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Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION [103889]

Facility

IP

$0.86

Service Code	NDC 63323-495-04
Hospital Charge Code	1721209
Hospital Revenue Code	250
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$0.69
Rate for Payer: Cash Price	$0.39
Rate for Payer: Cigna of CA HMO/PPO	$0.69
Rate for Payer: Health Smart Auto/Commercial	$0.52
Rate for Payer: LLUH Dept of Risk Management WC	$0.47
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.65

LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION [103889]

Facility

IP

$0.86

Service Code	NDC 63323-495-07
Hospital Charge Code	1721209
Hospital Revenue Code	250
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$0.69
Rate for Payer: Cash Price	$0.39
Rate for Payer: Cigna of CA HMO/PPO	$0.69
Rate for Payer: Health Smart Auto/Commercial	$0.52
Rate for Payer: LLUH Dept of Risk Management WC	$0.47
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.65

LIDOCAINE (PF) 20 MG/ML (2 %) INTRAVENOUS SOLUTION [118084]

Facility

OP

$0.83

Service Code	NDC 63323-208-05
Hospital Charge Code	1721212
Hospital Revenue Code	250
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$0.62
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.50
Rate for Payer: Aetna of CA Government/Medicare	$0.50
Rate for Payer: Cash Price	$0.37
Rate for Payer: Health Smart Auto/Commercial	$0.50
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.50
Rate for Payer: LLUH Dept of Risk Management WC	$0.46
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.62

LIDOCAINE (PF) 20 MG/ML (2 %) INTRAVENOUS SOLUTION [118084]

Facility

IP

$0.83

Service Code	NDC 63323-208-05
Hospital Charge Code	1721212
Hospital Revenue Code	250
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$0.66
Rate for Payer: Cash Price	$0.37
Rate for Payer: Cigna of CA HMO/PPO	$0.66
Rate for Payer: Health Smart Auto/Commercial	$0.50
Rate for Payer: LLUH Dept of Risk Management WC	$0.46
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.62

LIDOCAINE (PF) 40 MG/ML (4 %) INJECTION SOLUTION [4455]

Facility

IP

$1.16

Service Code	NDC 0409-4283-25
Hospital Charge Code	1726013
Hospital Revenue Code	250
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$0.93
Rate for Payer: Cash Price	$0.52
Rate for Payer: Cigna of CA HMO/PPO	$0.93
Rate for Payer: Health Smart Auto/Commercial	$0.70
Rate for Payer: LLUH Dept of Risk Management WC	$0.64
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.87

LIDOCAINE (PF) 40 MG/ML (4 %) INJECTION SOLUTION [4455]

Facility

OP

$1.16

Service Code	NDC 0409-4283-25
Hospital Charge Code	1726013
Hospital Revenue Code	250
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$0.87
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.70
Rate for Payer: Aetna of CA Government/Medicare	$0.70
Rate for Payer: Cash Price	$0.52
Rate for Payer: Health Smart Auto/Commercial	$0.70
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.70
Rate for Payer: LLUH Dept of Risk Management WC	$0.64
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.87

LIDOCAINE (PF) 40 MG/ML (4 %) INJECTION SOLUTION [4455]

Facility

OP

$1.16

Service Code	NDC 0409-4283-01
Hospital Charge Code	1726013
Hospital Revenue Code	250
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$0.87
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.70
Rate for Payer: Aetna of CA Government/Medicare	$0.70
Rate for Payer: Cash Price	$0.52
Rate for Payer: Health Smart Auto/Commercial	$0.70
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.70
Rate for Payer: LLUH Dept of Risk Management WC	$0.64
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.87

LIDOCAINE (PF) 40 MG/ML (4 %) INJECTION SOLUTION [4455]

Facility

IP

$1.16

Service Code	NDC 0409-4283-11
Hospital Charge Code	1726013
Hospital Revenue Code	250
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$0.93
Rate for Payer: Cash Price	$0.52
Rate for Payer: Cigna of CA HMO/PPO	$0.93
Rate for Payer: Health Smart Auto/Commercial	$0.70
Rate for Payer: LLUH Dept of Risk Management WC	$0.64
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.87

LIDOCAINE (PF) 40 MG/ML (4 %) INJECTION SOLUTION [4455]

Facility

IP

$1.16

Service Code	NDC 0409-4283-01
Hospital Charge Code	1726013
Hospital Revenue Code	250
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$0.93
Rate for Payer: Cash Price	$0.52
Rate for Payer: Cigna of CA HMO/PPO	$0.93
Rate for Payer: Health Smart Auto/Commercial	$0.70
Rate for Payer: LLUH Dept of Risk Management WC	$0.64
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.87

LIDOCAINE (PF) 40 MG/ML (4 %) INJECTION SOLUTION [4455]

Facility

OP

$1.16

Service Code	NDC 0409-4283-11
Hospital Charge Code	1726013
Hospital Revenue Code	250
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$0.87
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.70
Rate for Payer: Aetna of CA Government/Medicare	$0.70
Rate for Payer: Cash Price	$0.52
Rate for Payer: Health Smart Auto/Commercial	$0.70
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.70
Rate for Payer: LLUH Dept of Risk Management WC	$0.64
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.87

LIDOCAINE (PF) 50 MG/5 ML (1 %) INTRAVENOUS SYRINGE [4457]

Facility

IP

$2.46

Service Code	NDC 0409-9137-05
Hospital Charge Code	1720132
Hospital Revenue Code	250
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.97
Rate for Payer: Cash Price	$1.11
Rate for Payer: Cigna of CA HMO/PPO	$1.97
Rate for Payer: Health Smart Auto/Commercial	$1.48
Rate for Payer: LLUH Dept of Risk Management WC	$1.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.84

LIDOCAINE (PF) 50 MG/5 ML (1 %) INTRAVENOUS SYRINGE [4457]

Facility

OP

$2.46

Service Code	NDC 0409-9137-05
Hospital Charge Code	1720132
Hospital Revenue Code	250
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.84
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.48
Rate for Payer: Aetna of CA Government/Medicare	$1.48
Rate for Payer: Cash Price	$1.11
Rate for Payer: Health Smart Auto/Commercial	$1.48
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.48
Rate for Payer: LLUH Dept of Risk Management WC	$1.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.84

LIDOCAINE (PF) 50 MG/5 ML (1 %) INTRAVENOUS SYRINGE [4457]

Facility

IP

$3.57

Service Code	NDC 0409-4904-34
Hospital Charge Code	1720132
Hospital Revenue Code	250
Min. Negotiated Rate	$1.96
Max. Negotiated Rate	$2.86
Rate for Payer: Cash Price	$1.61
Rate for Payer: Cigna of CA HMO/PPO	$2.86
Rate for Payer: Health Smart Auto/Commercial	$2.14
Rate for Payer: LLUH Dept of Risk Management WC	$1.96
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.68

LIDOCAINE (PF) 50 MG/5 ML (1 %) INTRAVENOUS SYRINGE [4457]

Facility

OP

$3.57

Service Code	NDC 0409-4904-34
Hospital Charge Code	1720132
Hospital Revenue Code	250
Min. Negotiated Rate	$1.96
Max. Negotiated Rate	$2.68
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.14
Rate for Payer: Aetna of CA Government/Medicare	$2.14
Rate for Payer: Cash Price	$1.61
Rate for Payer: Health Smart Auto/Commercial	$2.14
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.14
Rate for Payer: LLUH Dept of Risk Management WC	$1.96
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.68

LIDOCAINE (PF) 50 MG/ML (5 %) IN 7.5 % DEXTROSE INTRATHECAL SOLUTION [27396]

Facility

IP

$5.56

Service Code	NDC 0409-4712-11
Hospital Charge Code	1720572
Hospital Revenue Code	250
Min. Negotiated Rate	$3.06
Max. Negotiated Rate	$4.45
Rate for Payer: Cash Price	$2.50
Rate for Payer: Cigna of CA HMO/PPO	$4.45
Rate for Payer: Health Smart Auto/Commercial	$3.34
Rate for Payer: LLUH Dept of Risk Management WC	$3.06
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.17

LIDOCAINE (PF) 50 MG/ML (5 %) IN 7.5 % DEXTROSE INTRATHECAL SOLUTION [27396]

Facility

OP

$5.56

Service Code	NDC 0409-4712-01
Hospital Charge Code	1720572
Hospital Revenue Code	250
Min. Negotiated Rate	$3.06
Max. Negotiated Rate	$4.17
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.34
Rate for Payer: Aetna of CA Government/Medicare	$3.34
Rate for Payer: Cash Price	$2.50
Rate for Payer: Health Smart Auto/Commercial	$3.34
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.34
Rate for Payer: LLUH Dept of Risk Management WC	$3.06
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.17

LIDOCAINE (PF) 50 MG/ML (5 %) IN 7.5 % DEXTROSE INTRATHECAL SOLUTION [27396]

Facility

IP

$5.56

Service Code	NDC 0409-4712-01
Hospital Charge Code	1720572
Hospital Revenue Code	250
Min. Negotiated Rate	$3.06
Max. Negotiated Rate	$4.45
Rate for Payer: Cash Price	$2.50
Rate for Payer: Cigna of CA HMO/PPO	$4.45
Rate for Payer: Health Smart Auto/Commercial	$3.34
Rate for Payer: LLUH Dept of Risk Management WC	$3.06
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.17

LIDOCAINE (PF) 50 MG/ML (5 %) IN 7.5 % DEXTROSE INTRATHECAL SOLUTION [27396]

Facility

OP

$5.56

Service Code	NDC 0409-4712-11
Hospital Charge Code	1720572
Hospital Revenue Code	250
Min. Negotiated Rate	$3.06
Max. Negotiated Rate	$4.17
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.34
Rate for Payer: Aetna of CA Government/Medicare	$3.34
Rate for Payer: Cash Price	$2.50
Rate for Payer: Health Smart Auto/Commercial	$3.34
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.34
Rate for Payer: LLUH Dept of Risk Management WC	$3.06
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.17

LIDOCAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION [105635]

Facility

OP

$0.10

Service Code	NDC 0409-4278-01
Hospital Charge Code	1721142
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 (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION [105635]

Facility

IP

$0.10

Service Code	NDC 0409-4278-01
Hospital Charge Code	1721142
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 (PF) 8 MG/ML (0.8 %) IN 5 % DEXTROSE INTRAVENOUS SOLUTION [14869]

Facility

OP

$0.04

Service Code	CPT J2001
Hospital Charge Code	1771168
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: 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 Beech St/Commercial/PHCS	$0.03

LIDOCAINE (PF) 8 MG/ML (0.8 %) IN 5 % DEXTROSE INTRAVENOUS SOLUTION [14869]

Facility

IP

$0.04

Service Code	CPT J2001
Hospital Charge Code	1771168
Hospital Revenue Code	636
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.03
Rate for Payer: Cash Price	$0.02
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$0.03

LIDOCAINE (PF) 8 MG/ML (0.8 %) IN 5 % DEXTROSE INTRAVENOUS SOLUTION - FOR PAIN (LLU) [408148692]

Facility

IP

$0.04

Service Code	CPT J2001
Hospital Charge Code	1771168
Hospital Revenue Code	636
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.03
Rate for Payer: Cash Price	$0.02
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$0.03

LIDOCAINE (PF) 8 MG/ML (0.8 %) IN 5 % DEXTROSE INTRAVENOUS SOLUTION - FOR PAIN (LLU) [408148692]

Facility

OP

$0.04

Service Code	CPT J2001
Hospital Charge Code	1771168
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: 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 Beech St/Commercial/PHCS	$0.03

LIDOCAINE (PF) 8 MG/ML (0.8 %) IN 5 % DEXTROSE IV BOLUS [40814869]

Facility

IP

$0.04

Service Code	CPT J2001
Hospital Charge Code	1771168
Hospital Revenue Code	636
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.03
Rate for Payer: Cash Price	$0.02
Rate for Payer: Cigna of CA 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 Beech St/Commercial/PHCS	$0.03

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