Ness County Hospital

All Charges

Charge

Type

Setting

Price

ALBUMIN SERUM

Facility

$43.00

Service Code	HCPCS 82040
Hospital Charge Code	8204000
Hospital Revenue Code	301
Min. Negotiated Rate	$10.63
Max. Negotiated Rate	$41.71
Rate for Payer: BCBS Commercial	$10.63
Rate for Payer: Cash Price	$32.25
Rate for Payer: Cash Price	$32.25
Rate for Payer: Celtic Commercial/Exchange	$19.87
Rate for Payer: Health Partners Plans Commercial	$40.85
Rate for Payer: UnitedHealthcare Commercial	$41.71
Rate for Payer: WPPA Commercial	$36.12

ALBUMIN SERUM,URINE,MICROALBUM

Facility

$47.00

Service Code	HCPCS 82044
Hospital Charge Code	8204400
Hospital Revenue Code	301
Min. Negotiated Rate	$21.71
Max. Negotiated Rate	$45.59
Rate for Payer: BCBS Commercial	$24.91
Rate for Payer: Cash Price	$35.25
Rate for Payer: Cash Price	$35.25
Rate for Payer: Celtic Commercial/Exchange	$21.71
Rate for Payer: Health Partners Plans Commercial	$44.65
Rate for Payer: UnitedHealthcare Commercial	$45.59
Rate for Payer: WPPA Commercial	$39.48

ALBUMIN SERUM,URINE,MICROALBUM

Facility

$47.00

Service Code	HCPCS 82044
Hospital Charge Code	8204400
Hospital Revenue Code	301
Min. Negotiated Rate	$38.54
Max. Negotiated Rate	$45.59
Rate for Payer: Cash Price	$35.25
Rate for Payer: Health Partners Plans Commercial	$44.65
Rate for Payer: UnitedHealthcare Commercial	$45.59
Rate for Payer: WPPA Commercial	$38.54

ALBUMIN URINE MICROALBUMIN

Facility

$86.00

Service Code	HCPCS 82043
Hospital Charge Code	8204300
Hospital Revenue Code	301
Min. Negotiated Rate	$70.52
Max. Negotiated Rate	$83.42
Rate for Payer: Cash Price	$64.50
Rate for Payer: Health Partners Plans Commercial	$81.70
Rate for Payer: UnitedHealthcare Commercial	$83.42
Rate for Payer: WPPA Commercial	$70.52

ALBUMIN URINE MICROALBUMIN

Facility

$86.00

Service Code	HCPCS 82043
Hospital Charge Code	8204300
Hospital Revenue Code	301
Min. Negotiated Rate	$24.82
Max. Negotiated Rate	$83.42
Rate for Payer: BCBS Commercial	$24.82
Rate for Payer: Cash Price	$64.50
Rate for Payer: Cash Price	$64.50
Rate for Payer: Celtic Commercial/Exchange	$39.73
Rate for Payer: Health Partners Plans Commercial	$81.70
Rate for Payer: UnitedHealthcare Commercial	$83.42
Rate for Payer: WPPA Commercial	$72.24

ALBUTEROL HFA-MDI (VENTOLIN/PROVENTIL) (PROAIR)

Facility

$202.00

Service Code	NDC 66993001968
Hospital Charge Code	2508737
Hospital Revenue Code	250
Min. Negotiated Rate	$165.64
Max. Negotiated Rate	$195.94
Rate for Payer: Cash Price	$151.73
Rate for Payer: Health Partners Plans Commercial	$191.90
Rate for Payer: UnitedHealthcare Commercial	$195.94
Rate for Payer: WPPA Commercial	$165.64

ALBUTEROL HFA-MDI (VENTOLIN/PROVENTIL) (PROAIR)

Facility

$202.00

Service Code	NDC 66993001968
Hospital Charge Code	2508737
Hospital Revenue Code	250
Min. Negotiated Rate	$93.32
Max. Negotiated Rate	$195.94
Rate for Payer: Cash Price	$151.73
Rate for Payer: Celtic Commercial/Exchange	$93.32
Rate for Payer: Health Partners Plans Commercial	$191.90
Rate for Payer: UnitedHealthcare Commercial	$195.94
Rate for Payer: WPPA Commercial	$169.68

ALBUTEROL SYRUP 2 MG/5 ML (VENTOLIN/PROVENTIL)

Facility

$1.00

Service Code	NDC 70752010212
Hospital Charge Code	2514073
Hospital Revenue Code	250
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$1.46
Rate for Payer: Celtic Commercial/Exchange	$0.46
Rate for Payer: Health Partners Plans Commercial	$0.95
Rate for Payer: UnitedHealthcare Commercial	$0.97
Rate for Payer: WPPA Commercial	$0.84

ALBUTEROL SYRUP 2 MG/5 ML (VENTOLIN/PROVENTIL)

Facility

$1.00

Service Code	NDC 70752010212
Hospital Charge Code	2514073
Hospital Revenue Code	250
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$1.46
Rate for Payer: Health Partners Plans Commercial	$0.95
Rate for Payer: UnitedHealthcare Commercial	$0.97
Rate for Payer: WPPA Commercial	$0.82

ALCOHOL BIOMRKR 1 OR 2 SCRN

Facility

$271.00

Service Code	HCPCS 80321
Hospital Charge Code	8032100
Hospital Revenue Code	300
Min. Negotiated Rate	$222.22
Max. Negotiated Rate	$262.87
Rate for Payer: Cash Price	$203.25
Rate for Payer: Health Partners Plans Commercial	$257.45
Rate for Payer: UnitedHealthcare Commercial	$262.87
Rate for Payer: WPPA Commercial	$222.22

ALCOHOL BIOMRKR 1 OR 2 SCRN

Facility

$271.00

Service Code	HCPCS 80321
Hospital Charge Code	8032100
Hospital Revenue Code	300
Min. Negotiated Rate	$46.39
Max. Negotiated Rate	$262.87
Rate for Payer: BCBS Commercial	$46.39
Rate for Payer: Cash Price	$203.25
Rate for Payer: Cash Price	$203.25
Rate for Payer: Celtic Commercial/Exchange	$125.20
Rate for Payer: Health Partners Plans Commercial	$257.45
Rate for Payer: UnitedHealthcare Commercial	$262.87
Rate for Payer: WPPA Commercial	$227.64

ALCOHOL, BREATH

Facility

$71.00

Service Code	HCPCS 82075
Hospital Charge Code	8207500
Hospital Revenue Code	301
Min. Negotiated Rate	$32.80
Max. Negotiated Rate	$68.87
Rate for Payer: BCBS Commercial	$34.51
Rate for Payer: Cash Price	$53.25
Rate for Payer: Cash Price	$53.25
Rate for Payer: Celtic Commercial/Exchange	$32.80
Rate for Payer: Health Partners Plans Commercial	$67.45
Rate for Payer: UnitedHealthcare Commercial	$68.87
Rate for Payer: WPPA Commercial	$59.64

ALCOHOL, BREATH

Facility

$71.00

Service Code	HCPCS 82075
Hospital Charge Code	8207500
Hospital Revenue Code	301
Min. Negotiated Rate	$58.22
Max. Negotiated Rate	$68.87
Rate for Payer: Cash Price	$53.25
Rate for Payer: Health Partners Plans Commercial	$67.45
Rate for Payer: UnitedHealthcare Commercial	$68.87
Rate for Payer: WPPA Commercial	$58.22

ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA

Facility

$5,856.00

Service Code	MSDRG 894
Min. Negotiated Rate	$5,856.00
Max. Negotiated Rate	$5,856.00
Rate for Payer: BCBS Commercial	$5,856.00

ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC

Facility

$18,860.45

Service Code	MSDRG 896
Min. Negotiated Rate	$18,860.45
Max. Negotiated Rate	$18,860.45
Rate for Payer: BCBS Commercial	$18,860.45

ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC

Facility

$8,821.34

Service Code	MSDRG 897
Min. Negotiated Rate	$8,821.34
Max. Negotiated Rate	$8,821.34
Rate for Payer: BCBS Commercial	$8,821.34

ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY

Facility

$16,609.68

Service Code	MSDRG 895
Min. Negotiated Rate	$16,609.68
Max. Negotiated Rate	$16,609.68
Rate for Payer: BCBS Commercial	$16,609.68

ALCOHOL ISOPROPYL 16 OZ

Facility

$4.00

Hospital Charge Code	2503555
Hospital Revenue Code	270
Min. Negotiated Rate	$3.28
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$3.60
Rate for Payer: Health Partners Plans Commercial	$3.80
Rate for Payer: UnitedHealthcare Commercial	$3.88
Rate for Payer: WPPA Commercial	$3.28

ALCOHOL ISOPROPYL 16 OZ

Facility

$4.00

Hospital Charge Code	2503555
Hospital Revenue Code	270
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$3.60
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

ALCOHOLS

Facility

$147.00

Service Code	HCPCS G0480
Hospital Charge Code	8032000
Hospital Revenue Code	300
Min. Negotiated Rate	$67.91
Max. Negotiated Rate	$142.59
Rate for Payer: BCBS Commercial	$73.42
Rate for Payer: Cash Price	$110.25
Rate for Payer: Cash Price	$110.25
Rate for Payer: Celtic Commercial/Exchange	$67.91
Rate for Payer: Health Partners Plans Commercial	$139.65
Rate for Payer: UnitedHealthcare Commercial	$142.59
Rate for Payer: WPPA Commercial	$123.48

ALCOHOLS

Facility

$147.00

Service Code	HCPCS G0480
Hospital Charge Code	8032000
Hospital Revenue Code	300
Min. Negotiated Rate	$120.54
Max. Negotiated Rate	$142.59
Rate for Payer: Cash Price	$110.25
Rate for Payer: Health Partners Plans Commercial	$139.65
Rate for Payer: UnitedHealthcare Commercial	$142.59
Rate for Payer: WPPA Commercial	$120.54

ALDACTONE 25MG TAB(SPIRONOLACTONE)

Facility

$2.00

Service Code	NDC 60687046511
Hospital Charge Code	2500189
Hospital Revenue Code	250
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.91
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

ALDACTONE 25MG TAB(SPIRONOLACTONE)

Facility

$2.00

Service Code	NDC 60687046511
Hospital Charge Code	2500189
Hospital Revenue Code	250
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.91
Rate for Payer: Health Partners Plans Commercial	$1.90
Rate for Payer: UnitedHealthcare Commercial	$1.94
Rate for Payer: WPPA Commercial	$1.64

ALDOLASE

Facility

$60.00

Service Code	HCPCS 82085
Hospital Charge Code	8208500
Hospital Revenue Code	301
Min. Negotiated Rate	$27.72
Max. Negotiated Rate	$58.20
Rate for Payer: BCBS Commercial	$32.21
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Celtic Commercial/Exchange	$27.72
Rate for Payer: Health Partners Plans Commercial	$57.00
Rate for Payer: UnitedHealthcare Commercial	$58.20
Rate for Payer: WPPA Commercial	$50.40

ALDOLASE

Facility

$60.00

Service Code	HCPCS 82085
Hospital Charge Code	8208500
Hospital Revenue Code	301
Min. Negotiated Rate	$49.20
Max. Negotiated Rate	$58.20
Rate for Payer: Cash Price	$45.00
Rate for Payer: Health Partners Plans Commercial	$57.00
Rate for Payer: UnitedHealthcare Commercial	$58.20
Rate for Payer: WPPA Commercial	$49.20

Know your out-of-pocket cost for care.

All Charges