Ness County Hospital

All Charges

Charge

Type

Setting

Price

FIT APPLIANCE PER DR.ORDER< 5"

Facility

$83.00

Service Code	HCPCS 99201 GP
Hospital Charge Code	4590071
Hospital Revenue Code	761
Min. Negotiated Rate	$38.35
Max. Negotiated Rate	$80.51
Rate for Payer: Cash Price	$62.44
Rate for Payer: Celtic Commercial/Exchange	$38.35
Rate for Payer: Health Partners Plans Commercial	$78.85
Rate for Payer: UnitedHealthcare Commercial	$80.51
Rate for Payer: WPPA Commercial	$69.72

FIT APPLIANCE PER DR.ORDER< 5"

Facility

$83.00

Service Code	HCPCS 99201 GP
Hospital Charge Code	4590071
Hospital Revenue Code	761
Min. Negotiated Rate	$68.06
Max. Negotiated Rate	$80.51
Rate for Payer: Cash Price	$62.44
Rate for Payer: Health Partners Plans Commercial	$78.85
Rate for Payer: UnitedHealthcare Commercial	$80.51
Rate for Payer: WPPA Commercial	$68.06

FLAGYL 250 MG TAB (METRONIDAZOLE)

Facility

$5.00

Service Code	NDC 60687052611
Hospital Charge Code	2502797
Hospital Revenue Code	250
Min. Negotiated Rate	$4.10
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$3.97
Rate for Payer: Health Partners Plans Commercial	$4.75
Rate for Payer: UnitedHealthcare Commercial	$4.85
Rate for Payer: WPPA Commercial	$4.10

FLAGYL 250 MG TAB (METRONIDAZOLE)

Facility

$5.00

Service Code	NDC 60687052611
Hospital Charge Code	2502797
Hospital Revenue Code	250
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$3.97
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

FLAGYL 500 MG PREMIX (METRONIDAZOLE) IV

Facility

$73.00

Service Code	NDC 00409015201
Hospital Charge Code	2515138
Hospital Revenue Code	250
Min. Negotiated Rate	$33.73
Max. Negotiated Rate	$70.81
Rate for Payer: Cash Price	$54.90
Rate for Payer: Celtic Commercial/Exchange	$33.73
Rate for Payer: Health Partners Plans Commercial	$69.35
Rate for Payer: UnitedHealthcare Commercial	$70.81
Rate for Payer: WPPA Commercial	$61.32

FLAGYL 500 MG PREMIX (METRONIDAZOLE) IV

Facility

$73.00

Service Code	NDC 00409015201
Hospital Charge Code	2515138
Hospital Revenue Code	250
Min. Negotiated Rate	$59.86
Max. Negotiated Rate	$70.81
Rate for Payer: Cash Price	$54.90
Rate for Payer: Health Partners Plans Commercial	$69.35
Rate for Payer: UnitedHealthcare Commercial	$70.81
Rate for Payer: WPPA Commercial	$59.86

Fleet Mineral Oil Enema 4.5 oz.

Facility

$7.00

Service Code	NDC 00132030140
Hospital Charge Code	2502805
Hospital Revenue Code	270
Min. Negotiated Rate	$5.74
Max. Negotiated Rate	$6.79
Rate for Payer: Cash Price	$5.62
Rate for Payer: Health Partners Plans Commercial	$6.65
Rate for Payer: UnitedHealthcare Commercial	$6.79
Rate for Payer: WPPA Commercial	$5.74

Fleet Mineral Oil Enema 4.5 oz.

Facility

$7.00

Service Code	NDC 00132030140
Hospital Charge Code	2502805
Hospital Revenue Code	270
Min. Negotiated Rate	$3.23
Max. Negotiated Rate	$6.79
Rate for Payer: Cash Price	$5.62
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

Fleets Enema - Pediatric

Facility

$4.00

Service Code	NDC 00132020220
Hospital Charge Code	2516052
Hospital Revenue Code	270
Min. Negotiated Rate	$3.28
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$3.49
Rate for Payer: Health Partners Plans Commercial	$3.80
Rate for Payer: UnitedHealthcare Commercial	$3.88
Rate for Payer: WPPA Commercial	$3.28

Fleets Enema - Pediatric

Facility

$4.00

Service Code	NDC 00132020220
Hospital Charge Code	2516052
Hospital Revenue Code	270
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$3.49
Rate for Payer: Celtic Commercial/Exchange	$1.85
Rate for Payer: Health Partners Plans Commercial	$3.80
Rate for Payer: UnitedHealthcare Commercial	$3.88
Rate for Payer: WPPA Commercial	$3.36

Fleets Regular Enema 4.5 oz. (saline enema)

Facility

$4.00

Service Code	NDC 00536741551
Hospital Charge Code	2502813
Hospital Revenue Code	270
Min. Negotiated Rate	$3.28
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$3.00
Rate for Payer: Health Partners Plans Commercial	$3.80
Rate for Payer: UnitedHealthcare Commercial	$3.88
Rate for Payer: WPPA Commercial	$3.28

Fleets Regular Enema 4.5 oz. (saline enema)

Facility

$4.00

Service Code	NDC 00536741551
Hospital Charge Code	2502813
Hospital Revenue Code	270
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$3.00
Rate for Payer: Celtic Commercial/Exchange	$1.85
Rate for Payer: Health Partners Plans Commercial	$3.80
Rate for Payer: UnitedHealthcare Commercial	$3.88
Rate for Payer: WPPA Commercial	$3.36

FLEXAGAUZE 1 FT MED SUPPLIES

Facility

$3.00

Hospital Charge Code	2702132
Hospital Revenue Code	270
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.70
Rate for Payer: Celtic Commercial/Exchange	$1.39
Rate for Payer: Health Partners Plans Commercial	$2.85
Rate for Payer: UnitedHealthcare Commercial	$2.91
Rate for Payer: WPPA Commercial	$2.52

FLEXAGAUZE 1 FT MED SUPPLIES

Facility

$3.00

Hospital Charge Code	2702132
Hospital Revenue Code	270
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.70
Rate for Payer: Health Partners Plans Commercial	$2.85
Rate for Payer: UnitedHealthcare Commercial	$2.91
Rate for Payer: WPPA Commercial	$2.46

FLEX COLONOSCOPY-REMOVAL/SNARE

Facility

$1,901.00

Service Code	HCPCS 45385
Hospital Charge Code	4538500
Hospital Revenue Code	761
Min. Negotiated Rate	$878.26
Max. Negotiated Rate	$1,843.97
Rate for Payer: BCBS Commercial	$1,473.85
Rate for Payer: Cash Price	$1,425.75
Rate for Payer: Cash Price	$1,425.75
Rate for Payer: Celtic Commercial/Exchange	$878.26
Rate for Payer: Health Partners Plans Commercial	$1,805.95
Rate for Payer: UnitedHealthcare Commercial	$1,843.97
Rate for Payer: WPPA Commercial	$1,596.84

FLEX COLONOSCOPY-REMOVAL/SNARE

Facility

$1,901.00

Service Code	HCPCS 45385
Hospital Charge Code	4538500
Hospital Revenue Code	761
Min. Negotiated Rate	$1,558.82
Max. Negotiated Rate	$1,843.97
Rate for Payer: Cash Price	$1,425.75
Rate for Payer: Health Partners Plans Commercial	$1,805.95
Rate for Payer: UnitedHealthcare Commercial	$1,843.97
Rate for Payer: WPPA Commercial	$1,558.82

FLEX COLONOSCOPY WITH BIOPSY

Facility

$2,073.00

Service Code	HCPCS 45380
Hospital Charge Code	4538000
Hospital Revenue Code	761
Min. Negotiated Rate	$1,699.86
Max. Negotiated Rate	$2,010.81
Rate for Payer: Cash Price	$1,554.75
Rate for Payer: Health Partners Plans Commercial	$1,969.35
Rate for Payer: UnitedHealthcare Commercial	$2,010.81
Rate for Payer: WPPA Commercial	$1,699.86

FLEX COLONOSCOPY WITH BIOPSY

Facility

$2,073.00

Service Code	HCPCS 45380
Hospital Charge Code	4538000
Hospital Revenue Code	761
Min. Negotiated Rate	$957.73
Max. Negotiated Rate	$2,010.81
Rate for Payer: BCBS Commercial	$1,473.85
Rate for Payer: Cash Price	$1,554.75
Rate for Payer: Cash Price	$1,554.75
Rate for Payer: Celtic Commercial/Exchange	$957.73
Rate for Payer: Health Partners Plans Commercial	$1,969.35
Rate for Payer: UnitedHealthcare Commercial	$2,010.81
Rate for Payer: WPPA Commercial	$1,741.32

FLEXERIL 10 MG TAB (CYCLOBENZAPRINE)

Facility

$4.00

Service Code	NDC 60687055811
Hospital Charge Code	2502821
Hospital Revenue Code	250
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$3.04
Rate for Payer: Celtic Commercial/Exchange	$1.85
Rate for Payer: Health Partners Plans Commercial	$3.80
Rate for Payer: UnitedHealthcare Commercial	$3.88
Rate for Payer: WPPA Commercial	$3.36

FLEXERIL 10 MG TAB (CYCLOBENZAPRINE)

Facility

$4.00

Service Code	NDC 60687055811
Hospital Charge Code	2502821
Hospital Revenue Code	250
Min. Negotiated Rate	$3.28
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$3.04
Rate for Payer: Health Partners Plans Commercial	$3.80
Rate for Payer: UnitedHealthcare Commercial	$3.88
Rate for Payer: WPPA Commercial	$3.28

FLEXIBLE TRACH ADAPTER 22MM

Facility

$15.00

Hospital Charge Code	4100500
Hospital Revenue Code	272
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

FLEXIBLE TRACH ADAPTER 22MM

Facility

$15.00

Hospital Charge Code	4100500
Hospital Revenue Code	272
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

FLOMAX 0.4 MG CAP (TAMSULOSIN)

Facility

$12.00

Service Code	NDC 68084029911
Hospital Charge Code	2503993
Hospital Revenue Code	250
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$11.64
Rate for Payer: Cash Price	$9.49
Rate for Payer: Celtic Commercial/Exchange	$5.54
Rate for Payer: Health Partners Plans Commercial	$11.40
Rate for Payer: UnitedHealthcare Commercial	$11.64
Rate for Payer: WPPA Commercial	$10.08

FLOMAX 0.4 MG CAP (TAMSULOSIN)

Facility

$12.00

Service Code	NDC 68084029911
Hospital Charge Code	2503993
Hospital Revenue Code	250
Min. Negotiated Rate	$9.84
Max. Negotiated Rate	$11.64
Rate for Payer: Cash Price	$9.49
Rate for Payer: Health Partners Plans Commercial	$11.40
Rate for Payer: UnitedHealthcare Commercial	$11.64
Rate for Payer: WPPA Commercial	$9.84

FLONASE NASAL SPRAY (FLUTICASONE PROPIONATE)

Facility

$280.00

Service Code	NDC 60505082901
Hospital Charge Code	2513950
Hospital Revenue Code	250
Min. Negotiated Rate	$129.36
Max. Negotiated Rate	$271.60
Rate for Payer: Cash Price	$210.19
Rate for Payer: Celtic Commercial/Exchange	$129.36
Rate for Payer: Health Partners Plans Commercial	$266.00
Rate for Payer: UnitedHealthcare Commercial	$271.60
Rate for Payer: WPPA Commercial	$235.20

Know your out-of-pocket cost for care.

All Charges