Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

LIDOCAINE-EPINEPHRINE (PF/NON-PF) 1.5 %-1:200,000 INJECTION SOLUTION. [40815956]

Facility

OP

$1.15

Service Code	NDC 63323-488-17
Hospital Charge Code	1720689
Hospital Revenue Code	250
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$0.86
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.69
Rate for Payer: Aetna of CA Government/Medicare	$0.69
Rate for Payer: Cash Price	$0.52
Rate for Payer: Health Smart Auto/Commercial	$0.69
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.69
Rate for Payer: LLUH Dept of Risk Management WC	$0.63
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.86

LIDOCAINE-EPINEPHRINE (PF/NON-PF) 1.5 %-1:200,000 INJECTION SOLUTION. [40815956]

Facility

IP

$1.15

Service Code	NDC 63323-488-17
Hospital Charge Code	1720689
Hospital Revenue Code	250
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$0.92
Rate for Payer: Cash Price	$0.52
Rate for Payer: Cigna of CA HMO/PPO	$0.92
Rate for Payer: Health Smart Auto/Commercial	$0.69
Rate for Payer: LLUH Dept of Risk Management WC	$0.63
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.86

LIDOCAINE-EPINEPHRINE (PF/NON-PF) 1.5 %-1:200,000 INJECTION SOLUTION. [40815956]

Facility

IP

$0.37

Service Code	NDC 0409-3181-01
Hospital Charge Code	1720563
Hospital Revenue Code	250
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.30
Rate for Payer: Cash Price	$0.17
Rate for Payer: Cigna of CA HMO/PPO	$0.30
Rate for Payer: Health Smart Auto/Commercial	$0.22
Rate for Payer: LLUH Dept of Risk Management WC	$0.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.28

LIDOCAINE-EPINEPHRINE (PF/NON-PF) 1.5 %-1:200,000 INJECTION SOLUTION. [40815956]

Facility

OP

$0.37

Service Code	NDC 0409-3181-01
Hospital Charge Code	1720563
Hospital Revenue Code	250
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.28
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.22
Rate for Payer: Aetna of CA Government/Medicare	$0.22
Rate for Payer: Cash Price	$0.17
Rate for Payer: Health Smart Auto/Commercial	$0.22
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.22
Rate for Payer: LLUH Dept of Risk Management WC	$0.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.28

LIDOCAINE-EPINEPHRINE (PF/NON-PF) 1.5 %-1:200,000 INJECTION SOLUTION. [40815956]

Facility

IP

$1.30

Service Code	NDC 0409-1209-01
Hospital Charge Code	1722038
Hospital Revenue Code	250
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$1.04
Rate for Payer: Cash Price	$0.59
Rate for Payer: Cigna of CA HMO/PPO	$1.04
Rate for Payer: Health Smart Auto/Commercial	$0.78
Rate for Payer: LLUH Dept of Risk Management WC	$0.72
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.98

LIDOCAINE-EPINEPHRINE (PF/NON-PF) 1.5 %-1:200,000 INJECTION SOLUTION. [40815956]

Facility

IP

$0.63

Service Code	NDC 63323-488-37
Hospital Charge Code	1720563
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.50
Rate for Payer: Cash Price	$0.28
Rate for Payer: Cigna of CA HMO/PPO	$0.50
Rate for Payer: Health Smart Auto/Commercial	$0.38
Rate for Payer: LLUH Dept of Risk Management WC	$0.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.47

LIDOCAINE-EPINEPHRINE (PF/NON-PF) 1.5 %-1:200,000 INJECTION SOLUTION. [40815956]

Facility

OP

$1.30

Service Code	NDC 0409-1209-01
Hospital Charge Code	1722038
Hospital Revenue Code	250
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$0.98
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.78
Rate for Payer: Aetna of CA Government/Medicare	$0.78
Rate for Payer: Cash Price	$0.59
Rate for Payer: Health Smart Auto/Commercial	$0.78
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.78
Rate for Payer: LLUH Dept of Risk Management WC	$0.72
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.98

LIDOCAINE/EPI/TETRACAINE (LET) TOPICAL SOLN [4080616]

Facility

IP

$5.94

Service Code	NDC 71266-6276-3
Hospital Charge Code	1743677
Hospital Revenue Code	259
Min. Negotiated Rate	$3.27
Max. Negotiated Rate	$4.75
Rate for Payer: Cash Price	$2.67
Rate for Payer: Cigna of CA HMO/PPO	$4.75
Rate for Payer: Health Smart Auto/Commercial	$3.56
Rate for Payer: LLUH Dept of Risk Management WC	$3.27
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.46

LIDOCAINE/EPI/TETRACAINE (LET) TOPICAL SOLN [4080616]

Facility

IP

$0.17

Service Code	NDC 9408-0616-02
Hospital Charge Code	1743677
Hospital Revenue Code	259
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.14
Rate for Payer: Cash Price	$0.08
Rate for Payer: Cigna of CA HMO/PPO	$0.14
Rate for Payer: Health Smart Auto/Commercial	$0.10
Rate for Payer: LLUH Dept of Risk Management WC	$0.09
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.13

LIDOCAINE/EPI/TETRACAINE (LET) TOPICAL SOLN [4080616]

Facility

OP

$5.94

Service Code	NDC 71266-6276-3
Hospital Charge Code	1743677
Hospital Revenue Code	259
Min. Negotiated Rate	$3.27
Max. Negotiated Rate	$4.46
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.56
Rate for Payer: Aetna of CA Government/Medicare	$3.56
Rate for Payer: Cash Price	$2.67
Rate for Payer: Health Smart Auto/Commercial	$3.56
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.56
Rate for Payer: LLUH Dept of Risk Management WC	$3.27
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.46

LIDOCAINE/EPI/TETRACAINE (LET) TOPICAL SOLN [4080616]

Facility

OP

$0.17

Service Code	NDC 9408-0616-02
Hospital Charge Code	1743677
Hospital Revenue Code	259
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.13
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.10
Rate for Payer: Aetna of CA Government/Medicare	$0.10
Rate for Payer: Cash Price	$0.08
Rate for Payer: Health Smart Auto/Commercial	$0.10
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.10
Rate for Payer: LLUH Dept of Risk Management WC	$0.09
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.13

LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION [4452]

Facility

OP

$0.10

Service Code	NDC 0409-4276-16
Hospital Charge Code	1721062
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.08
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.06
Rate for Payer: Aetna of CA Government/Medicare	$0.06
Rate for Payer: Cash Price	$0.05
Rate for Payer: Health Smart Auto/Commercial	$0.06
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.06
Rate for Payer: LLUH Dept of Risk Management WC	$0.06
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.08

LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION [4452]

Facility

IP

$0.10

Service Code	NDC 0409-4276-16
Hospital Charge Code	1721062
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.08
Rate for Payer: Cash Price	$0.05
Rate for Payer: Cigna of CA HMO/PPO	$0.08
Rate for Payer: Health Smart Auto/Commercial	$0.06
Rate for Payer: LLUH Dept of Risk Management WC	$0.06
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.08

LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION [4452]

Facility

OP

$0.10

Service Code	NDC 0409-4276-01
Hospital Charge Code	1721062
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.08
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.06
Rate for Payer: Aetna of CA Government/Medicare	$0.06
Rate for Payer: Cash Price	$0.05
Rate for Payer: Health Smart Auto/Commercial	$0.06
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.06
Rate for Payer: LLUH Dept of Risk Management WC	$0.06
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.08

LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION [4452]

Facility

IP

$0.10

Service Code	NDC 0409-4276-01
Hospital Charge Code	1721062
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.08
Rate for Payer: Cash Price	$0.05
Rate for Payer: Cigna of CA HMO/PPO	$0.08
Rate for Payer: Health Smart Auto/Commercial	$0.06
Rate for Payer: LLUH Dept of Risk Management WC	$0.06
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.08

LIDOCAINE HCL 20 MG/ML (2 %) INJECTION SOLUTION [4454]

Facility

IP

$0.23

Service Code	NDC 63323-486-27
Hospital Charge Code	1721025
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.18
Rate for Payer: Cash Price	$0.10
Rate for Payer: Cigna of CA HMO/PPO	$0.18
Rate for Payer: Health Smart Auto/Commercial	$0.14
Rate for Payer: LLUH Dept of Risk Management WC	$0.13
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.17

LIDOCAINE HCL 20 MG/ML (2 %) INJECTION SOLUTION [4454]

Facility

IP

$0.23

Service Code	NDC 63323-486-02
Hospital Charge Code	1721025
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.18
Rate for Payer: Cash Price	$0.10
Rate for Payer: Cigna of CA HMO/PPO	$0.18
Rate for Payer: Health Smart Auto/Commercial	$0.14
Rate for Payer: LLUH Dept of Risk Management WC	$0.13
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.17

LIDOCAINE HCL 20 MG/ML (2 %) INJECTION SOLUTION [4454]

Facility

OP

$0.23

Service Code	NDC 63323-486-02
Hospital Charge Code	1721025
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.17
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.14
Rate for Payer: Aetna of CA Government/Medicare	$0.14
Rate for Payer: Cash Price	$0.10
Rate for Payer: Health Smart Auto/Commercial	$0.14
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.14
Rate for Payer: LLUH Dept of Risk Management WC	$0.13
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.17

LIDOCAINE HCL 20 MG/ML (2 %) INJECTION SOLUTION [4454]

Facility

OP

$0.23

Service Code	NDC 63323-486-27
Hospital Charge Code	1721025
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.17
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.14
Rate for Payer: Aetna of CA Government/Medicare	$0.14
Rate for Payer: Cash Price	$0.10
Rate for Payer: Health Smart Auto/Commercial	$0.14
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.14
Rate for Payer: LLUH Dept of Risk Management WC	$0.13
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.17

LIDOCAINE HCL 2 % MUCOSAL JELLY [4448]

Facility

IP

$1.12

Service Code	NDC 9999-1544-43
Hospital Charge Code	1782008
Hospital Revenue Code	259
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$0.90
Rate for Payer: Cash Price	$0.50
Rate for Payer: Cigna of CA HMO/PPO	$0.90
Rate for Payer: Health Smart Auto/Commercial	$0.67
Rate for Payer: LLUH Dept of Risk Management WC	$0.62
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.84

LIDOCAINE HCL 2 % MUCOSAL JELLY [4448]

Facility

OP

$1.12

Service Code	NDC 9999-1544-43
Hospital Charge Code	1782008
Hospital Revenue Code	259
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$0.84
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.67
Rate for Payer: Aetna of CA Government/Medicare	$0.67
Rate for Payer: Cash Price	$0.50
Rate for Payer: Health Smart Auto/Commercial	$0.67
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.67
Rate for Payer: LLUH Dept of Risk Management WC	$0.62
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.84

LIDOCAINE HCL 2 % MUCOSAL SOLUTION [111639]

Facility

IP

$1.18

Service Code	NDC 62135-712-42
Hospital Charge Code	NDG111639
Hospital Revenue Code	259
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$0.94
Rate for Payer: Cash Price	$0.53
Rate for Payer: Cigna of CA HMO/PPO	$0.94
Rate for Payer: Health Smart Auto/Commercial	$0.71
Rate for Payer: LLUH Dept of Risk Management WC	$0.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.89

LIDOCAINE HCL 2 % MUCOSAL SOLUTION [111639]

Facility

OP

$0.30

Service Code	NDC 0121-0903-15
Hospital Charge Code	1716025
Hospital Revenue Code	259
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.23
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.18
Rate for Payer: Aetna of CA Government/Medicare	$0.18
Rate for Payer: Cash Price	$0.14
Rate for Payer: Health Smart Auto/Commercial	$0.18
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.18
Rate for Payer: LLUH Dept of Risk Management WC	$0.17
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.23

LIDOCAINE HCL 2 % MUCOSAL SOLUTION [111639]

Facility

OP

$1.18

Service Code	NDC 62135-712-42
Hospital Charge Code	NDG111639
Hospital Revenue Code	259
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$0.89
Rate for Payer: Cash Price	$0.53
Rate for Payer: Health Smart Auto/Commercial	$0.71
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.71
Rate for Payer: Aetna of CA Government/Medicare	$0.71
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.71
Rate for Payer: LLUH Dept of Risk Management WC	$0.65
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.89

LIDOCAINE HCL 2 % MUCOSAL SOLUTION [111639]

Facility

IP

$0.13

Service Code	NDC 0054-3500-49
Hospital Charge Code	NDG111639
Hospital Revenue Code	259
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.10
Rate for Payer: Cash Price	$0.06
Rate for Payer: Cigna of CA HMO/PPO	$0.10
Rate for Payer: Health Smart Auto/Commercial	$0.08
Rate for Payer: LLUH Dept of Risk Management WC	$0.07
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.10

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