Heights University Hospital

All Charges

Charge

Type

Setting

Price

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

LIDOCAINE INJ/2%/25G 5/8

Facility

$8.00

Hospital Charge Code	60634272
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/2%/25G 5/8

Facility

$8.00

Hospital Charge Code	60634272
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 5ML 2% W/EPI

Facility

$17.95

Hospital Charge Code	60629098
Hospital Revenue Code	250
Min. Negotiated Rate	$2.69
Max. Negotiated Rate	$2.69
Rate for Payer: Qualcare PPO/HMO/WC	$2.69

LIDOCAINE INJ 5ML 2% W/EPI

Facility

$17.95

Hospital Charge Code	60629098
Hospital Revenue Code	250
Min. Negotiated Rate	$2.33
Max. Negotiated Rate	$8.97
Rate for Payer: Aetna Commercial	$5.38
Rate for Payer: Aetna Medicare Advantage	$5.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.58
Rate for Payer: Cigna Commercial	$8.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.33
Rate for Payer: Oxford Commercial	$8.97
Rate for Payer: Qualcare PPO/HMO/WC	$2.69
Rate for Payer: UnitedHealthcare Commercial	$8.97

LIDOCAINE JELLY 2%6ML GLYDO

Facility

$47.84

Service Code	NDC 25021067376
Hospital Charge Code	606390539
Hospital Revenue Code	250
Min. Negotiated Rate	$6.22
Max. Negotiated Rate	$23.92
Rate for Payer: Aetna Commercial	$14.35
Rate for Payer: Aetna Medicare Advantage	$14.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.20
Rate for Payer: Cigna Commercial	$23.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.22
Rate for Payer: Oxford Commercial	$23.92
Rate for Payer: Qualcare PPO/HMO/WC	$7.18
Rate for Payer: UnitedHealthcare Commercial	$23.92

LIDOCAINE JELLY 2%6ML GLYDO

Facility

$47.84

Service Code	NDC 25021067376
Hospital Charge Code	606390539
Hospital Revenue Code	250
Min. Negotiated Rate	$7.18
Max. Negotiated Rate	$7.18
Rate for Payer: Qualcare PPO/HMO/WC	$7.18

LIDOCAINE JELLY UROJET

Facility

$9.00

Hospital Charge Code	6012777
Hospital Revenue Code	252
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$2.70
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.17
Rate for Payer: Oxford Commercial	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.35
Rate for Payer: UnitedHealthcare Commercial	$4.50

LIDOCAINE JELLY UROJET

Facility

$9.00

Hospital Charge Code	6012777
Hospital Revenue Code	252
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

LIDOCAINE JELY 2% 20MG/ML 11ML

Facility

$51.05

Service Code	NDC 25021067377
Hospital Charge Code	606390281
Hospital Revenue Code	250
Min. Negotiated Rate	$7.66
Max. Negotiated Rate	$7.66
Rate for Payer: Qualcare PPO/HMO/WC	$7.66

LIDOCAINE JELY 2% 20MG/ML 11ML

Facility

$51.05

Service Code	NDC 25021067377
Hospital Charge Code	606390281
Hospital Revenue Code	250
Min. Negotiated Rate	$6.64
Max. Negotiated Rate	$25.52
Rate for Payer: Aetna Commercial	$15.31
Rate for Payer: Aetna Medicare Advantage	$15.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.02
Rate for Payer: Cigna Commercial	$25.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.64
Rate for Payer: Oxford Commercial	$25.52
Rate for Payer: Qualcare PPO/HMO/WC	$7.66
Rate for Payer: UnitedHealthcare Commercial	$25.52

LIDOCAINE MPF 5% W/GLUC 7.5%

Facility

$73.00

Hospital Charge Code	6006845
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 MPF 5% W/GLUC 7.5%

Facility

$73.00

Hospital Charge Code	6006845
Hospital Revenue Code	250
Min. Negotiated Rate	$10.95
Max. Negotiated Rate	$10.95
Rate for Payer: Qualcare PPO/HMO/WC	$10.95

LIDOCAINE ORAL 20MG/ML 120ML

Facility

$34.60

Hospital Charge Code	6003263
Hospital Revenue Code	251
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$17.30
Rate for Payer: Aetna Commercial	$10.38
Rate for Payer: Aetna Medicare Advantage	$10.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.82
Rate for Payer: Cigna Commercial	$17.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.50
Rate for Payer: Oxford Commercial	$17.30
Rate for Payer: Qualcare PPO/HMO/WC	$5.19
Rate for Payer: UnitedHealthcare Commercial	$17.30

LIDOCAINE ORAL 20MG/ML 120ML

Facility

$34.60

Hospital Charge Code	6003263
Hospital Revenue Code	251
Min. Negotiated Rate	$5.19
Max. Negotiated Rate	$5.19
Rate for Payer: Qualcare PPO/HMO/WC	$5.19

LIDOCAINE PF 1% INJ (2ML)

Facility

$7.64

Service Code	NDC 409471332
Hospital Charge Code	6063943127
Hospital Revenue Code	250
Min. Negotiated Rate	$1.15
Max. Negotiated Rate	$1.15
Rate for Payer: Qualcare PPO/HMO/WC	$1.15

LIDOCAINE PF 1% INJ (2ML)

Facility

$7.64

Service Code	NDC 409471332
Hospital Charge Code	6063943127
Hospital Revenue Code	250
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$3.82
Rate for Payer: Aetna Commercial	$2.29
Rate for Payer: Aetna Medicare Advantage	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.95
Rate for Payer: Cigna Commercial	$3.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.99
Rate for Payer: Oxford Commercial	$3.82
Rate for Payer: Qualcare PPO/HMO/WC	$1.15
Rate for Payer: UnitedHealthcare Commercial	$3.82

LIDOCAINE (PRE-MIX)

Facility

$70.40

Hospital Charge Code	6008155
Hospital Revenue Code	250
Min. Negotiated Rate	$9.15
Max. Negotiated Rate	$35.20
Rate for Payer: Aetna Commercial	$21.12
Rate for Payer: Aetna Medicare Advantage	$21.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.95
Rate for Payer: Cigna Commercial	$35.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.15
Rate for Payer: Oxford Commercial	$35.20
Rate for Payer: Qualcare PPO/HMO/WC	$10.56
Rate for Payer: UnitedHealthcare Commercial	$35.20

LIDOCAINE (PRE-MIX)

Facility

$70.40

Hospital Charge Code	6008155
Hospital Revenue Code	250
Min. Negotiated Rate	$10.56
Max. Negotiated Rate	$10.56
Rate for Payer: Qualcare PPO/HMO/WC	$10.56

LIDOCAINE PRES-FREE 1.5%

Facility

$38.00

Hospital Charge Code	60634764
Hospital Revenue Code	250
Min. Negotiated Rate	$5.70
Max. Negotiated Rate	$5.70
Rate for Payer: Qualcare PPO/HMO/WC	$5.70

LIDOCAINE PRES-FREE 1.5%

Facility

$38.00

Hospital Charge Code	60634764
Hospital Revenue Code	250
Min. Negotiated Rate	$4.94
Max. Negotiated Rate	$19.00
Rate for Payer: Aetna Commercial	$11.40
Rate for Payer: Aetna Medicare Advantage	$11.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.69
Rate for Payer: Cigna Commercial	$19.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.94
Rate for Payer: Oxford Commercial	$19.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.70
Rate for Payer: UnitedHealthcare Commercial	$19.00

LIDOCAINE PRES-FREE 2%AMP

Facility

$7.00

Hospital Charge Code	60634787
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

LIDOCAINE PRES-FREE 2%AMP

Facility

$7.00

Hospital Charge Code	60634787
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/PRILOCAINE 1 CREAM

Facility

$343.25

Hospital Charge Code	60628418
Hospital Revenue Code	250
Min. Negotiated Rate	$51.49
Max. Negotiated Rate	$51.49
Rate for Payer: Qualcare PPO/HMO/WC	$51.49

LIDOCAINE/PRILOCAINE 1 CREAM

Facility

$343.25

Hospital Charge Code	60628418
Hospital Revenue Code	250
Min. Negotiated Rate	$44.62
Max. Negotiated Rate	$171.62
Rate for Payer: Aetna Commercial	$102.97
Rate for Payer: Aetna Medicare Advantage	$102.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$87.53
Rate for Payer: Cigna Commercial	$171.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.62
Rate for Payer: Oxford Commercial	$171.62
Rate for Payer: Qualcare PPO/HMO/WC	$51.49
Rate for Payer: UnitedHealthcare Commercial	$171.62

Know your out-of-pocket cost for care.

All Charges