Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

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 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	$0.22
Max. Negotiated Rate	$3.82
Rate for Payer: Aetna Commercial	$2.90
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	$1.99
Rate for Payer: Oxford Commercial	$1.53
Rate for Payer: Qualcare PPO/HMO/WC	$1.15
Rate for Payer: UnitedHealthcare Commercial	$1.53
Rate for Payer: UnitedHealthcare Community & State	$0.24
Rate for Payer: Wellpoint Medicaid Managed Care	$0.22

LIDOCAINE/PRILOCAINE 2.5 5MG

Facility

$57.08

Service Code	NDC 168035730
Hospital Charge Code	606351010
Hospital Revenue Code	250
Min. Negotiated Rate	$1.62
Max. Negotiated Rate	$28.54
Rate for Payer: Aetna Commercial	$21.69
Rate for Payer: Aetna Medicare Advantage	$17.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.56
Rate for Payer: Cigna Commercial	$28.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.84
Rate for Payer: Oxford Commercial	$11.42
Rate for Payer: Qualcare PPO/HMO/WC	$8.56
Rate for Payer: UnitedHealthcare Commercial	$11.42
Rate for Payer: UnitedHealthcare Community & State	$1.80
Rate for Payer: Wellpoint Medicaid Managed Care	$1.62

LIDOCAINE/PRILOCAINE 2.5 5MG

Facility

$57.08

Service Code	NDC 168035730
Hospital Charge Code	606351010
Hospital Revenue Code	250
Min. Negotiated Rate	$8.56
Max. Negotiated Rate	$8.56
Rate for Payer: Qualcare PPO/HMO/WC	$8.56

LIDOCAINE RUGBY PATCH 4%

Facility

$187.53

Service Code	NDC 536120207
Hospital Charge Code	606390564
Hospital Revenue Code	250
Min. Negotiated Rate	$5.33
Max. Negotiated Rate	$93.77
Rate for Payer: Aetna Commercial	$71.26
Rate for Payer: Aetna Medicare Advantage	$56.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.82
Rate for Payer: Cigna Commercial	$93.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.76
Rate for Payer: Oxford Commercial	$37.51
Rate for Payer: Qualcare PPO/HMO/WC	$28.13
Rate for Payer: UnitedHealthcare Commercial	$37.51
Rate for Payer: UnitedHealthcare Community & State	$5.93
Rate for Payer: Wellpoint Medicaid Managed Care	$5.33

LIDOCAINE RUGBY PATCH 4%

Facility

$187.53

Service Code	NDC 536120207
Hospital Charge Code	606390564
Hospital Revenue Code	250
Min. Negotiated Rate	$28.13
Max. Negotiated Rate	$28.13
Rate for Payer: Qualcare PPO/HMO/WC	$28.13

LIDOCAINE SYR 100MG/5ML

Facility

$24.59

Service Code	HCPCS J2003
Hospital Charge Code	60627569
Hospital Revenue Code	636
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$12.29
Rate for Payer: Aetna Commercial	$9.34
Rate for Payer: Aetna Medicare Advantage	$7.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.27
Rate for Payer: Cigna Commercial	$12.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.95
Rate for Payer: Qualcare PPO/HMO/WC	$3.69
Rate for Payer: UnitedHealthcare Community & State	$0.78
Rate for Payer: Wellpoint Medicaid Managed Care	$0.70

LIDOCAINE SYR 100MG/5ML

Facility

$24.59

Service Code	HCPCS J2003
Hospital Charge Code	60627569
Hospital Revenue Code	636
Min. Negotiated Rate	$3.69
Max. Negotiated Rate	$5.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.95
Rate for Payer: Qualcare PPO/HMO/WC	$3.69

LIDOCAINE TOP 2% 10ML JELLY

Facility

$11.26

Service Code	NDC 76329301305
Hospital Charge Code	6003271
Hospital Revenue Code	250
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.69

LIDOCAINE TOP 2% 10ML JELLY

Facility

$11.26

Service Code	NDC 76329301305
Hospital Charge Code	6003271
Hospital Revenue Code	250
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$5.63
Rate for Payer: Aetna Commercial	$4.28
Rate for Payer: Aetna Medicare Advantage	$3.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.87
Rate for Payer: Cigna Commercial	$5.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.93
Rate for Payer: Oxford Commercial	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$1.69
Rate for Payer: UnitedHealthcare Commercial	$2.25
Rate for Payer: UnitedHealthcare Community & State	$0.36
Rate for Payer: Wellpoint Medicaid Managed Care	$0.32

LIDOCAINE UNPRES INJ 1.5%

Facility

$30.69

Service Code	NDC 409477601
Hospital Charge Code	6003297
Hospital Revenue Code	250
Min. Negotiated Rate	$4.60
Max. Negotiated Rate	$4.60
Rate for Payer: Qualcare PPO/HMO/WC	$4.60

LIDOCAINE UNPRES INJ 1.5%

Facility

$30.69

Service Code	NDC 409477601
Hospital Charge Code	6003297
Hospital Revenue Code	250
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$15.35
Rate for Payer: Aetna Commercial	$11.66
Rate for Payer: Aetna Medicare Advantage	$9.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.83
Rate for Payer: Cigna Commercial	$15.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.98
Rate for Payer: Oxford Commercial	$6.14
Rate for Payer: Qualcare PPO/HMO/WC	$4.60
Rate for Payer: UnitedHealthcare Commercial	$6.14
Rate for Payer: UnitedHealthcare Community & State	$0.97
Rate for Payer: Wellpoint Medicaid Managed Care	$0.87

LIDOCAINE VISC 2% 100ML

Facility

$88.44

Service Code	NDC 54350049
Hospital Charge Code	60628414
Hospital Revenue Code	250
Min. Negotiated Rate	$2.51
Max. Negotiated Rate	$44.22
Rate for Payer: Aetna Commercial	$33.61
Rate for Payer: Aetna Medicare Advantage	$26.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.55
Rate for Payer: Cigna Commercial	$44.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.99
Rate for Payer: Oxford Commercial	$17.69
Rate for Payer: Qualcare PPO/HMO/WC	$13.27
Rate for Payer: UnitedHealthcare Commercial	$17.69
Rate for Payer: UnitedHealthcare Community & State	$2.79
Rate for Payer: Wellpoint Medicaid Managed Care	$2.51

LIDOCAINE VISC 2% 100ML

Facility

$88.44

Service Code	NDC 54350049
Hospital Charge Code	60628414
Hospital Revenue Code	250
Min. Negotiated Rate	$13.27
Max. Negotiated Rate	$13.27
Rate for Payer: Qualcare PPO/HMO/WC	$13.27

LIDOCAINE VISC 2% 30ML

Facility

$6.37

Service Code	NDC 63739069457
Hospital Charge Code	60628415
Hospital Revenue Code	250
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$0.96
Rate for Payer: Qualcare PPO/HMO/WC	$0.96

LIDOCAINE VISC 2% 30ML

Facility

$6.37

Service Code	NDC 63739069457
Hospital Charge Code	60628415
Hospital Revenue Code	250
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$3.19
Rate for Payer: Aetna Commercial	$2.42
Rate for Payer: Aetna Medicare Advantage	$1.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.62
Rate for Payer: Cigna Commercial	$3.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.66
Rate for Payer: Oxford Commercial	$1.27
Rate for Payer: Qualcare PPO/HMO/WC	$0.96
Rate for Payer: UnitedHealthcare Commercial	$1.27
Rate for Payer: UnitedHealthcare Community & State	$0.20
Rate for Payer: Wellpoint Medicaid Managed Care	$0.18

LIDOCAINE W/EPINPH INJ 2%

Facility

$47.50

Service Code	NDC 63323048257
Hospital Charge Code	60628277
Hospital Revenue Code	250
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$23.75
Rate for Payer: Aetna Commercial	$18.05
Rate for Payer: Aetna Medicare Advantage	$14.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.11
Rate for Payer: Cigna Commercial	$23.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.35
Rate for Payer: Oxford Commercial	$9.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.12
Rate for Payer: UnitedHealthcare Commercial	$9.50
Rate for Payer: UnitedHealthcare Community & State	$1.50
Rate for Payer: Wellpoint Medicaid Managed Care	$1.35

LIDOCAINE W/EPINPH INJ 2%

Facility

$47.50

Service Code	NDC 63323048257
Hospital Charge Code	60628277
Hospital Revenue Code	250
Min. Negotiated Rate	$7.12
Max. Negotiated Rate	$7.12
Rate for Payer: Qualcare PPO/HMO/WC	$7.12

LIDO/PRILO CREAM (5GM)

Facility

$53.87

Service Code	NDC 115146860
Hospital Charge Code	6063943126
Hospital Revenue Code	250
Min. Negotiated Rate	$1.53
Max. Negotiated Rate	$26.93
Rate for Payer: Aetna Commercial	$20.47
Rate for Payer: Aetna Medicare Advantage	$16.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.74
Rate for Payer: Cigna Commercial	$26.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.01
Rate for Payer: Oxford Commercial	$10.77
Rate for Payer: Qualcare PPO/HMO/WC	$8.08
Rate for Payer: UnitedHealthcare Commercial	$10.77
Rate for Payer: UnitedHealthcare Community & State	$1.70
Rate for Payer: Wellpoint Medicaid Managed Care	$1.53

LIDO/PRILO CREAM (5GM)

Facility

$53.87

Service Code	NDC 115146860
Hospital Charge Code	6063943126
Hospital Revenue Code	250
Min. Negotiated Rate	$8.08
Max. Negotiated Rate	$8.08
Rate for Payer: Qualcare PPO/HMO/WC	$8.08

LIFE PORT IMPLANT (BARD)

Facility

$975.00

Service Code	HCPCS C1788
Hospital Charge Code	270658505
Hospital Revenue Code	278
Min. Negotiated Rate	$27.69
Max. Negotiated Rate	$487.50
Rate for Payer: Aetna Commercial	$370.50
Rate for Payer: Aetna Medicare Advantage	$292.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$248.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$248.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$195.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$248.62
Rate for Payer: Cigna Commercial	$487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$235.95
Rate for Payer: Qualcare PPO/HMO/WC	$146.25
Rate for Payer: UnitedHealthcare Community & State	$30.81
Rate for Payer: Wellpoint Medicaid Managed Care	$27.69

LIFE PORT IMPLANT (BARD)

Facility

$975.00

Service Code	HCPCS C1788
Hospital Charge Code	270658505
Hospital Revenue Code	278
Min. Negotiated Rate	$146.25
Max. Negotiated Rate	$235.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$235.95
Rate for Payer: Qualcare PPO/HMO/WC	$146.25

LIFEPORT INFUSION SET W/Y-SITE

Facility

$38.00

Hospital Charge Code	270331909
Hospital Revenue Code	272
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$19.00
Rate for Payer: Aetna Commercial	$14.44
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	$9.88
Rate for Payer: Oxford Commercial	$7.60
Rate for Payer: Qualcare PPO/HMO/WC	$5.70
Rate for Payer: UnitedHealthcare Commercial	$7.60
Rate for Payer: UnitedHealthcare Community & State	$1.20
Rate for Payer: Wellpoint Medicaid Managed Care	$1.08

LIFEPORT INFUSION SET W/Y-SITE

Facility

$38.00

Hospital Charge Code	270331909
Hospital Revenue Code	272
Min. Negotiated Rate	$5.70
Max. Negotiated Rate	$5.70
Rate for Payer: Qualcare PPO/HMO/WC	$5.70

Know your out-of-pocket cost for care.

All Charges