Ness County Hospital

All Charges

Charge

Type

Setting

Price

LORTAB 7.5/325MG/15ML LIQUID

Facility

$17.00

Hospital Charge Code	2518975
Hospital Revenue Code	250
Min. Negotiated Rate	$13.94
Max. Negotiated Rate	$16.49
Rate for Payer: Cash Price	$12.75
Rate for Payer: Health Partners Plans Commercial	$16.15
Rate for Payer: UnitedHealthcare Commercial	$16.49
Rate for Payer: WPPA Commercial	$13.94

LORTAB 7.5/325MG/15ML LIQUID

Facility

$17.00

Hospital Charge Code	2518975
Hospital Revenue Code	250
Min. Negotiated Rate	$7.85
Max. Negotiated Rate	$16.49
Rate for Payer: Cash Price	$12.75
Rate for Payer: Celtic Commercial/Exchange	$7.85
Rate for Payer: Health Partners Plans Commercial	$16.15
Rate for Payer: UnitedHealthcare Commercial	$16.49
Rate for Payer: WPPA Commercial	$14.28

LORTAB 7.5/325 MG TAB (HYDROCODONE/ACE) (NORCO)

Facility

$2.00

Service Code	NDC 60687040711
Hospital Charge Code	2517001
Hospital Revenue Code	250
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.99
Rate for Payer: Health Partners Plans Commercial	$1.90
Rate for Payer: UnitedHealthcare Commercial	$1.94
Rate for Payer: WPPA Commercial	$1.64

LORTAB 7.5/325 MG TAB (HYDROCODONE/ACE) (NORCO)

Facility

$2.00

Service Code	NDC 60687040711
Hospital Charge Code	2517001
Hospital Revenue Code	250
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.99
Rate for Payer: Celtic Commercial/Exchange	$0.92
Rate for Payer: Health Partners Plans Commercial	$1.90
Rate for Payer: UnitedHealthcare Commercial	$1.94
Rate for Payer: WPPA Commercial	$1.68

LOTENSIN 10 MG TAB (BENAZEPRIL HCL)

Facility

$15.00

Service Code	NDC 50268011015
Hospital Charge Code	2511608
Hospital Revenue Code	250
Min. Negotiated Rate	$12.30
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$11.25
Rate for Payer: Health Partners Plans Commercial	$14.25
Rate for Payer: UnitedHealthcare Commercial	$14.55
Rate for Payer: WPPA Commercial	$12.30

LOTENSIN 10 MG TAB (BENAZEPRIL HCL)

Facility

$15.00

Service Code	NDC 50268011015
Hospital Charge Code	2511608
Hospital Revenue Code	250
Min. Negotiated Rate	$6.93
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$11.25
Rate for Payer: Celtic Commercial/Exchange	$6.93
Rate for Payer: Health Partners Plans Commercial	$14.25
Rate for Payer: UnitedHealthcare Commercial	$14.55
Rate for Payer: WPPA Commercial	$12.60

LOTRIMIN CREAM 1% - 1 oz. tube (CLOTRIMAZOLE)

Facility

$27.00

Service Code	NDC 24385020503
Hospital Charge Code	2510550
Hospital Revenue Code	250
Min. Negotiated Rate	$12.47
Max. Negotiated Rate	$26.19
Rate for Payer: Cash Price	$20.25
Rate for Payer: Celtic Commercial/Exchange	$12.47
Rate for Payer: Health Partners Plans Commercial	$25.65
Rate for Payer: UnitedHealthcare Commercial	$26.19
Rate for Payer: WPPA Commercial	$22.68

LOTRIMIN CREAM 1% - 1 oz. tube (CLOTRIMAZOLE)

Facility

$27.00

Service Code	NDC 24385020503
Hospital Charge Code	2510550
Hospital Revenue Code	250
Min. Negotiated Rate	$22.14
Max. Negotiated Rate	$26.19
Rate for Payer: Cash Price	$20.25
Rate for Payer: Health Partners Plans Commercial	$25.65
Rate for Payer: UnitedHealthcare Commercial	$26.19
Rate for Payer: WPPA Commercial	$22.14

LOTRISONE CREAM - 15 GM tube (CLOTRIMAZOLE & BETAMETHASONE DIPROPRIONATE)

Facility

$168.00

Service Code	NDC 68462029817
Hospital Charge Code	2511699
Hospital Revenue Code	250
Min. Negotiated Rate	$137.76
Max. Negotiated Rate	$162.96
Rate for Payer: Cash Price	$126.45
Rate for Payer: Health Partners Plans Commercial	$159.60
Rate for Payer: UnitedHealthcare Commercial	$162.96
Rate for Payer: WPPA Commercial	$137.76

LOTRISONE CREAM - 15 GM tube (CLOTRIMAZOLE & BETAMETHASONE DIPROPRIONATE)

Facility

$168.00

Service Code	NDC 68462029817
Hospital Charge Code	2511699
Hospital Revenue Code	250
Min. Negotiated Rate	$77.62
Max. Negotiated Rate	$162.96
Rate for Payer: Cash Price	$126.45
Rate for Payer: Celtic Commercial/Exchange	$77.62
Rate for Payer: Health Partners Plans Commercial	$159.60
Rate for Payer: UnitedHealthcare Commercial	$162.96
Rate for Payer: WPPA Commercial	$141.12

LOVENOX 100 MG/ML INJ. (ENOXAPARIN)

Facility

$297.00

Service Code	NDC 00548560800
Hospital Charge Code	2513323
Hospital Revenue Code	250
Min. Negotiated Rate	$243.54
Max. Negotiated Rate	$288.09
Rate for Payer: Cash Price	$223.27
Rate for Payer: Health Partners Plans Commercial	$282.15
Rate for Payer: UnitedHealthcare Commercial	$288.09
Rate for Payer: WPPA Commercial	$243.54

LOVENOX 100 MG/ML INJ. (ENOXAPARIN)

Facility

$297.00

Service Code	NDC 00548560800
Hospital Charge Code	2513323
Hospital Revenue Code	250
Min. Negotiated Rate	$137.21
Max. Negotiated Rate	$288.09
Rate for Payer: Cash Price	$223.27
Rate for Payer: Celtic Commercial/Exchange	$137.21
Rate for Payer: Health Partners Plans Commercial	$282.15
Rate for Payer: UnitedHealthcare Commercial	$288.09
Rate for Payer: WPPA Commercial	$249.48

LOVENOX 110MG/1.1 ML INJ.

Facility

$327.00

Hospital Charge Code	2517787
Hospital Revenue Code	250
Min. Negotiated Rate	$268.14
Max. Negotiated Rate	$317.19
Rate for Payer: Cash Price	$245.59
Rate for Payer: Health Partners Plans Commercial	$310.65
Rate for Payer: UnitedHealthcare Commercial	$317.19
Rate for Payer: WPPA Commercial	$268.14

LOVENOX 110MG/1.1 ML INJ.

Facility

$327.00

Hospital Charge Code	2517787
Hospital Revenue Code	250
Min. Negotiated Rate	$151.07
Max. Negotiated Rate	$317.19
Rate for Payer: Cash Price	$245.59
Rate for Payer: Celtic Commercial/Exchange	$151.07
Rate for Payer: Health Partners Plans Commercial	$310.65
Rate for Payer: UnitedHealthcare Commercial	$317.19
Rate for Payer: WPPA Commercial	$274.68

LOVENOX 120MG/1.2ML INJ

Facility

$357.00

Hospital Charge Code	2514487
Hospital Revenue Code	250
Min. Negotiated Rate	$292.74
Max. Negotiated Rate	$346.29
Rate for Payer: Cash Price	$267.90
Rate for Payer: Health Partners Plans Commercial	$339.15
Rate for Payer: UnitedHealthcare Commercial	$346.29
Rate for Payer: WPPA Commercial	$292.74

LOVENOX 120MG/1.2ML INJ

Facility

$357.00

Hospital Charge Code	2514487
Hospital Revenue Code	250
Min. Negotiated Rate	$164.93
Max. Negotiated Rate	$346.29
Rate for Payer: Cash Price	$267.90
Rate for Payer: Celtic Commercial/Exchange	$164.93
Rate for Payer: Health Partners Plans Commercial	$339.15
Rate for Payer: UnitedHealthcare Commercial	$346.29
Rate for Payer: WPPA Commercial	$299.88

LOVENOX 130MG/1.3 ML

Facility

$387.00

Hospital Charge Code	2516813
Hospital Revenue Code	250
Min. Negotiated Rate	$178.79
Max. Negotiated Rate	$375.39
Rate for Payer: Cash Price	$290.25
Rate for Payer: Celtic Commercial/Exchange	$178.79
Rate for Payer: Health Partners Plans Commercial	$367.65
Rate for Payer: UnitedHealthcare Commercial	$375.39
Rate for Payer: WPPA Commercial	$325.08

LOVENOX 130MG/1.3 ML

Facility

$387.00

Hospital Charge Code	2516813
Hospital Revenue Code	250
Min. Negotiated Rate	$317.34
Max. Negotiated Rate	$375.39
Rate for Payer: Cash Price	$290.25
Rate for Payer: Health Partners Plans Commercial	$367.65
Rate for Payer: UnitedHealthcare Commercial	$375.39
Rate for Payer: WPPA Commercial	$317.34

LOVENOX 150MG 1.5ML

Facility

$446.00

Hospital Charge Code	2517945
Hospital Revenue Code	250
Min. Negotiated Rate	$365.72
Max. Negotiated Rate	$432.62
Rate for Payer: Cash Price	$334.91
Rate for Payer: Health Partners Plans Commercial	$423.70
Rate for Payer: UnitedHealthcare Commercial	$432.62
Rate for Payer: WPPA Commercial	$365.72

LOVENOX 150MG 1.5ML

Facility

$446.00

Hospital Charge Code	2517945
Hospital Revenue Code	250
Min. Negotiated Rate	$206.05
Max. Negotiated Rate	$432.62
Rate for Payer: Cash Price	$334.91
Rate for Payer: Celtic Commercial/Exchange	$206.05
Rate for Payer: Health Partners Plans Commercial	$423.70
Rate for Payer: UnitedHealthcare Commercial	$432.62
Rate for Payer: WPPA Commercial	$374.64

LOVENOX 160MG

Facility

$476.00

Hospital Charge Code	2516862
Hospital Revenue Code	250
Min. Negotiated Rate	$219.91
Max. Negotiated Rate	$461.72
Rate for Payer: Cash Price	$357.22
Rate for Payer: Celtic Commercial/Exchange	$219.91
Rate for Payer: Health Partners Plans Commercial	$452.20
Rate for Payer: UnitedHealthcare Commercial	$461.72
Rate for Payer: WPPA Commercial	$399.84

LOVENOX 160MG

Facility

$476.00

Hospital Charge Code	2516862
Hospital Revenue Code	250
Min. Negotiated Rate	$390.32
Max. Negotiated Rate	$461.72
Rate for Payer: Cash Price	$357.22
Rate for Payer: Health Partners Plans Commercial	$452.20
Rate for Payer: UnitedHealthcare Commercial	$461.72
Rate for Payer: WPPA Commercial	$390.32

LOVENOX 170MG/1.7ML

Facility

$506.00

Hospital Charge Code	2516631
Hospital Revenue Code	250
Min. Negotiated Rate	$414.92
Max. Negotiated Rate	$490.82
Rate for Payer: Cash Price	$379.58
Rate for Payer: Health Partners Plans Commercial	$480.70
Rate for Payer: UnitedHealthcare Commercial	$490.82
Rate for Payer: WPPA Commercial	$414.92

LOVENOX 170MG/1.7ML

Facility

$506.00

Hospital Charge Code	2516631
Hospital Revenue Code	250
Min. Negotiated Rate	$233.77
Max. Negotiated Rate	$490.82
Rate for Payer: Cash Price	$379.58
Rate for Payer: Celtic Commercial/Exchange	$233.77
Rate for Payer: Health Partners Plans Commercial	$480.70
Rate for Payer: UnitedHealthcare Commercial	$490.82
Rate for Payer: WPPA Commercial	$425.04

LOVENOX 180 MG/1.8 ML

Facility

$535.00

Hospital Charge Code	2516649
Hospital Revenue Code	250
Min. Negotiated Rate	$438.70
Max. Negotiated Rate	$518.95
Rate for Payer: Cash Price	$401.89
Rate for Payer: Health Partners Plans Commercial	$508.25
Rate for Payer: UnitedHealthcare Commercial	$518.95
Rate for Payer: WPPA Commercial	$438.70

Know your out-of-pocket cost for care.

All Charges