Heights University Hospital

All Charges

Charge

Type

Setting

Price

LIDOCAINE ABBOJECT 1%/5ML

Facility

$7.00

Hospital Charge Code	60634273
Hospital Revenue Code	250
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.10
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.91
Rate for Payer: Oxford Commercial	$3.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$3.50

LIDOCAINE ABBOJECT 1%/5ML

Facility

$7.00

Hospital Charge Code	60634273
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

LIDOCAINE ABBOJECT/2000MG

Facility

$15.00

Hospital Charge Code	60634276
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna Commercial	$4.50
Rate for Payer: Aetna Medicare Advantage	$4.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.83
Rate for Payer: Cigna Commercial	$7.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.95
Rate for Payer: Oxford Commercial	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$2.25
Rate for Payer: UnitedHealthcare Commercial	$7.50

LIDOCAINE ABBOJECT/2000MG

Facility

$15.00

Hospital Charge Code	60634276
Hospital Revenue Code	250
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$2.25

LIDOCAINE ABBOJECT 2%/5ML

Facility

$7.00

Hospital Charge Code	60634274
Hospital Revenue Code	250
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.10
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.91
Rate for Payer: Oxford Commercial	$3.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$3.50

LIDOCAINE ABBOJECT 2%/5ML

Facility

$7.00

Hospital Charge Code	60634274
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

LIDOCAINE @ EPI 2%/100000 30ML

Facility

$14.00

Service Code	NDC 409318202
Hospital Charge Code	606350926
Hospital Revenue Code	250
Min. Negotiated Rate	$1.82
Max. Negotiated Rate	$7.00
Rate for Payer: Aetna Commercial	$4.20
Rate for Payer: Aetna Medicare Advantage	$4.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.57
Rate for Payer: Cigna Commercial	$7.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.82
Rate for Payer: Oxford Commercial	$7.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.10
Rate for Payer: UnitedHealthcare Commercial	$7.00

LIDOCAINE @ EPI 2%/100000 30ML

Facility

$14.00

Service Code	NDC 409318202
Hospital Charge Code	606350926
Hospital Revenue Code	250
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$2.10
Rate for Payer: Qualcare PPO/HMO/WC	$2.10

LIDOCAINE HCI 10MG/ML

Facility

$73.00

Hospital Charge Code	4800855
Hospital Revenue Code	250
Min. Negotiated Rate	$9.49
Max. Negotiated Rate	$36.50
Rate for Payer: Aetna Commercial	$21.90
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	$9.49
Rate for Payer: Oxford Commercial	$36.50
Rate for Payer: Qualcare PPO/HMO/WC	$10.95
Rate for Payer: UnitedHealthcare Commercial	$36.50

LIDOCAINE HCI 10MG/ML

Facility

$73.00

Hospital Charge Code	4800855
Hospital Revenue Code	250
Min. Negotiated Rate	$10.95
Max. Negotiated Rate	$10.95
Rate for Payer: Qualcare PPO/HMO/WC	$10.95

LIDOCAINE HYDROCHLORIDE 2% GEL

Facility

$28.68

Service Code	NDC 17478071130
Hospital Charge Code	6003289
Hospital Revenue Code	251
Min. Negotiated Rate	$3.73
Max. Negotiated Rate	$14.34
Rate for Payer: Aetna Commercial	$8.60
Rate for Payer: Aetna Medicare Advantage	$8.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.31
Rate for Payer: Cigna Commercial	$14.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.73
Rate for Payer: Oxford Commercial	$14.34
Rate for Payer: Qualcare PPO/HMO/WC	$4.30
Rate for Payer: UnitedHealthcare Commercial	$14.34

LIDOCAINE HYDROCHLORIDE 2% GEL

Facility

$28.68

Service Code	NDC 17478071130
Hospital Charge Code	6003289
Hospital Revenue Code	251
Min. Negotiated Rate	$4.30
Max. Negotiated Rate	$4.30
Rate for Payer: Qualcare PPO/HMO/WC	$4.30

LIDOCAINE INJ 1% 10ML MDV

Facility

$13.13

Service Code	NDC 63323020110
Hospital Charge Code	60628270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.71
Max. Negotiated Rate	$6.57
Rate for Payer: Aetna Commercial	$3.94
Rate for Payer: Aetna Medicare Advantage	$3.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.35
Rate for Payer: Cigna Commercial	$6.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.71
Rate for Payer: Oxford Commercial	$6.57
Rate for Payer: Qualcare PPO/HMO/WC	$1.97
Rate for Payer: UnitedHealthcare Commercial	$6.57

LIDOCAINE INJ 1% 10ML MDV

Facility

$13.13

Service Code	NDC 63323020110
Hospital Charge Code	60628270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.97
Max. Negotiated Rate	$1.97
Rate for Payer: Qualcare PPO/HMO/WC	$1.97

LIDOCAINE INJ 1 % 10 ML VIAL

Facility

$5.00

Hospital Charge Code	60629316W
Hospital Revenue Code	250
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.50
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.65
Rate for Payer: Oxford Commercial	$2.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$2.50

LIDOCAINE INJ 1 % 10 ML VIAL

Facility

$5.00

Hospital Charge Code	60629316W
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

LIDOCAINE INJ 1%/20ML VIA

Facility

$8.00

Hospital Charge Code	60634277
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 INJ 1%/20ML VIA

Facility

$8.00

Hospital Charge Code	60634277
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 1%/25G 5/8

Facility

$8.00

Hospital Charge Code	60634271
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 INJ 1%/25G 5/8

Facility

$8.00

Hospital Charge Code	60634271
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 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	$11.24
Max. Negotiated Rate	$43.23
Rate for Payer: Aetna Commercial	$25.93
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	$11.24
Rate for Payer: Oxford Commercial	$43.23
Rate for Payer: Qualcare PPO/HMO/WC	$12.97
Rate for Payer: UnitedHealthcare Commercial	$43.23

LIDOCAINEINJ 1% 548108100

Facility

$111.25

Hospital Charge Code	60628272
Hospital Revenue Code	250
Min. Negotiated Rate	$14.46
Max. Negotiated Rate	$55.62
Rate for Payer: Aetna Commercial	$33.38
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	$14.46
Rate for Payer: Oxford Commercial	$55.62
Rate for Payer: Qualcare PPO/HMO/WC	$16.69
Rate for Payer: UnitedHealthcare Commercial	$55.62

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

Know your out-of-pocket cost for care.

All Charges