Ness County Hospital

All Charges

Charge

Type

Setting

Price

LIPID PANEL

Facility

$155.00

Service Code	HCPCS 80061
Hospital Charge Code	8006100
Hospital Revenue Code	301
Min. Negotiated Rate	$43.18
Max. Negotiated Rate	$150.35
Rate for Payer: BCBS Commercial	$43.18
Rate for Payer: Cash Price	$116.25
Rate for Payer: Cash Price	$116.25
Rate for Payer: Celtic Commercial/Exchange	$71.61
Rate for Payer: Health Partners Plans Commercial	$147.25
Rate for Payer: UnitedHealthcare Commercial	$150.35
Rate for Payer: WPPA Commercial	$130.20

LIPITOR 10 MG TAB (ATORVASTATIN)

Facility

$16.00

Service Code	NDC 68084009711
Hospital Charge Code	2515591
Hospital Revenue Code	250
Min. Negotiated Rate	$13.12
Max. Negotiated Rate	$15.52
Rate for Payer: Cash Price	$12.15
Rate for Payer: Health Partners Plans Commercial	$15.20
Rate for Payer: UnitedHealthcare Commercial	$15.52
Rate for Payer: WPPA Commercial	$13.12

LIPITOR 10 MG TAB (ATORVASTATIN)

Facility

$16.00

Service Code	NDC 68084009711
Hospital Charge Code	2515591
Hospital Revenue Code	250
Min. Negotiated Rate	$7.39
Max. Negotiated Rate	$15.52
Rate for Payer: Cash Price	$12.15
Rate for Payer: Celtic Commercial/Exchange	$7.39
Rate for Payer: Health Partners Plans Commercial	$15.20
Rate for Payer: UnitedHealthcare Commercial	$15.52
Rate for Payer: WPPA Commercial	$13.44

LIPOPROTEIN BLOOD BY NMR

Facility

$78.00

Service Code	HCPCS 83704
Hospital Charge Code	8370400
Hospital Revenue Code	301
Min. Negotiated Rate	$63.96
Max. Negotiated Rate	$75.66
Rate for Payer: Cash Price	$58.50
Rate for Payer: Health Partners Plans Commercial	$74.10
Rate for Payer: UnitedHealthcare Commercial	$75.66
Rate for Payer: WPPA Commercial	$63.96

LIPOPROTEIN BLOOD BY NMR

Facility

$78.00

Service Code	HCPCS 83704
Hospital Charge Code	8370400
Hospital Revenue Code	301
Min. Negotiated Rate	$36.04
Max. Negotiated Rate	$75.66
Rate for Payer: BCBS Commercial	$40.62
Rate for Payer: Cash Price	$58.50
Rate for Payer: Cash Price	$58.50
Rate for Payer: Celtic Commercial/Exchange	$36.04
Rate for Payer: Health Partners Plans Commercial	$74.10
Rate for Payer: UnitedHealthcare Commercial	$75.66
Rate for Payer: WPPA Commercial	$65.52

LIPOPROTEIN, DIR MSRMNT (HDL)

Facility

$56.00

Service Code	HCPCS 83718
Hospital Charge Code	8371800
Hospital Revenue Code	301
Min. Negotiated Rate	$17.57
Max. Negotiated Rate	$54.32
Rate for Payer: BCBS Commercial	$17.57
Rate for Payer: Cash Price	$42.00
Rate for Payer: Cash Price	$42.00
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

LIPOPROTEIN, DIR MSRMNT (HDL)

Facility

$56.00

Service Code	HCPCS 83718
Hospital Charge Code	8371800
Hospital Revenue Code	301
Min. Negotiated Rate	$45.92
Max. Negotiated Rate	$54.32
Rate for Payer: Cash Price	$42.00
Rate for Payer: Health Partners Plans Commercial	$53.20
Rate for Payer: UnitedHealthcare Commercial	$54.32
Rate for Payer: WPPA Commercial	$45.92

LIPOPROTEIN,DIR MSRMNT-LDL

Facility

$54.00

Service Code	HCPCS 80061
Hospital Charge Code	8372100
Hospital Revenue Code	301
Min. Negotiated Rate	$24.95
Max. Negotiated Rate	$52.38
Rate for Payer: BCBS Commercial	$43.18
Rate for Payer: Cash Price	$40.50
Rate for Payer: Cash Price	$40.50
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

LIPOPROTEIN,DIR MSRMNT-LDL

Facility

$54.00

Service Code	HCPCS 80061
Hospital Charge Code	8372100
Hospital Revenue Code	301
Min. Negotiated Rate	$44.28
Max. Negotiated Rate	$52.38
Rate for Payer: Cash Price	$40.50
Rate for Payer: Health Partners Plans Commercial	$51.30
Rate for Payer: UnitedHealthcare Commercial	$52.38
Rate for Payer: WPPA Commercial	$44.28

LISTERIA ANTIBODY, CF, SERUM

Facility

$58.00

Service Code	HCPCS 86609
Hospital Charge Code	8660900
Hospital Revenue Code	302
Min. Negotiated Rate	$26.80
Max. Negotiated Rate	$56.26
Rate for Payer: BCBS Commercial	$33.65
Rate for Payer: Cash Price	$43.50
Rate for Payer: Cash Price	$43.50
Rate for Payer: Celtic Commercial/Exchange	$26.80
Rate for Payer: Health Partners Plans Commercial	$55.10
Rate for Payer: UnitedHealthcare Commercial	$56.26
Rate for Payer: WPPA Commercial	$48.72

LISTERIA ANTIBODY, CF, SERUM

Facility

$58.00

Service Code	HCPCS 86609
Hospital Charge Code	8660900
Hospital Revenue Code	302
Min. Negotiated Rate	$47.56
Max. Negotiated Rate	$56.26
Rate for Payer: Cash Price	$43.50
Rate for Payer: Health Partners Plans Commercial	$55.10
Rate for Payer: UnitedHealthcare Commercial	$56.26
Rate for Payer: WPPA Commercial	$47.56

LITHIUM

Facility

$84.00

Service Code	HCPCS 80178
Hospital Charge Code	8017800
Hospital Revenue Code	301
Min. Negotiated Rate	$26.44
Max. Negotiated Rate	$81.48
Rate for Payer: BCBS Commercial	$26.44
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cash Price	$63.00
Rate for Payer: Celtic Commercial/Exchange	$38.81
Rate for Payer: Health Partners Plans Commercial	$79.80
Rate for Payer: UnitedHealthcare Commercial	$81.48
Rate for Payer: WPPA Commercial	$70.56

LITHIUM

Facility

$84.00

Service Code	HCPCS 80178
Hospital Charge Code	8017800
Hospital Revenue Code	301
Min. Negotiated Rate	$68.88
Max. Negotiated Rate	$81.48
Rate for Payer: Cash Price	$63.00
Rate for Payer: Health Partners Plans Commercial	$79.80
Rate for Payer: UnitedHealthcare Commercial	$81.48
Rate for Payer: WPPA Commercial	$68.88

Lithium carbonate 150 mg cap

Facility

$5.00

Service Code	NDC 00054852625
Hospital Charge Code	2517852
Hospital Revenue Code	250
Min. Negotiated Rate	$4.10
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$4.24
Rate for Payer: Health Partners Plans Commercial	$4.75
Rate for Payer: UnitedHealthcare Commercial	$4.85
Rate for Payer: WPPA Commercial	$4.10

Lithium carbonate 150 mg cap

Facility

$5.00

Service Code	NDC 00054852625
Hospital Charge Code	2517852
Hospital Revenue Code	250
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$4.24
Rate for Payer: Celtic Commercial/Exchange	$2.31
Rate for Payer: Health Partners Plans Commercial	$4.75
Rate for Payer: UnitedHealthcare Commercial	$4.85
Rate for Payer: WPPA Commercial	$4.20

LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT

Facility

$117,445.52

Service Code	MSDRG 005
Min. Negotiated Rate	$117,445.52
Max. Negotiated Rate	$117,445.52
Rate for Payer: BCBS Commercial	$117,445.52

LIVER TRANSPLANT WITHOUT MCC

Facility

$53,910.95

Service Code	MSDRG 006
Min. Negotiated Rate	$53,910.95
Max. Negotiated Rate	$53,910.95
Rate for Payer: BCBS Commercial	$53,910.95

LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC

Facility

$14,543.14

Service Code	MSDRG 496
Min. Negotiated Rate	$14,543.14
Max. Negotiated Rate	$14,543.14
Rate for Payer: BCBS Commercial	$14,543.14

LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH MCC

Facility

$32,323.71

Service Code	MSDRG 495
Min. Negotiated Rate	$32,323.71
Max. Negotiated Rate	$32,323.71
Rate for Payer: BCBS Commercial	$32,323.71

LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CC/MCC

Facility

$9,891.94

Service Code	MSDRG 497
Min. Negotiated Rate	$9,891.94
Max. Negotiated Rate	$9,891.94
Rate for Payer: BCBS Commercial	$9,891.94

LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITH CC/MCC

Facility

$17,358.45

Service Code	MSDRG 498
Min. Negotiated Rate	$17,358.45
Max. Negotiated Rate	$17,358.45
Rate for Payer: BCBS Commercial	$17,358.45

LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITHOUT CC/MCC

Facility

$8,614.26

Service Code	MSDRG 499
Min. Negotiated Rate	$8,614.26
Max. Negotiated Rate	$8,614.26
Rate for Payer: BCBS Commercial	$8,614.26

LOCOST SKN SUB AP F/N/HF/G>100

Facility

$581.00

Service Code	HCPCS C5277
Hospital Charge Code	C527723
Hospital Revenue Code	761
Min. Negotiated Rate	$268.42
Max. Negotiated Rate	$809.01
Rate for Payer: BCBS Commercial	$809.01
Rate for Payer: Cash Price	$435.75
Rate for Payer: Cash Price	$435.75
Rate for Payer: Celtic Commercial/Exchange	$268.42
Rate for Payer: Health Partners Plans Commercial	$551.95
Rate for Payer: UnitedHealthcare Commercial	$563.57
Rate for Payer: WPPA Commercial	$488.04

LOCOST SKN SUB AP F/N/HF/G>100

Facility

$581.00

Service Code	HCPCS C5277
Hospital Charge Code	C527723
Hospital Revenue Code	761
Min. Negotiated Rate	$476.42
Max. Negotiated Rate	$563.57
Rate for Payer: Cash Price	$435.75
Rate for Payer: Health Partners Plans Commercial	$551.95
Rate for Payer: UnitedHealthcare Commercial	$563.57
Rate for Payer: WPPA Commercial	$476.42

LOCOST SKN SUB AP F/N/HF/G 25

Facility

$581.00

Service Code	HCPCS C5275
Hospital Charge Code	C527523
Hospital Revenue Code	761
Min. Negotiated Rate	$476.42
Max. Negotiated Rate	$563.57
Rate for Payer: Cash Price	$435.75
Rate for Payer: Health Partners Plans Commercial	$551.95
Rate for Payer: UnitedHealthcare Commercial	$563.57
Rate for Payer: WPPA Commercial	$476.42

Know your out-of-pocket cost for care.

All Charges