Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

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	$0.41
Max. Negotiated Rate	$7.27
Rate for Payer: Aetna Commercial	$5.53
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	$3.78
Rate for Payer: Oxford Commercial	$2.91
Rate for Payer: Qualcare PPO/HMO/WC	$2.18
Rate for Payer: UnitedHealthcare Commercial	$2.91
Rate for Payer: UnitedHealthcare Community & State	$0.46
Rate for Payer: Wellpoint Medicaid Managed Care	$0.41

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	$1.44
Max. Negotiated Rate	$25.30
Rate for Payer: Aetna Commercial	$19.22
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	$13.15
Rate for Payer: Oxford Commercial	$10.12
Rate for Payer: Qualcare PPO/HMO/WC	$7.59
Rate for Payer: UnitedHealthcare Commercial	$10.12
Rate for Payer: UnitedHealthcare Community & State	$1.60
Rate for Payer: Wellpoint Medicaid Managed Care	$1.44

LIDOCAINE 4% SOL LARYNG-O-JET

Facility

$104.52

Service Code	NDC 76329630005
Hospital Charge Code	60628274
Hospital Revenue Code	250
Min. Negotiated Rate	$2.97
Max. Negotiated Rate	$52.26
Rate for Payer: Aetna Commercial	$39.72
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	$27.18
Rate for Payer: Oxford Commercial	$20.90
Rate for Payer: Qualcare PPO/HMO/WC	$15.68
Rate for Payer: UnitedHealthcare Commercial	$20.90
Rate for Payer: UnitedHealthcare Community & State	$3.30
Rate for Payer: Wellpoint Medicaid Managed Care	$2.97

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 5% OINT

Facility

$1,985.08

Service Code	NDC 168020437
Hospital Charge Code	60628417
Hospital Revenue Code	250
Min. Negotiated Rate	$56.38
Max. Negotiated Rate	$992.54
Rate for Payer: Aetna Commercial	$754.33
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	$516.12
Rate for Payer: Oxford Commercial	$397.02
Rate for Payer: Qualcare PPO/HMO/WC	$297.76
Rate for Payer: UnitedHealthcare Commercial	$397.02
Rate for Payer: UnitedHealthcare Community & State	$62.73
Rate for Payer: Wellpoint Medicaid Managed Care	$56.38

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% PATCH

Facility

$69.68

Service Code	NDC 63481068706
Hospital Charge Code	60629189
Hospital Revenue Code	250
Min. Negotiated Rate	$1.98
Max. Negotiated Rate	$34.84
Rate for Payer: Aetna Commercial	$26.48
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	$18.12
Rate for Payer: Oxford Commercial	$13.94
Rate for Payer: Qualcare PPO/HMO/WC	$10.45
Rate for Payer: UnitedHealthcare Commercial	$13.94
Rate for Payer: UnitedHealthcare Community & State	$2.20
Rate for Payer: Wellpoint Medicaid Managed Care	$1.98

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 @ EPI 2%/100000 30ML

Facility

$14.00

Service Code	NDC 409318202
Hospital Charge Code	606350926
Hospital Revenue Code	250
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$7.00
Rate for Payer: Aetna Commercial	$5.32
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	$3.64
Rate for Payer: Oxford Commercial	$2.80
Rate for Payer: Qualcare PPO/HMO/WC	$2.10
Rate for Payer: UnitedHealthcare Commercial	$2.80
Rate for Payer: UnitedHealthcare Community & State	$0.44
Rate for Payer: Wellpoint Medicaid Managed Care	$0.40

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	$10.95
Max. Negotiated Rate	$10.95
Rate for Payer: Qualcare PPO/HMO/WC	$10.95

LIDOCAINE HCI 10MG/ML

Facility

$73.00

Hospital Charge Code	4800855
Hospital Revenue Code	250
Min. Negotiated Rate	$2.07
Max. Negotiated Rate	$36.50
Rate for Payer: Aetna Commercial	$27.74
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	$18.98
Rate for Payer: Oxford Commercial	$14.60
Rate for Payer: Qualcare PPO/HMO/WC	$10.95
Rate for Payer: UnitedHealthcare Commercial	$14.60
Rate for Payer: UnitedHealthcare Community & State	$2.31
Rate for Payer: Wellpoint Medicaid Managed Care	$2.07

LIDOCAINE HYDROCHLORIDE 2% GEL

Facility

$28.68

Service Code	NDC 17478071130
Hospital Charge Code	6003289
Hospital Revenue Code	251
Min. Negotiated Rate	$0.81
Max. Negotiated Rate	$14.34
Rate for Payer: Aetna Commercial	$10.90
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	$7.46
Rate for Payer: Oxford Commercial	$5.74
Rate for Payer: Qualcare PPO/HMO/WC	$4.30
Rate for Payer: UnitedHealthcare Commercial	$5.74
Rate for Payer: UnitedHealthcare Community & State	$0.91
Rate for Payer: Wellpoint Medicaid Managed Care	$0.81

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	$1.97
Max. Negotiated Rate	$1.97
Rate for Payer: Qualcare PPO/HMO/WC	$1.97

LIDOCAINE INJ 1% 10ML MDV

Facility

$13.13

Service Code	NDC 63323020110
Hospital Charge Code	60628270
Hospital Revenue Code	250
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$6.57
Rate for Payer: Aetna Commercial	$4.99
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	$3.41
Rate for Payer: Oxford Commercial	$2.63
Rate for Payer: Qualcare PPO/HMO/WC	$1.97
Rate for Payer: UnitedHealthcare Commercial	$2.63
Rate for Payer: UnitedHealthcare Community & State	$0.41
Rate for Payer: Wellpoint Medicaid Managed Care	$0.37

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 % 10 ML VIAL

Facility

$5.00

Hospital Charge Code	60629316W
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
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	$1.30
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.16
Rate for Payer: Wellpoint Medicaid Managed Care	$0.14

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 20ML 2% W/EPI

Facility

$25.46

Service Code	NDC 409014710
Hospital Charge Code	60629099
Hospital Revenue Code	250
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$12.73
Rate for Payer: Aetna Commercial	$9.67
Rate for Payer: Aetna Medicare Advantage	$7.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.49
Rate for Payer: Cigna Commercial	$12.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.62
Rate for Payer: Oxford Commercial	$5.09
Rate for Payer: Qualcare PPO/HMO/WC	$3.82
Rate for Payer: UnitedHealthcare Commercial	$5.09
Rate for Payer: UnitedHealthcare Community & State	$0.80
Rate for Payer: Wellpoint Medicaid Managed Care	$0.72

LIDOCAINE JELLY 2%6ML GLYDO

Facility

$47.84

Service Code	NDC 25021067376
Hospital Charge Code	606390539
Hospital Revenue Code	250
Min. Negotiated Rate	$1.36
Max. Negotiated Rate	$23.92
Rate for Payer: Aetna Commercial	$18.18
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	$12.44
Rate for Payer: Oxford Commercial	$9.57
Rate for Payer: Qualcare PPO/HMO/WC	$7.18
Rate for Payer: UnitedHealthcare Commercial	$9.57
Rate for Payer: UnitedHealthcare Community & State	$1.51
Rate for Payer: Wellpoint Medicaid Managed Care	$1.36

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 JELY 2% 20MG/ML 11ML

Facility

$51.05

Service Code	NDC 25021067377
Hospital Charge Code	606390281
Hospital Revenue Code	250
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$25.52
Rate for Payer: Aetna Commercial	$19.40
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	$13.27
Rate for Payer: Oxford Commercial	$10.21
Rate for Payer: Qualcare PPO/HMO/WC	$7.66
Rate for Payer: UnitedHealthcare Commercial	$10.21
Rate for Payer: UnitedHealthcare Community & State	$1.61
Rate for Payer: Wellpoint Medicaid Managed Care	$1.45

Know your out-of-pocket cost for care.

All Charges