Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

LIDOCAINE 1.5%EPI 1 2 INJ 5ML

Facility

$18.02

Service Code	NDC 409120901
Hospital Charge Code	606390202
Hospital Revenue Code	250
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$9.01
Rate for Payer: Aetna Commercial	$6.85
Rate for Payer: Aetna Medicare Advantage	$5.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.60
Rate for Payer: Cigna Commercial	$9.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.69
Rate for Payer: Oxford Commercial	$3.60
Rate for Payer: Qualcare PPO/HMO/WC	$2.70
Rate for Payer: UnitedHealthcare Commercial	$3.60
Rate for Payer: UnitedHealthcare Community & State	$0.57
Rate for Payer: Wellpoint Medicaid Managed Care	$0.51

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 1% ABBOJECT 5ML

Facility

$59.83

Service Code	NDC 409490434
Hospital Charge Code	6063943311
Hospital Revenue Code	250
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$29.91
Rate for Payer: Aetna Commercial	$22.74
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	$15.56
Rate for Payer: Oxford Commercial	$11.97
Rate for Payer: Qualcare PPO/HMO/WC	$8.97
Rate for Payer: UnitedHealthcare Commercial	$11.97
Rate for Payer: UnitedHealthcare Community & State	$1.89
Rate for Payer: Wellpoint Medicaid Managed Care	$1.70

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	$0.26
Max. Negotiated Rate	$4.59
Rate for Payer: Aetna Commercial	$3.49
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	$2.39
Rate for Payer: Oxford Commercial	$1.84
Rate for Payer: Qualcare PPO/HMO/WC	$1.38
Rate for Payer: UnitedHealthcare Commercial	$1.84
Rate for Payer: UnitedHealthcare Community & State	$0.29
Rate for Payer: Wellpoint Medicaid Managed Care	$0.26

LIDOCAINE 1% SOL

Facility

$24.12

Service Code	NDC 409427001
Hospital Charge Code	60629316
Hospital Revenue Code	250
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$12.06
Rate for Payer: Aetna Commercial	$9.17
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	$6.27
Rate for Payer: Oxford Commercial	$4.82
Rate for Payer: Qualcare PPO/HMO/WC	$3.62
Rate for Payer: UnitedHealthcare Commercial	$4.82
Rate for Payer: UnitedHealthcare Community & State	$0.76
Rate for Payer: Wellpoint Medicaid Managed Care	$0.69

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

LIDOCAINE1%WEPI 1,200,000 10ML

Facility

$59.36

Service Code	NDC 63323048717
Hospital Charge Code	606390272
Hospital Revenue Code	250
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$29.68
Rate for Payer: Aetna Commercial	$22.56
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	$15.43
Rate for Payer: Oxford Commercial	$11.87
Rate for Payer: Qualcare PPO/HMO/WC	$8.90
Rate for Payer: UnitedHealthcare Commercial	$11.87
Rate for Payer: UnitedHealthcare Community & State	$1.88
Rate for Payer: Wellpoint Medicaid Managed Care	$1.69

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

LIDOCAINE 2% 5ML INJ

Facility

$16.88

Service Code	NDC 63323020805
Hospital Charge Code	606350950
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$8.44
Rate for Payer: Aetna Commercial	$6.41
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	$4.39
Rate for Payer: Oxford Commercial	$3.38
Rate for Payer: Qualcare PPO/HMO/WC	$2.53
Rate for Payer: UnitedHealthcare Commercial	$3.38
Rate for Payer: UnitedHealthcare Community & State	$0.53
Rate for Payer: Wellpoint Medicaid Managed Care	$0.48

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 2.5% 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 2.5% OINT

Facility

$2,613.87

Service Code	NDC 45861006130
Hospital Charge Code	60628416
Hospital Revenue Code	250
Min. Negotiated Rate	$74.23
Max. Negotiated Rate	$1,306.93
Rate for Payer: Aetna Commercial	$993.27
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	$679.61
Rate for Payer: Oxford Commercial	$522.77
Rate for Payer: Qualcare PPO/HMO/WC	$392.08
Rate for Payer: UnitedHealthcare Commercial	$522.77
Rate for Payer: UnitedHealthcare Community & State	$82.60
Rate for Payer: Wellpoint Medicaid Managed Care	$74.23

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	$0.86
Max. Negotiated Rate	$15.07
Rate for Payer: Aetna Commercial	$11.46
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	$7.84
Rate for Payer: Oxford Commercial	$6.03
Rate for Payer: Qualcare PPO/HMO/WC	$4.52
Rate for Payer: UnitedHealthcare Commercial	$6.03
Rate for Payer: UnitedHealthcare Community & State	$0.95
Rate for Payer: Wellpoint Medicaid Managed Care	$0.86

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% SOL

Facility

$4.00

Service Code	NDC 63323048627
Hospital Charge Code	60628273
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
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	$1.04
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

LIDOCAINE 2% UROJET GEL

Facility

$28.54

Service Code	NDC 76329301305
Hospital Charge Code	60635902
Hospital Revenue Code	250
Min. Negotiated Rate	$0.81
Max. Negotiated Rate	$14.27
Rate for Payer: Aetna Commercial	$10.85
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	$7.42
Rate for Payer: Oxford Commercial	$5.71
Rate for Payer: Qualcare PPO/HMO/WC	$4.28
Rate for Payer: UnitedHealthcare Commercial	$5.71
Rate for Payer: UnitedHealthcare Community & State	$0.90
Rate for Payer: Wellpoint Medicaid Managed Care	$0.81

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	$2.99
Max. Negotiated Rate	$52.66
Rate for Payer: Aetna Commercial	$40.02
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	$27.38
Rate for Payer: Oxford Commercial	$21.06
Rate for Payer: Qualcare PPO/HMO/WC	$15.80
Rate for Payer: UnitedHealthcare Commercial	$21.06
Rate for Payer: UnitedHealthcare Community & State	$3.33
Rate for Payer: Wellpoint Medicaid Managed Care	$2.99

LIDOCAINE 2% W/ EPI

Facility

$105.32

Service Code	NDC 63323048921
Hospital Charge Code	60629138
Hospital Revenue Code	250
Min. Negotiated Rate	$15.80
Max. Negotiated Rate	$15.80
Rate for Payer: Qualcare PPO/HMO/WC	$15.80

LIDOCAINE 4% 50ML TOPICAL (OR)

Facility

$321.60

Service Code	NDC 54350547
Hospital Charge Code	606390301
Hospital Revenue Code	250
Min. Negotiated Rate	$9.13
Max. Negotiated Rate	$160.80
Rate for Payer: Aetna Commercial	$122.21
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	$83.62
Rate for Payer: Oxford Commercial	$64.32
Rate for Payer: Qualcare PPO/HMO/WC	$48.24
Rate for Payer: UnitedHealthcare Commercial	$64.32
Rate for Payer: UnitedHealthcare Community & State	$10.16
Rate for Payer: Wellpoint Medicaid Managed Care	$9.13

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	$1.60
Max. Negotiated Rate	$28.14
Rate for Payer: Aetna Commercial	$21.39
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	$14.63
Rate for Payer: Oxford Commercial	$11.26
Rate for Payer: Qualcare PPO/HMO/WC	$8.44
Rate for Payer: UnitedHealthcare Commercial	$11.26
Rate for Payer: UnitedHealthcare Community & State	$1.78
Rate for Payer: Wellpoint Medicaid Managed Care	$1.60

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

Know your out-of-pocket cost for care.

All Charges