Ness County Hospital

All Charges

Charge

Type

Setting

Price

LOVENOX 180 MG/1.8 ML

Facility

$535.00

Hospital Charge Code	2516649
Hospital Revenue Code	250
Min. Negotiated Rate	$247.17
Max. Negotiated Rate	$518.95
Rate for Payer: Cash Price	$401.89
Rate for Payer: Celtic Commercial/Exchange	$247.17
Rate for Payer: Health Partners Plans Commercial	$508.25
Rate for Payer: UnitedHealthcare Commercial	$518.95
Rate for Payer: WPPA Commercial	$449.40

LOVENOX 190 MG/ 1.9 ML INJ.

Facility

$565.00

Hospital Charge Code	2517779
Hospital Revenue Code	250
Min. Negotiated Rate	$261.03
Max. Negotiated Rate	$548.05
Rate for Payer: Cash Price	$424.20
Rate for Payer: Celtic Commercial/Exchange	$261.03
Rate for Payer: Health Partners Plans Commercial	$536.75
Rate for Payer: UnitedHealthcare Commercial	$548.05
Rate for Payer: WPPA Commercial	$474.60

LOVENOX 190 MG/ 1.9 ML INJ.

Facility

$565.00

Hospital Charge Code	2517779
Hospital Revenue Code	250
Min. Negotiated Rate	$463.30
Max. Negotiated Rate	$548.05
Rate for Payer: Cash Price	$424.20
Rate for Payer: Health Partners Plans Commercial	$536.75
Rate for Payer: UnitedHealthcare Commercial	$548.05
Rate for Payer: WPPA Commercial	$463.30

LOVENOX 225 MG (2.25 ML)

Facility

$669.00

Hospital Charge Code	2519114
Hospital Revenue Code	250
Min. Negotiated Rate	$548.58
Max. Negotiated Rate	$648.93
Rate for Payer: Cash Price	$502.35
Rate for Payer: Health Partners Plans Commercial	$635.55
Rate for Payer: UnitedHealthcare Commercial	$648.93
Rate for Payer: WPPA Commercial	$548.58

LOVENOX 225 MG (2.25 ML)

Facility

$669.00

Hospital Charge Code	2519114
Hospital Revenue Code	250
Min. Negotiated Rate	$309.08
Max. Negotiated Rate	$648.93
Rate for Payer: Cash Price	$502.35
Rate for Payer: Celtic Commercial/Exchange	$309.08
Rate for Payer: Health Partners Plans Commercial	$635.55
Rate for Payer: UnitedHealthcare Commercial	$648.93
Rate for Payer: WPPA Commercial	$561.96

LOVENOX 30 MG/0.3 ML INJ

Facility

$89.00

Hospital Charge Code	2516573
Hospital Revenue Code	250
Min. Negotiated Rate	$41.12
Max. Negotiated Rate	$86.33
Rate for Payer: Cash Price	$66.97
Rate for Payer: Celtic Commercial/Exchange	$41.12
Rate for Payer: Health Partners Plans Commercial	$84.55
Rate for Payer: UnitedHealthcare Commercial	$86.33
Rate for Payer: WPPA Commercial	$74.76

LOVENOX 30 MG/0.3 ML INJ

Facility

$89.00

Hospital Charge Code	2516573
Hospital Revenue Code	250
Min. Negotiated Rate	$72.98
Max. Negotiated Rate	$86.33
Rate for Payer: Cash Price	$66.97
Rate for Payer: Health Partners Plans Commercial	$84.55
Rate for Payer: UnitedHealthcare Commercial	$86.33
Rate for Payer: WPPA Commercial	$72.98

LOVENOX 40MG/0.4ML INJ

Facility

$119.00

Hospital Charge Code	2511244
Hospital Revenue Code	250
Min. Negotiated Rate	$54.98
Max. Negotiated Rate	$115.43
Rate for Payer: Cash Price	$89.32
Rate for Payer: Celtic Commercial/Exchange	$54.98
Rate for Payer: Health Partners Plans Commercial	$113.05
Rate for Payer: UnitedHealthcare Commercial	$115.43
Rate for Payer: WPPA Commercial	$99.96

LOVENOX 40MG/0.4ML INJ

Facility

$119.00

Hospital Charge Code	2511244
Hospital Revenue Code	250
Min. Negotiated Rate	$97.58
Max. Negotiated Rate	$115.43
Rate for Payer: Cash Price	$89.32
Rate for Payer: Health Partners Plans Commercial	$113.05
Rate for Payer: UnitedHealthcare Commercial	$115.43
Rate for Payer: WPPA Commercial	$97.58

LOVENOX 50MG (O.5 ML)

Facility

$148.00

Hospital Charge Code	2513643
Hospital Revenue Code	250
Min. Negotiated Rate	$68.38
Max. Negotiated Rate	$143.56
Rate for Payer: Cash Price	$111.64
Rate for Payer: Celtic Commercial/Exchange	$68.38
Rate for Payer: Health Partners Plans Commercial	$140.60
Rate for Payer: UnitedHealthcare Commercial	$143.56
Rate for Payer: WPPA Commercial	$124.32

LOVENOX 50MG (O.5 ML)

Facility

$148.00

Hospital Charge Code	2513643
Hospital Revenue Code	250
Min. Negotiated Rate	$121.36
Max. Negotiated Rate	$143.56
Rate for Payer: Cash Price	$111.64
Rate for Payer: Health Partners Plans Commercial	$140.60
Rate for Payer: UnitedHealthcare Commercial	$143.56
Rate for Payer: WPPA Commercial	$121.36

LOVENOX 60MG/0.6ML INJ

Facility

$178.00

Hospital Charge Code	2514107
Hospital Revenue Code	250
Min. Negotiated Rate	$145.96
Max. Negotiated Rate	$172.66
Rate for Payer: Cash Price	$133.95
Rate for Payer: Health Partners Plans Commercial	$169.10
Rate for Payer: UnitedHealthcare Commercial	$172.66
Rate for Payer: WPPA Commercial	$145.96

LOVENOX 60MG/0.6ML INJ

Facility

$178.00

Hospital Charge Code	2514107
Hospital Revenue Code	250
Min. Negotiated Rate	$82.24
Max. Negotiated Rate	$172.66
Rate for Payer: Cash Price	$133.95
Rate for Payer: Celtic Commercial/Exchange	$82.24
Rate for Payer: Health Partners Plans Commercial	$169.10
Rate for Payer: UnitedHealthcare Commercial	$172.66
Rate for Payer: WPPA Commercial	$149.52

LOVENOX 70MG (0.7 ML)

Facility

$208.00

Hospital Charge Code	2509994
Hospital Revenue Code	250
Min. Negotiated Rate	$96.10
Max. Negotiated Rate	$201.76
Rate for Payer: Cash Price	$156.28
Rate for Payer: Celtic Commercial/Exchange	$96.10
Rate for Payer: Health Partners Plans Commercial	$197.60
Rate for Payer: UnitedHealthcare Commercial	$201.76
Rate for Payer: WPPA Commercial	$174.72

LOVENOX 70MG (0.7 ML)

Facility

$208.00

Hospital Charge Code	2509994
Hospital Revenue Code	250
Min. Negotiated Rate	$170.56
Max. Negotiated Rate	$201.76
Rate for Payer: Cash Price	$156.28
Rate for Payer: Health Partners Plans Commercial	$197.60
Rate for Payer: UnitedHealthcare Commercial	$201.76
Rate for Payer: WPPA Commercial	$170.56

LOVENOX 80MG/0.8ML INJ

Facility

$238.00

Hospital Charge Code	2514917
Hospital Revenue Code	250
Min. Negotiated Rate	$109.96
Max. Negotiated Rate	$230.86
Rate for Payer: Cash Price	$178.61
Rate for Payer: Celtic Commercial/Exchange	$109.96
Rate for Payer: Health Partners Plans Commercial	$226.10
Rate for Payer: UnitedHealthcare Commercial	$230.86
Rate for Payer: WPPA Commercial	$199.92

LOVENOX 80MG/0.8ML INJ

Facility

$238.00

Hospital Charge Code	2514917
Hospital Revenue Code	250
Min. Negotiated Rate	$195.16
Max. Negotiated Rate	$230.86
Rate for Payer: Cash Price	$178.61
Rate for Payer: Health Partners Plans Commercial	$226.10
Rate for Payer: UnitedHealthcare Commercial	$230.86
Rate for Payer: WPPA Commercial	$195.16

LOVENOX 90MG/0.9ML INJ

Facility

$267.00

Hospital Charge Code	2518012
Hospital Revenue Code	250
Min. Negotiated Rate	$123.35
Max. Negotiated Rate	$258.99
Rate for Payer: Cash Price	$200.92
Rate for Payer: Celtic Commercial/Exchange	$123.35
Rate for Payer: Health Partners Plans Commercial	$253.65
Rate for Payer: UnitedHealthcare Commercial	$258.99
Rate for Payer: WPPA Commercial	$224.28

LOVENOX 90MG/0.9ML INJ

Facility

$267.00

Hospital Charge Code	2518012
Hospital Revenue Code	250
Min. Negotiated Rate	$218.94
Max. Negotiated Rate	$258.99
Rate for Payer: Cash Price	$200.92
Rate for Payer: Health Partners Plans Commercial	$253.65
Rate for Payer: UnitedHealthcare Commercial	$258.99
Rate for Payer: WPPA Commercial	$218.94

LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC

Facility

$20,853.69

Service Code	MSDRG 493
Min. Negotiated Rate	$20,853.69
Max. Negotiated Rate	$20,853.69
Rate for Payer: BCBS Commercial	$20,853.69

LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH MCC

Facility

$30,798.00

Service Code	MSDRG 492
Min. Negotiated Rate	$30,798.00
Max. Negotiated Rate	$30,798.00
Rate for Payer: BCBS Commercial	$30,798.00

LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITHOUT CC/MCC

Facility

$16,434.76

Service Code	MSDRG 494
Min. Negotiated Rate	$16,434.76
Max. Negotiated Rate	$16,434.76
Rate for Payer: BCBS Commercial	$16,434.76

LOWER EXTREMITY INFANT 2 V MIN

Facility

$297.00

Service Code	HCPCS 73592
Hospital Charge Code	3293592
Hospital Revenue Code	320
Min. Negotiated Rate	$137.21
Max. Negotiated Rate	$288.09
Rate for Payer: BCBS Commercial	$138.45
Rate for Payer: Cash Price	$222.75
Rate for Payer: Cash Price	$222.75
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

LOWER EXTREMITY INFANT 2 V MIN

Facility

$297.00

Service Code	HCPCS 73592
Hospital Charge Code	3293592
Hospital Revenue Code	320
Min. Negotiated Rate	$243.54
Max. Negotiated Rate	$288.09
Rate for Payer: Cash Price	$222.75
Rate for Payer: Health Partners Plans Commercial	$282.15
Rate for Payer: UnitedHealthcare Commercial	$288.09
Rate for Payer: WPPA Commercial	$243.54

L-SPINE 2-3 VIEWS

Facility

$351.00

Service Code	HCPCS 72100
Hospital Charge Code	3270012
Hospital Revenue Code	320
Min. Negotiated Rate	$287.82
Max. Negotiated Rate	$340.47
Rate for Payer: Cash Price	$263.25
Rate for Payer: Health Partners Plans Commercial	$333.45
Rate for Payer: UnitedHealthcare Commercial	$340.47
Rate for Payer: WPPA Commercial	$287.82

Know your out-of-pocket cost for care.

All Charges