Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

lidocaine Top 2% Gel w/Appl [HMC]

Facility

IP

$32.08

Service Code	NDC 76329301205
Hospital Charge Code	3808117
Hospital Revenue Code	250
Min. Negotiated Rate	$28.87
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$28.87
Rate for Payer: UnitedHealthcare Commercial	$30.48
Rate for Payer: WPPA Medicare Advantage	$1,200.00

lidocaine Top 2% Gel w/Appl [HMC]

Facility

OP

$32.60

Service Code	NDC 76329301105
Hospital Charge Code	3808117
Hospital Revenue Code	250
Min. Negotiated Rate	$13.04
Max. Negotiated Rate	$30.97
Rate for Payer: Aetna Commercial	$29.34
Rate for Payer: Humana Medicare Advantage	$13.69
Rate for Payer: UnitedHealthcare Commercial	$30.97
Rate for Payer: UnitedHealthcare Medicaid	$13.04
Rate for Payer: WPPA Medicare Advantage	$19.56

lidocaine Top 2% Sol 15 mL [HMC]

Facility

IP

$14.12

Service Code	NDC 00054350049
Hospital Charge Code	3803919
Hospital Revenue Code	250
Min. Negotiated Rate	$12.71
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$12.71
Rate for Payer: UnitedHealthcare Commercial	$13.41
Rate for Payer: WPPA Medicare Advantage	$1,200.00

lidocaine Top 2% Sol 15 mL [HMC]

Facility

OP

$23.48

Service Code	NDC 00121495040
Hospital Charge Code	3803919
Hospital Revenue Code	250
Min. Negotiated Rate	$9.39
Max. Negotiated Rate	$22.31
Rate for Payer: Aetna Commercial	$21.13
Rate for Payer: Humana Medicare Advantage	$9.86
Rate for Payer: UnitedHealthcare Commercial	$22.31
Rate for Payer: UnitedHealthcare Medicaid	$9.39
Rate for Payer: WPPA Medicare Advantage	$14.09

lidocaine Top 2% Sol 15 mL [HMC]

Facility

IP

$12.16

Service Code	NDC 50383036317
Hospital Charge Code	3803919
Hospital Revenue Code	250
Min. Negotiated Rate	$10.94
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$10.94
Rate for Payer: UnitedHealthcare Commercial	$11.55
Rate for Payer: WPPA Medicare Advantage	$1,200.00

lidocaine Top 2% Sol 15 mL [HMC]

Facility

OP

$12.16

Service Code	NDC 50383036317
Hospital Charge Code	3803919
Hospital Revenue Code	250
Min. Negotiated Rate	$4.86
Max. Negotiated Rate	$11.55
Rate for Payer: Aetna Commercial	$10.94
Rate for Payer: Humana Medicare Advantage	$5.11
Rate for Payer: UnitedHealthcare Commercial	$11.55
Rate for Payer: UnitedHealthcare Medicaid	$4.86
Rate for Payer: WPPA Medicare Advantage	$7.30

lidocaine Top 2% Sol 15 mL [HMC]

Facility

OP

$14.12

Service Code	NDC 00054350049
Hospital Charge Code	3803919
Hospital Revenue Code	250
Min. Negotiated Rate	$5.65
Max. Negotiated Rate	$13.41
Rate for Payer: Aetna Commercial	$12.71
Rate for Payer: Humana Medicare Advantage	$5.93
Rate for Payer: UnitedHealthcare Commercial	$13.41
Rate for Payer: UnitedHealthcare Medicaid	$5.65
Rate for Payer: WPPA Medicare Advantage	$8.47

lidocaine Top 2% Sol 15 mL [HMC]

Facility

IP

$12.16

Service Code	NDC 50383077517
Hospital Charge Code	3803919
Hospital Revenue Code	250
Min. Negotiated Rate	$10.94
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$10.94
Rate for Payer: UnitedHealthcare Commercial	$11.55
Rate for Payer: WPPA Medicare Advantage	$1,200.00

lidocaine Top 2% Sol 15 mL [HMC]

Facility

OP

$12.16

Service Code	NDC 50383077517
Hospital Charge Code	3803919
Hospital Revenue Code	250
Min. Negotiated Rate	$4.86
Max. Negotiated Rate	$11.55
Rate for Payer: Aetna Commercial	$10.94
Rate for Payer: Humana Medicare Advantage	$5.11
Rate for Payer: UnitedHealthcare Commercial	$11.55
Rate for Payer: UnitedHealthcare Medicaid	$4.86
Rate for Payer: WPPA Medicare Advantage	$7.30

lidocaine Top 2% Sol 15 mL [HMC]

Facility

IP

$19.34

Service Code	NDC 00121090340
Hospital Charge Code	3803919
Hospital Revenue Code	250
Min. Negotiated Rate	$17.41
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$17.41
Rate for Payer: UnitedHealthcare Commercial	$18.37
Rate for Payer: WPPA Medicare Advantage	$1,200.00

lidocaine Top 2% Sol 15 mL [HMC]

Facility

OP

$19.34

Service Code	NDC 00121090340
Hospital Charge Code	3803919
Hospital Revenue Code	250
Min. Negotiated Rate	$7.74
Max. Negotiated Rate	$18.37
Rate for Payer: Aetna Commercial	$17.41
Rate for Payer: Humana Medicare Advantage	$8.12
Rate for Payer: UnitedHealthcare Commercial	$18.37
Rate for Payer: UnitedHealthcare Medicaid	$7.74
Rate for Payer: WPPA Medicare Advantage	$11.60

lidocaine Top 2% Sol 15 mL [HMC]

Facility

IP

$23.48

Service Code	NDC 00121495040
Hospital Charge Code	3803919
Hospital Revenue Code	250
Min. Negotiated Rate	$21.13
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$21.13
Rate for Payer: UnitedHealthcare Commercial	$22.31
Rate for Payer: WPPA Medicare Advantage	$1,200.00

lidocaine topical 4% Cream [HMC]

Facility

OP

$60.50

Service Code	NDC 24357070130
Hospital Charge Code	3801604
Hospital Revenue Code	259
Min. Negotiated Rate	$24.20
Max. Negotiated Rate	$57.48
Rate for Payer: Aetna Commercial	$54.45
Rate for Payer: Humana Medicare Advantage	$25.41
Rate for Payer: UnitedHealthcare Commercial	$57.48
Rate for Payer: UnitedHealthcare Medicaid	$24.20
Rate for Payer: WPPA Medicare Advantage	$36.30

lidocaine topical 4% Cream [HMC]

Facility

IP

$60.50

Service Code	NDC 24357070130
Hospital Charge Code	3801604
Hospital Revenue Code	259
Min. Negotiated Rate	$54.45
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$54.45
Rate for Payer: UnitedHealthcare Commercial	$57.48
Rate for Payer: WPPA Medicare Advantage	$1,200.00

lidocaine topical 4% Sol 50 mL [HMC]

Facility

OP

$39.39

Service Code	NDC 00527600480
Hospital Charge Code	3803920
Hospital Revenue Code	250
Min. Negotiated Rate	$15.76
Max. Negotiated Rate	$37.42
Rate for Payer: Aetna Commercial	$35.45
Rate for Payer: Humana Medicare Advantage	$16.54
Rate for Payer: UnitedHealthcare Commercial	$37.42
Rate for Payer: UnitedHealthcare Medicaid	$15.76
Rate for Payer: WPPA Medicare Advantage	$23.63

lidocaine topical 4% Sol 50 mL [HMC]

Facility

IP

$39.39

Service Code	NDC 00527600480
Hospital Charge Code	3803920
Hospital Revenue Code	250
Min. Negotiated Rate	$35.45
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$35.45
Rate for Payer: UnitedHealthcare Commercial	$37.42
Rate for Payer: WPPA Medicare Advantage	$1,200.00

lidocaine topical Patch 4% Film [HMC]

Facility

IP

$8.92

Service Code	NDC 00536120207
Hospital Charge Code	3800880
Hospital Revenue Code	250
Min. Negotiated Rate	$8.03
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$8.03
Rate for Payer: UnitedHealthcare Commercial	$8.47
Rate for Payer: WPPA Medicare Advantage	$1,200.00

lidocaine topical Patch 4% Film [HMC]

Facility

OP

$9.51

Service Code	NDC 00536120215
Hospital Charge Code	3800880
Hospital Revenue Code	250
Min. Negotiated Rate	$3.80
Max. Negotiated Rate	$9.03
Rate for Payer: Aetna Commercial	$8.56
Rate for Payer: Humana Medicare Advantage	$3.99
Rate for Payer: UnitedHealthcare Commercial	$9.03
Rate for Payer: UnitedHealthcare Medicaid	$3.80
Rate for Payer: WPPA Medicare Advantage	$5.71

lidocaine topical Patch 4% Film [HMC]

Facility

OP

$13.18

Service Code	NDC 46581083001
Hospital Charge Code	3800880
Hospital Revenue Code	250
Min. Negotiated Rate	$5.27
Max. Negotiated Rate	$12.52
Rate for Payer: Aetna Commercial	$11.86
Rate for Payer: Humana Medicare Advantage	$5.54
Rate for Payer: UnitedHealthcare Commercial	$12.52
Rate for Payer: UnitedHealthcare Medicaid	$5.27
Rate for Payer: WPPA Medicare Advantage	$7.91

lidocaine topical Patch 4% Film [HMC]

Facility

IP

$9.51

Service Code	NDC 00536120215
Hospital Charge Code	3800880
Hospital Revenue Code	250
Min. Negotiated Rate	$8.56
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$8.56
Rate for Payer: UnitedHealthcare Commercial	$9.03
Rate for Payer: WPPA Medicare Advantage	$1,200.00

lidocaine topical Patch 4% Film [HMC]

Facility

IP

$13.18

Service Code	NDC 46581083001
Hospital Charge Code	3800880
Hospital Revenue Code	250
Min. Negotiated Rate	$11.86
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$11.86
Rate for Payer: UnitedHealthcare Commercial	$12.52
Rate for Payer: WPPA Medicare Advantage	$1,200.00

lidocaine topical Patch 4% Film [HMC]

Facility

OP

$8.92

Service Code	NDC 00536120207
Hospital Charge Code	3800880
Hospital Revenue Code	250
Min. Negotiated Rate	$3.57
Max. Negotiated Rate	$8.47
Rate for Payer: Aetna Commercial	$8.03
Rate for Payer: Humana Medicare Advantage	$3.75
Rate for Payer: UnitedHealthcare Commercial	$8.47
Rate for Payer: UnitedHealthcare Medicaid	$3.57
Rate for Payer: WPPA Medicare Advantage	$5.35

lidocaine Top Patch 5% film [HMC]

Facility

IP

$28.40

Service Code	NDC 00591267930
Hospital Charge Code	3800937
Hospital Revenue Code	250
Min. Negotiated Rate	$25.56
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$25.56
Rate for Payer: UnitedHealthcare Commercial	$26.98
Rate for Payer: WPPA Medicare Advantage	$1,200.00

lidocaine Top Patch 5% film [HMC]

Facility

IP

$28.40

Service Code	NDC 00591352530
Hospital Charge Code	3800937
Hospital Revenue Code	250
Min. Negotiated Rate	$25.56
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$25.56
Rate for Payer: UnitedHealthcare Commercial	$26.98
Rate for Payer: WPPA Medicare Advantage	$1,200.00

lidocaine Top Patch 5% film [HMC]

Facility

OP

$28.40

Service Code	NDC 00591267930
Hospital Charge Code	3800937
Hospital Revenue Code	250
Min. Negotiated Rate	$11.36
Max. Negotiated Rate	$26.98
Rate for Payer: Aetna Commercial	$25.56
Rate for Payer: Humana Medicare Advantage	$11.93
Rate for Payer: UnitedHealthcare Commercial	$26.98
Rate for Payer: UnitedHealthcare Medicaid	$11.36
Rate for Payer: WPPA Medicare Advantage	$17.04

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