Ness County Hospital

All Charges

Charge

Type

Setting

Price

LAB- HIV

Facility

$80.00

Service Code	HCPCS 87390
Hospital Charge Code	8739000
Hospital Revenue Code	302
Min. Negotiated Rate	$65.60
Max. Negotiated Rate	$77.60
Rate for Payer: Cash Price	$60.00
Rate for Payer: Health Partners Plans Commercial	$76.00
Rate for Payer: UnitedHealthcare Commercial	$77.60
Rate for Payer: WPPA Commercial	$65.60

LAB-QUANTITATIVE

Facility

$28.00

Service Code	HCPCS 86593
Hospital Charge Code	8659300
Hospital Revenue Code	302
Min. Negotiated Rate	$22.96
Max. Negotiated Rate	$27.16
Rate for Payer: Cash Price	$21.00
Rate for Payer: Health Partners Plans Commercial	$26.60
Rate for Payer: UnitedHealthcare Commercial	$27.16
Rate for Payer: WPPA Commercial	$22.96

LAB-QUANTITATIVE

Facility

$28.00

Service Code	HCPCS 86593
Hospital Charge Code	8659300
Hospital Revenue Code	302
Min. Negotiated Rate	$12.94
Max. Negotiated Rate	$27.16
Rate for Payer: BCBS Commercial	$22.56
Rate for Payer: Cash Price	$21.00
Rate for Payer: Cash Price	$21.00
Rate for Payer: Celtic Commercial/Exchange	$12.94
Rate for Payer: Health Partners Plans Commercial	$26.60
Rate for Payer: UnitedHealthcare Commercial	$27.16
Rate for Payer: WPPA Commercial	$23.52

LACERATION TRAY

Facility

$33.00

Hospital Charge Code	2708011
Hospital Revenue Code	270
Min. Negotiated Rate	$27.06
Max. Negotiated Rate	$32.01
Rate for Payer: Cash Price	$24.75
Rate for Payer: Health Partners Plans Commercial	$31.35
Rate for Payer: UnitedHealthcare Commercial	$32.01
Rate for Payer: WPPA Commercial	$27.06

LACERATION TRAY

Facility

$33.00

Hospital Charge Code	2708011
Hospital Revenue Code	270
Min. Negotiated Rate	$15.25
Max. Negotiated Rate	$32.01
Rate for Payer: Cash Price	$24.75
Rate for Payer: Celtic Commercial/Exchange	$15.25
Rate for Payer: Health Partners Plans Commercial	$31.35
Rate for Payer: UnitedHealthcare Commercial	$32.01
Rate for Payer: WPPA Commercial	$27.72

LAC-HYDRIN LOTION (AMMONIUM HYDRATE)

Facility

$54.00

Service Code	NDC 45802052555
Hospital Charge Code	2503852
Hospital Revenue Code	250
Min. Negotiated Rate	$44.28
Max. Negotiated Rate	$52.38
Rate for Payer: Cash Price	$41.03
Rate for Payer: Health Partners Plans Commercial	$51.30
Rate for Payer: UnitedHealthcare Commercial	$52.38
Rate for Payer: WPPA Commercial	$44.28

LAC-HYDRIN LOTION (AMMONIUM HYDRATE)

Facility

$54.00

Service Code	NDC 45802052555
Hospital Charge Code	2503852
Hospital Revenue Code	250
Min. Negotiated Rate	$24.95
Max. Negotiated Rate	$52.38
Rate for Payer: Cash Price	$41.03
Rate for Payer: Celtic Commercial/Exchange	$24.95
Rate for Payer: Health Partners Plans Commercial	$51.30
Rate for Payer: UnitedHealthcare Commercial	$52.38
Rate for Payer: WPPA Commercial	$45.36

LACTATE DEHYDROGENASE(LD)(LDH)

Facility

$63.00

Service Code	HCPCS 83615
Hospital Charge Code	8361500
Hospital Revenue Code	301
Min. Negotiated Rate	$22.78
Max. Negotiated Rate	$61.11
Rate for Payer: BCBS Commercial	$22.78
Rate for Payer: Cash Price	$47.25
Rate for Payer: Cash Price	$47.25
Rate for Payer: Celtic Commercial/Exchange	$29.11
Rate for Payer: Health Partners Plans Commercial	$59.85
Rate for Payer: UnitedHealthcare Commercial	$61.11
Rate for Payer: WPPA Commercial	$52.92

LACTATE DEHYDROGENASE(LD)(LDH)

Facility

$63.00

Service Code	HCPCS 83615
Hospital Charge Code	8361500
Hospital Revenue Code	301
Min. Negotiated Rate	$51.66
Max. Negotiated Rate	$61.11
Rate for Payer: Cash Price	$47.25
Rate for Payer: Health Partners Plans Commercial	$59.85
Rate for Payer: UnitedHealthcare Commercial	$61.11
Rate for Payer: WPPA Commercial	$51.66

LACTATED RINGERS 1000ML IV

Facility

$100.00

Service Code	HCPCS J7120
Hospital Charge Code	2580405
Hospital Revenue Code	258
Min. Negotiated Rate	$2.96
Max. Negotiated Rate	$97.00
Rate for Payer: BCBS Commercial	$2.96
Rate for Payer: Cash Price	$75.00
Rate for Payer: Cash Price	$75.00
Rate for Payer: Celtic Commercial/Exchange	$46.20
Rate for Payer: Health Partners Plans Commercial	$95.00
Rate for Payer: UnitedHealthcare Commercial	$97.00
Rate for Payer: WPPA Commercial	$84.00

LACTATED RINGERS 1000ML IV

Facility

$100.00

Service Code	HCPCS J7120
Hospital Charge Code	2580405
Hospital Revenue Code	258
Min. Negotiated Rate	$82.00
Max. Negotiated Rate	$97.00
Rate for Payer: Cash Price	$75.00
Rate for Payer: Health Partners Plans Commercial	$95.00
Rate for Payer: UnitedHealthcare Commercial	$97.00
Rate for Payer: WPPA Commercial	$82.00

LACTATED RINGERS 500CC IV

Facility

$63.00

Service Code	HCPCS J7120
Hospital Charge Code	2580728
Hospital Revenue Code	636
Min. Negotiated Rate	$51.66
Max. Negotiated Rate	$61.11
Rate for Payer: Cash Price	$47.55
Rate for Payer: Health Partners Plans Commercial	$59.85
Rate for Payer: UnitedHealthcare Commercial	$61.11
Rate for Payer: WPPA Commercial	$51.66

LACTATED RINGERS 500CC IV

Facility

$63.00

Service Code	HCPCS J7120
Hospital Charge Code	2580728
Hospital Revenue Code	636
Min. Negotiated Rate	$2.96
Max. Negotiated Rate	$61.11
Rate for Payer: BCBS Commercial	$2.96
Rate for Payer: Cash Price	$47.55
Rate for Payer: Cash Price	$47.55
Rate for Payer: Celtic Commercial/Exchange	$29.11
Rate for Payer: Health Partners Plans Commercial	$59.85
Rate for Payer: UnitedHealthcare Commercial	$61.11
Rate for Payer: WPPA Commercial	$52.92

LACTATE (LACTIC ACID)

Facility

$137.00

Service Code	HCPCS 83605
Hospital Charge Code	8360500
Hospital Revenue Code	301
Min. Negotiated Rate	$47.35
Max. Negotiated Rate	$132.89
Rate for Payer: BCBS Commercial	$47.35
Rate for Payer: Cash Price	$102.75
Rate for Payer: Cash Price	$102.75
Rate for Payer: Celtic Commercial/Exchange	$63.29
Rate for Payer: Health Partners Plans Commercial	$130.15
Rate for Payer: UnitedHealthcare Commercial	$132.89
Rate for Payer: WPPA Commercial	$115.08

LACTATE (LACTIC ACID)

Facility

$137.00

Service Code	HCPCS 83605
Hospital Charge Code	8360500
Hospital Revenue Code	301
Min. Negotiated Rate	$112.34
Max. Negotiated Rate	$132.89
Rate for Payer: Cash Price	$102.75
Rate for Payer: Health Partners Plans Commercial	$130.15
Rate for Payer: UnitedHealthcare Commercial	$132.89
Rate for Payer: WPPA Commercial	$112.34

LACTOFERRIN, FECAL; QUANTITATIVE

Facility

$68.00

Service Code	HCPCS 83631
Hospital Charge Code	8363100
Hospital Revenue Code	301
Min. Negotiated Rate	$31.42
Max. Negotiated Rate	$65.96
Rate for Payer: BCBS Commercial	$42.12
Rate for Payer: Cash Price	$51.00
Rate for Payer: Cash Price	$51.00
Rate for Payer: Celtic Commercial/Exchange	$31.42
Rate for Payer: Health Partners Plans Commercial	$64.60
Rate for Payer: UnitedHealthcare Commercial	$65.96
Rate for Payer: WPPA Commercial	$57.12

LACTOFERRIN, FECAL; QUANTITATIVE

Facility

$68.00

Service Code	HCPCS 83631
Hospital Charge Code	8363100
Hospital Revenue Code	301
Min. Negotiated Rate	$55.76
Max. Negotiated Rate	$65.96
Rate for Payer: Cash Price	$51.00
Rate for Payer: Health Partners Plans Commercial	$64.60
Rate for Payer: UnitedHealthcare Commercial	$65.96
Rate for Payer: WPPA Commercial	$55.76

LACTULOSE 20 GM/30 ML OS U.D.

Facility

$8.00

Service Code	NDC 00121115430
Hospital Charge Code	2512622
Hospital Revenue Code	250
Min. Negotiated Rate	$3.70
Max. Negotiated Rate	$7.76
Rate for Payer: Cash Price	$6.71
Rate for Payer: Celtic Commercial/Exchange	$3.70
Rate for Payer: Health Partners Plans Commercial	$7.60
Rate for Payer: UnitedHealthcare Commercial	$7.76
Rate for Payer: WPPA Commercial	$6.72

LACTULOSE 20 GM/30 ML OS U.D.

Facility

$8.00

Service Code	NDC 00121115430
Hospital Charge Code	2512622
Hospital Revenue Code	250
Min. Negotiated Rate	$6.56
Max. Negotiated Rate	$7.76
Rate for Payer: Cash Price	$6.71
Rate for Payer: Health Partners Plans Commercial	$7.60
Rate for Payer: UnitedHealthcare Commercial	$7.76
Rate for Payer: WPPA Commercial	$6.56

LAMISIL CREAM 15 GM tube (TERBINATINE HYDROCHLORIDE)

Facility

$36.00

Service Code	NDC 24385052405
Hospital Charge Code	2503878
Hospital Revenue Code	250
Min. Negotiated Rate	$29.52
Max. Negotiated Rate	$34.92
Rate for Payer: Cash Price	$27.49
Rate for Payer: Health Partners Plans Commercial	$34.20
Rate for Payer: UnitedHealthcare Commercial	$34.92
Rate for Payer: WPPA Commercial	$29.52

LAMISIL CREAM 15 GM tube (TERBINATINE HYDROCHLORIDE)

Facility

$36.00

Service Code	NDC 24385052405
Hospital Charge Code	2503878
Hospital Revenue Code	250
Min. Negotiated Rate	$16.63
Max. Negotiated Rate	$34.92
Rate for Payer: Cash Price	$27.49
Rate for Payer: Celtic Commercial/Exchange	$16.63
Rate for Payer: Health Partners Plans Commercial	$34.20
Rate for Payer: UnitedHealthcare Commercial	$34.92
Rate for Payer: WPPA Commercial	$30.24

LAMOTRIGINE

Facility

$75.00

Service Code	HCPCS 80175
Hospital Charge Code	8017500
Hospital Revenue Code	301
Min. Negotiated Rate	$34.65
Max. Negotiated Rate	$72.75
Rate for Payer: BCBS Commercial	$36.45
Rate for Payer: Cash Price	$56.25
Rate for Payer: Cash Price	$56.25
Rate for Payer: Celtic Commercial/Exchange	$34.65
Rate for Payer: Health Partners Plans Commercial	$71.25
Rate for Payer: UnitedHealthcare Commercial	$72.75
Rate for Payer: WPPA Commercial	$63.00

LAMOTRIGINE

Facility

$75.00

Service Code	HCPCS 80175
Hospital Charge Code	8017500
Hospital Revenue Code	301
Min. Negotiated Rate	$61.50
Max. Negotiated Rate	$72.75
Rate for Payer: Cash Price	$56.25
Rate for Payer: Health Partners Plans Commercial	$71.25
Rate for Payer: UnitedHealthcare Commercial	$72.75
Rate for Payer: WPPA Commercial	$61.50

LAMOTRIGINE (LAMCIL)

Facility

$108.00

Service Code	HCPCS 80299
Hospital Charge Code	8029911
Hospital Revenue Code	301
Min. Negotiated Rate	$49.90
Max. Negotiated Rate	$104.76
Rate for Payer: BCBS Commercial	$65.71
Rate for Payer: Cash Price	$81.00
Rate for Payer: Cash Price	$81.00
Rate for Payer: Celtic Commercial/Exchange	$49.90
Rate for Payer: Health Partners Plans Commercial	$102.60
Rate for Payer: UnitedHealthcare Commercial	$104.76
Rate for Payer: WPPA Commercial	$90.72

LAMOTRIGINE (LAMCIL)

Facility

$108.00

Service Code	HCPCS 80299
Hospital Charge Code	8029911
Hospital Revenue Code	301
Min. Negotiated Rate	$88.56
Max. Negotiated Rate	$104.76
Rate for Payer: Cash Price	$81.00
Rate for Payer: Health Partners Plans Commercial	$102.60
Rate for Payer: UnitedHealthcare Commercial	$104.76
Rate for Payer: WPPA Commercial	$88.56

Know your out-of-pocket cost for care.

All Charges