Ness County Hospital

All Charges

Charge

Type

Setting

Price

LIDOCAINE 1 % 10 ML INJ.

Facility

$38.00

Service Code	NDC 55150025110
Hospital Charge Code	2508018
Hospital Revenue Code	250
Min. Negotiated Rate	$17.56
Max. Negotiated Rate	$36.86
Rate for Payer: Cash Price	$28.50
Rate for Payer: Celtic Commercial/Exchange	$17.56
Rate for Payer: Health Partners Plans Commercial	$36.10
Rate for Payer: UnitedHealthcare Commercial	$36.86
Rate for Payer: WPPA Commercial	$31.92

LIDOCAINE 1 % 10 ML INJ.

Facility

$38.00

Service Code	NDC 55150025110
Hospital Charge Code	2508018
Hospital Revenue Code	250
Min. Negotiated Rate	$31.16
Max. Negotiated Rate	$36.86
Rate for Payer: Cash Price	$28.50
Rate for Payer: Health Partners Plans Commercial	$36.10
Rate for Payer: UnitedHealthcare Commercial	$36.86
Rate for Payer: WPPA Commercial	$31.16

LIDOCAINE 1% 20 ML INJ. (XYLOCAINE)

Facility

$26.00

Service Code	NDC 00409427601
Hospital Charge Code	2515229
Hospital Revenue Code	250
Min. Negotiated Rate	$12.01
Max. Negotiated Rate	$25.22
Rate for Payer: Cash Price	$19.80
Rate for Payer: Celtic Commercial/Exchange	$12.01
Rate for Payer: Health Partners Plans Commercial	$24.70
Rate for Payer: UnitedHealthcare Commercial	$25.22
Rate for Payer: WPPA Commercial	$21.84

LIDOCAINE 1% 20 ML INJ. (XYLOCAINE)

Facility

$26.00

Service Code	NDC 00409427601
Hospital Charge Code	2515229
Hospital Revenue Code	250
Min. Negotiated Rate	$21.32
Max. Negotiated Rate	$25.22
Rate for Payer: Cash Price	$19.80
Rate for Payer: Health Partners Plans Commercial	$24.70
Rate for Payer: UnitedHealthcare Commercial	$25.22
Rate for Payer: WPPA Commercial	$21.32

LIDOCAINE 1% 2 ML AMP (XYLOCAINE)

Facility

$21.00

Service Code	NDC 00409471332
Hospital Charge Code	2514313
Hospital Revenue Code	250
Min. Negotiated Rate	$17.22
Max. Negotiated Rate	$20.37
Rate for Payer: Cash Price	$16.05
Rate for Payer: Health Partners Plans Commercial	$19.95
Rate for Payer: UnitedHealthcare Commercial	$20.37
Rate for Payer: WPPA Commercial	$17.22

LIDOCAINE 1% 2 ML AMP (XYLOCAINE)

Facility

$21.00

Service Code	NDC 00409471332
Hospital Charge Code	2514313
Hospital Revenue Code	250
Min. Negotiated Rate	$9.70
Max. Negotiated Rate	$20.37
Rate for Payer: Cash Price	$16.05
Rate for Payer: Celtic Commercial/Exchange	$9.70
Rate for Payer: Health Partners Plans Commercial	$19.95
Rate for Payer: UnitedHealthcare Commercial	$20.37
Rate for Payer: WPPA Commercial	$17.64

LIDOCAINE 2% - 100 MG/5 ML INJ. SYR.

Facility

$56.00

Service Code	NDC 76329339001
Hospital Charge Code	2504009
Hospital Revenue Code	250
Min. Negotiated Rate	$25.87
Max. Negotiated Rate	$54.32
Rate for Payer: Cash Price	$42.53
Rate for Payer: Celtic Commercial/Exchange	$25.87
Rate for Payer: Health Partners Plans Commercial	$53.20
Rate for Payer: UnitedHealthcare Commercial	$54.32
Rate for Payer: WPPA Commercial	$47.04

LIDOCAINE 2% - 100 MG/5 ML INJ. SYR.

Facility

$56.00

Service Code	NDC 76329339001
Hospital Charge Code	2504009
Hospital Revenue Code	250
Min. Negotiated Rate	$45.92
Max. Negotiated Rate	$54.32
Rate for Payer: Cash Price	$42.53
Rate for Payer: Health Partners Plans Commercial	$53.20
Rate for Payer: UnitedHealthcare Commercial	$54.32
Rate for Payer: WPPA Commercial	$45.92

LIDOCAINE 2% 10 ML INJ. (XYLOCAINE)

Facility

$13.00

Service Code	NDC 55150025410
Hospital Charge Code	2518066
Hospital Revenue Code	250
Min. Negotiated Rate	$6.01
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$10.27
Rate for Payer: Celtic Commercial/Exchange	$6.01
Rate for Payer: Health Partners Plans Commercial	$12.35
Rate for Payer: UnitedHealthcare Commercial	$12.61
Rate for Payer: WPPA Commercial	$10.92

LIDOCAINE 2% 10 ML INJ. (XYLOCAINE)

Facility

$13.00

Service Code	NDC 55150025410
Hospital Charge Code	2518066
Hospital Revenue Code	250
Min. Negotiated Rate	$10.66
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$10.27
Rate for Payer: Health Partners Plans Commercial	$12.35
Rate for Payer: UnitedHealthcare Commercial	$12.61
Rate for Payer: WPPA Commercial	$10.66

LIDOCAINE 2 GM Premix in D5W IV

Facility

$28.00

Service Code	NDC 00264959410
Hospital Charge Code	2517811
Hospital Revenue Code	250
Min. Negotiated Rate	$22.96
Max. Negotiated Rate	$27.16
Rate for Payer: Cash Price	$21.08
Rate for Payer: Health Partners Plans Commercial	$26.60
Rate for Payer: UnitedHealthcare Commercial	$27.16
Rate for Payer: WPPA Commercial	$22.96

LIDOCAINE 2 GM Premix in D5W IV

Facility

$28.00

Service Code	NDC 00264959410
Hospital Charge Code	2517811
Hospital Revenue Code	250
Min. Negotiated Rate	$12.94
Max. Negotiated Rate	$27.16
Rate for Payer: Cash Price	$21.08
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

LIDOCAINE HCL 4% TOP SOLN.

Facility

$211.00

Service Code	NDC 00527600480
Hospital Charge Code	2519916
Hospital Revenue Code	270
Min. Negotiated Rate	$173.02
Max. Negotiated Rate	$204.67
Rate for Payer: Cash Price	$158.85
Rate for Payer: Health Partners Plans Commercial	$200.45
Rate for Payer: UnitedHealthcare Commercial	$204.67
Rate for Payer: WPPA Commercial	$173.02

LIDOCAINE HCL 4% TOP SOLN.

Facility

$211.00

Service Code	NDC 00527600480
Hospital Charge Code	2519916
Hospital Revenue Code	270
Min. Negotiated Rate	$97.48
Max. Negotiated Rate	$204.67
Rate for Payer: Cash Price	$158.85
Rate for Payer: Celtic Commercial/Exchange	$97.48
Rate for Payer: Health Partners Plans Commercial	$200.45
Rate for Payer: UnitedHealthcare Commercial	$204.67
Rate for Payer: WPPA Commercial	$177.24

LIDOCAINE/PRILOCAINE 2.5 %/2.5 %

Facility

$31.00

Service Code	NDC 00574204230
Hospital Charge Code	2507952
Hospital Revenue Code	270
Min. Negotiated Rate	$14.32
Max. Negotiated Rate	$30.07
Rate for Payer: Cash Price	$23.25
Rate for Payer: Celtic Commercial/Exchange	$14.32
Rate for Payer: Health Partners Plans Commercial	$29.45
Rate for Payer: UnitedHealthcare Commercial	$30.07
Rate for Payer: WPPA Commercial	$26.04

LIDOCAINE/PRILOCAINE 2.5 %/2.5 %

Facility

$31.00

Service Code	NDC 00574204230
Hospital Charge Code	2507952
Hospital Revenue Code	270
Min. Negotiated Rate	$25.42
Max. Negotiated Rate	$30.07
Rate for Payer: Cash Price	$23.25
Rate for Payer: Health Partners Plans Commercial	$29.45
Rate for Payer: UnitedHealthcare Commercial	$30.07
Rate for Payer: WPPA Commercial	$25.42

LIDOCAINE TOP ADHESIVE PATCH

Facility

$211.00

Service Code	NDC 00591352511
Hospital Charge Code	2519916
Hospital Revenue Code	270
Min. Negotiated Rate	$173.02
Max. Negotiated Rate	$204.67
Rate for Payer: Cash Price	$158.85
Rate for Payer: Health Partners Plans Commercial	$200.45
Rate for Payer: UnitedHealthcare Commercial	$204.67
Rate for Payer: WPPA Commercial	$173.02

LIDOCAINE TOP ADHESIVE PATCH

Facility

$211.00

Service Code	NDC 00591352511
Hospital Charge Code	2519916
Hospital Revenue Code	270
Min. Negotiated Rate	$97.48
Max. Negotiated Rate	$204.67
Rate for Payer: Cash Price	$158.85
Rate for Payer: Celtic Commercial/Exchange	$97.48
Rate for Payer: Health Partners Plans Commercial	$200.45
Rate for Payer: UnitedHealthcare Commercial	$204.67
Rate for Payer: WPPA Commercial	$177.24

LIDOCAINE VISCOUS 15 ML U.D. (LIDOCAINE HCL)

Facility

$7.00

Service Code	NDC 50383077517
Hospital Charge Code	2508067
Hospital Revenue Code	250
Min. Negotiated Rate	$3.23
Max. Negotiated Rate	$6.79
Rate for Payer: Cash Price	$5.55
Rate for Payer: Celtic Commercial/Exchange	$3.23
Rate for Payer: Health Partners Plans Commercial	$6.65
Rate for Payer: UnitedHealthcare Commercial	$6.79
Rate for Payer: WPPA Commercial	$5.88

LIDOCAINE VISCOUS 15 ML U.D. (LIDOCAINE HCL)

Facility

$7.00

Service Code	NDC 50383077517
Hospital Charge Code	2508067
Hospital Revenue Code	250
Min. Negotiated Rate	$5.74
Max. Negotiated Rate	$6.79
Rate for Payer: Cash Price	$5.55
Rate for Payer: Health Partners Plans Commercial	$6.65
Rate for Payer: UnitedHealthcare Commercial	$6.79
Rate for Payer: WPPA Commercial	$5.74

Lidocaine Viscous (lidocaine HCl) MM solution

Facility

$39.00

Service Code	NDC 50383077504
Hospital Charge Code	2512721
Hospital Revenue Code	250
Min. Negotiated Rate	$31.98
Max. Negotiated Rate	$37.83
Rate for Payer: Cash Price	$29.70
Rate for Payer: Health Partners Plans Commercial	$37.05
Rate for Payer: UnitedHealthcare Commercial	$37.83
Rate for Payer: WPPA Commercial	$31.98

Lidocaine Viscous (lidocaine HCl) MM solution

Facility

$39.00

Service Code	NDC 50383077504
Hospital Charge Code	2512721
Hospital Revenue Code	250
Min. Negotiated Rate	$18.02
Max. Negotiated Rate	$37.83
Rate for Payer: Cash Price	$29.70
Rate for Payer: Celtic Commercial/Exchange	$18.02
Rate for Payer: Health Partners Plans Commercial	$37.05
Rate for Payer: UnitedHealthcare Commercial	$37.83
Rate for Payer: WPPA Commercial	$32.76

LIDOCAINE W/EPI 1% 20 ML INJ. (XYLOCAINE W/EPI)

Facility

$14.00

Service Code	NDC 00409000701
Hospital Charge Code	2508059
Hospital Revenue Code	250
Min. Negotiated Rate	$6.47
Max. Negotiated Rate	$13.58
Rate for Payer: Cash Price	$10.58
Rate for Payer: Celtic Commercial/Exchange	$6.47
Rate for Payer: Health Partners Plans Commercial	$13.30
Rate for Payer: UnitedHealthcare Commercial	$13.58
Rate for Payer: WPPA Commercial	$11.76

LIDOCAINE W/EPI 1% 20 ML INJ. (XYLOCAINE W/EPI)

Facility

$14.00

Service Code	NDC 00409000701
Hospital Charge Code	2508059
Hospital Revenue Code	250
Min. Negotiated Rate	$11.48
Max. Negotiated Rate	$13.58
Rate for Payer: Cash Price	$10.58
Rate for Payer: Health Partners Plans Commercial	$13.30
Rate for Payer: UnitedHealthcare Commercial	$13.58
Rate for Payer: WPPA Commercial	$11.48

LIDODERM PATCH

Facility

$28.00

Hospital Charge Code	2516896
Hospital Revenue Code	250
Min. Negotiated Rate	$12.94
Max. Negotiated Rate	$27.16
Rate for Payer: Cash Price	$21.08
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

Know your out-of-pocket cost for care.

All Charges