Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

LIDOCAINE 5 % TOPICAL GEL [154443]

Facility

OP

$0.67

Service Code	NDC 63135-581-10
Hospital Charge Code	901700003
Hospital Revenue Code	250
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.54
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.40
Rate for Payer: Aetna of CA Government/Medicare	$0.40
Rate for Payer: Cash Price	$0.37
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.54
Rate for Payer: Health Smart Auto/Commercial	$0.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.40
Rate for Payer: LLUH Dept of Risk Management WC	$0.37
Rate for Payer: Multiplan Commercial	$0.50

LIDOCAINE 5 % TOPICAL GEL [154443]

Facility

IP

$0.67

Service Code	NDC 63135-581-10
Hospital Charge Code	901700003
Hospital Revenue Code	250
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.54
Rate for Payer: Cash Price	$0.37
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.54
Rate for Payer: Health Smart Auto/Commercial	$0.40
Rate for Payer: LLUH Dept of Risk Management WC	$0.37
Rate for Payer: Multiplan Commercial	$0.50

LIDOCAINE 5 % TOPICAL OINTMENT [154444]

Facility

IP

$0.31

Service Code	NDC 33342-405-30
Hospital Charge Code	901700003
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.25
Rate for Payer: Cash Price	$0.17
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.25
Rate for Payer: Health Smart Auto/Commercial	$0.19
Rate for Payer: LLUH Dept of Risk Management WC	$0.17
Rate for Payer: Multiplan Commercial	$0.23

LIDOCAINE 5 % TOPICAL OINTMENT [154444]

Facility

IP

$0.85

Service Code	NDC 51672-3020-9
Hospital Charge Code	901700003
Hospital Revenue Code	250
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$0.68
Rate for Payer: Cash Price	$0.47
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.68
Rate for Payer: Health Smart Auto/Commercial	$0.51
Rate for Payer: LLUH Dept of Risk Management WC	$0.47
Rate for Payer: Multiplan Commercial	$0.64

LIDOCAINE 5 % TOPICAL OINTMENT [154444]

Facility

OP

$0.93

Service Code	NDC 68462-418-20
Hospital Charge Code	901700003
Hospital Revenue Code	250
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$0.74
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.56
Rate for Payer: Aetna of CA Government/Medicare	$0.56
Rate for Payer: Cash Price	$0.51
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.74
Rate for Payer: Health Smart Auto/Commercial	$0.56
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.56
Rate for Payer: LLUH Dept of Risk Management WC	$0.51
Rate for Payer: Multiplan Commercial	$0.70

LIDOCAINE 5 % TOPICAL OINTMENT [154444]

Facility

IP

$1.20

Service Code	NDC 51672-3020-2
Hospital Charge Code	901700003
Hospital Revenue Code	250
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$0.96
Rate for Payer: Cash Price	$0.66
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.96
Rate for Payer: Health Smart Auto/Commercial	$0.72
Rate for Payer: LLUH Dept of Risk Management WC	$0.66
Rate for Payer: Multiplan Commercial	$0.90

LIDOCAINE 5 % TOPICAL OINTMENT [154444]

Facility

OP

$1.20

Service Code	NDC 51672-3020-2
Hospital Charge Code	901700003
Hospital Revenue Code	250
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$0.96
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.72
Rate for Payer: Aetna of CA Government/Medicare	$0.72
Rate for Payer: Cash Price	$0.66
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.96
Rate for Payer: Health Smart Auto/Commercial	$0.72
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.72
Rate for Payer: LLUH Dept of Risk Management WC	$0.66
Rate for Payer: Multiplan Commercial	$0.90

LIDOCAINE 5 % TOPICAL OINTMENT [154444]

Facility

IP

$8.13

Service Code	NDC 0168-0204-37
Hospital Charge Code	901700003
Hospital Revenue Code	250
Min. Negotiated Rate	$4.47
Max. Negotiated Rate	$6.50
Rate for Payer: Cash Price	$4.47
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$6.50
Rate for Payer: Health Smart Auto/Commercial	$4.88
Rate for Payer: LLUH Dept of Risk Management WC	$4.47
Rate for Payer: Multiplan Commercial	$6.10

LIDOCAINE 5 % TOPICAL OINTMENT [154444]

Facility

IP

$0.93

Service Code	NDC 68462-418-20
Hospital Charge Code	901700003
Hospital Revenue Code	250
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$0.74
Rate for Payer: Cash Price	$0.51
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.74
Rate for Payer: Health Smart Auto/Commercial	$0.56
Rate for Payer: LLUH Dept of Risk Management WC	$0.51
Rate for Payer: Multiplan Commercial	$0.70

LIDOCAINE 5 % TOPICAL OINTMENT [154444]

Facility

OP

$0.85

Service Code	NDC 51672-3020-9
Hospital Charge Code	901700003
Hospital Revenue Code	250
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$0.68
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.51
Rate for Payer: Aetna of CA Government/Medicare	$0.51
Rate for Payer: Cash Price	$0.47
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.68
Rate for Payer: Health Smart Auto/Commercial	$0.51
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.51
Rate for Payer: LLUH Dept of Risk Management WC	$0.47
Rate for Payer: Multiplan Commercial	$0.64

LIDOCAINE 5 % TOPICAL OINTMENT [154444]

Facility

OP

$0.31

Service Code	NDC 33342-405-30
Hospital Charge Code	901700003
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.19
Rate for Payer: Aetna of CA Government/Medicare	$0.19
Rate for Payer: Cash Price	$0.17
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.25
Rate for Payer: Health Smart Auto/Commercial	$0.19
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.19
Rate for Payer: LLUH Dept of Risk Management WC	$0.17
Rate for Payer: Multiplan Commercial	$0.23

LIDOCAINE 5 % TOPICAL OINTMENT [154444]

Facility

OP

$8.13

Service Code	NDC 0168-0204-37
Hospital Charge Code	901700003
Hospital Revenue Code	250
Min. Negotiated Rate	$4.47
Max. Negotiated Rate	$6.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.88
Rate for Payer: Aetna of CA Government/Medicare	$4.88
Rate for Payer: Cash Price	$4.47
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$6.50
Rate for Payer: Health Smart Auto/Commercial	$4.88
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.88
Rate for Payer: LLUH Dept of Risk Management WC	$4.47
Rate for Payer: Multiplan Commercial	$6.10

LIDOCAINE 5 % TOPICAL PATCH [28203]

Facility

OP

$9.86

Service Code	NDC 0378-9055-16
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$5.42
Max. Negotiated Rate	$7.89
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.92
Rate for Payer: Aetna of CA Government/Medicare	$5.92
Rate for Payer: Cash Price	$5.43
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$7.89
Rate for Payer: Health Smart Auto/Commercial	$5.92
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.92
Rate for Payer: LLUH Dept of Risk Management WC	$5.42
Rate for Payer: Multiplan Commercial	$7.39

LIDOCAINE 5 % TOPICAL PATCH [28203]

Facility

OP

$9.86

Service Code	NDC 0378-9055-93
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$5.42
Max. Negotiated Rate	$7.89
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$5.92
Rate for Payer: Aetna of CA Government/Medicare	$5.92
Rate for Payer: Cash Price	$5.43
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$7.89
Rate for Payer: Health Smart Auto/Commercial	$5.92
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$5.92
Rate for Payer: LLUH Dept of Risk Management WC	$5.42
Rate for Payer: Multiplan Commercial	$7.39

LIDOCAINE 5 % TOPICAL PATCH [28203]

Facility

IP

$9.86

Service Code	NDC 0378-9055-93
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$5.42
Max. Negotiated Rate	$7.89
Rate for Payer: Cash Price	$5.43
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$7.89
Rate for Payer: Health Smart Auto/Commercial	$5.92
Rate for Payer: LLUH Dept of Risk Management WC	$5.42
Rate for Payer: Multiplan Commercial	$7.39

LIDOCAINE 5 % TOPICAL PATCH [28203]

Facility

IP

$3.59

Service Code	NDC 0603-1880-16
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.97
Max. Negotiated Rate	$2.87
Rate for Payer: Cash Price	$1.98
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.87
Rate for Payer: Health Smart Auto/Commercial	$2.15
Rate for Payer: LLUH Dept of Risk Management WC	$1.97
Rate for Payer: Multiplan Commercial	$2.69

LIDOCAINE 5 % TOPICAL PATCH [28203]

Facility

IP

$9.86

Service Code	NDC 0378-9055-16
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$5.42
Max. Negotiated Rate	$7.89
Rate for Payer: Cash Price	$5.43
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$7.89
Rate for Payer: Health Smart Auto/Commercial	$5.92
Rate for Payer: LLUH Dept of Risk Management WC	$5.42
Rate for Payer: Multiplan Commercial	$7.39

LIDOCAINE 5 % TOPICAL PATCH [28203]

Facility

OP

$3.59

Service Code	NDC 0591-3525-30
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.97
Max. Negotiated Rate	$2.87
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.15
Rate for Payer: Aetna of CA Government/Medicare	$2.15
Rate for Payer: Cash Price	$1.98
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.87
Rate for Payer: Health Smart Auto/Commercial	$2.15
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.15
Rate for Payer: LLUH Dept of Risk Management WC	$1.97
Rate for Payer: Multiplan Commercial	$2.69

LIDOCAINE 5 % TOPICAL PATCH [28203]

Facility

OP

$3.59

Service Code	NDC 0603-1880-16
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.97
Max. Negotiated Rate	$2.87
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.15
Rate for Payer: Aetna of CA Government/Medicare	$2.15
Rate for Payer: Cash Price	$1.98
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.87
Rate for Payer: Health Smart Auto/Commercial	$2.15
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.15
Rate for Payer: LLUH Dept of Risk Management WC	$1.97
Rate for Payer: Multiplan Commercial	$2.69

LIDOCAINE 5 % TOPICAL PATCH [28203]

Facility

OP

$3.59

Service Code	NDC 0603-1880-10
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.97
Max. Negotiated Rate	$2.87
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.15
Rate for Payer: Aetna of CA Government/Medicare	$2.15
Rate for Payer: Cash Price	$1.98
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.87
Rate for Payer: Health Smart Auto/Commercial	$2.15
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.15
Rate for Payer: LLUH Dept of Risk Management WC	$1.97
Rate for Payer: Multiplan Commercial	$2.69

LIDOCAINE 5 % TOPICAL PATCH [28203]

Facility

IP

$3.59

Service Code	NDC 0603-1880-10
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.97
Max. Negotiated Rate	$2.87
Rate for Payer: Cash Price	$1.98
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.87
Rate for Payer: Health Smart Auto/Commercial	$2.15
Rate for Payer: LLUH Dept of Risk Management WC	$1.97
Rate for Payer: Multiplan Commercial	$2.69

LIDOCAINE 5 % TOPICAL PATCH [28203]

Facility

IP

$3.59

Service Code	NDC 0591-3525-30
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$1.97
Max. Negotiated Rate	$2.87
Rate for Payer: Cash Price	$1.98
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$2.87
Rate for Payer: Health Smart Auto/Commercial	$2.15
Rate for Payer: LLUH Dept of Risk Management WC	$1.97
Rate for Payer: Multiplan Commercial	$2.69

LIDOCAINE (8MG/ML) 2 G/250 ML D5W BAG - CODE [4080568]

Facility

OP

$0.04

Service Code	HCPCS J2002
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.03
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.02
Rate for Payer: Aetna of CA Government/Medicare	$0.02
Rate for Payer: Cash Price	$0.02
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.03
Rate for Payer: Health Smart Auto/Commercial	$0.02
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.02
Rate for Payer: Multiplan Commercial	$0.03

LIDOCAINE (8MG/ML) 2 G/250 ML D5W BAG - CODE [4080568]

Facility

IP

$0.04

Service Code	HCPCS J2002
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.03
Rate for Payer: Cash Price	$0.02
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.03
Rate for Payer: Health Smart Auto/Commercial	$0.02
Rate for Payer: LLUH Dept of Risk Management WC	$0.02
Rate for Payer: Multiplan Commercial	$0.03

LIDOCAINE-EPINEPHRINE 0.5 %-1:200,000 INJECTION SOLUTION [14870]

Facility

OP

$0.09

Service Code	HCPCS J2004
Hospital Charge Code	901700025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.07
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.05
Rate for Payer: Aetna of CA Government/Medicare	$0.05
Rate for Payer: Cash Price	$0.05
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.07
Rate for Payer: Health Smart Auto/Commercial	$0.05
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.05
Rate for Payer: LLUH Dept of Risk Management WC	$0.05
Rate for Payer: Multiplan Commercial	$0.07

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