG-O-JET

Facility

$104.52

Service Code	NDC 76329630005
Hospital Charge Code	60628274
Hospital Revenue Code	250
Min. Negotiated Rate	$13.59
Max. Negotiated Rate	$52.26
Rate for Payer: Aetna Commercial	$31.36
Rate for Payer: Aetna Medicare Advantage	$31.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.65
Rate for Payer: Cigna Commercial	$52.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.59
Rate for Payer: Oxford Commercial	$52.26
Rate for Payer: Qualcare PPO/HMO/WC	$15.68
Rate for Payer: UnitedHealthcare Commercial	$52.26

LIDOCAINE 5% GLUCOSE 7.5%

Facility

$46.45

Hospital Charge Code	6012769
Hospital Revenue Code	250
Min. Negotiated Rate	$6.04
Max. Negotiated Rate	$23.23
Rate for Payer: Aetna Commercial	$13.94
Rate for Payer: Aetna Medicare Advantage	$13.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.84
Rate for Payer: Cigna Commercial	$23.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.04
Rate for Payer: Oxford Commercial	$23.23
Rate for Payer: Qualcare PPO/HMO/WC	$6.97
Rate for Payer: UnitedHealthcare Commercial	$23.23

LIDOCAINE 5% GLUCOSE 7.5%

Facility

$46.45

Hospital Charge Code	6012769
Hospital Revenue Code	250
Min. Negotiated Rate	$6.97
Max. Negotiated Rate	$6.97
Rate for Payer: Qualcare PPO/HMO/WC	$6.97

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% OINT

Facility

$1,985.08

Service Code	NDC 168020437
Hospital Charge Code	60628417
Hospital Revenue Code	250
Min. Negotiated Rate	$258.06
Max. Negotiated Rate	$992.54
Rate for Payer: Aetna Commercial	$595.52
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	$258.06
Rate for Payer: Oxford Commercial	$992.54
Rate for Payer: Qualcare PPO/HMO/WC	$297.76
Rate for Payer: UnitedHealthcare Commercial	$992.54

LIDOCAINE 5% PATCH

Facility

$69.68

Service Code	NDC 63481068706
Hospital Charge Code	60629189
Hospital Revenue Code	250
Min. Negotiated Rate	$9.06
Max. Negotiated Rate	$34.84
Rate for Payer: Aetna Commercial	$20.90
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	$9.06
Rate for Payer: Oxford Commercial	$34.84
Rate for Payer: Qualcare PPO/HMO/WC	$10.45
Rate for Payer: UnitedHealthcare Commercial	$34.84

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 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	$0.78
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$1.80
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	$0.78
Rate for Payer: Oxford Commercial	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$3.00

Know your out-of-pocket cost for care.

All Charges