Ness County Hospital

All Charges

Charge

Type

Setting

Price

ALDOSTERONE

Facility

$217.00

Service Code	HCPCS 82088
Hospital Charge Code	8208800
Hospital Revenue Code	301
Min. Negotiated Rate	$177.94
Max. Negotiated Rate	$210.49
Rate for Payer: Cash Price	$162.75
Rate for Payer: Health Partners Plans Commercial	$206.15
Rate for Payer: UnitedHealthcare Commercial	$210.49
Rate for Payer: WPPA Commercial	$177.94

ALDOSTERONE

Facility

$217.00

Service Code	HCPCS 82088
Hospital Charge Code	8208800
Hospital Revenue Code	301
Min. Negotiated Rate	$100.25
Max. Negotiated Rate	$210.49
Rate for Payer: BCBS Commercial	$123.20
Rate for Payer: Cash Price	$162.75
Rate for Payer: Cash Price	$162.75
Rate for Payer: Celtic Commercial/Exchange	$100.25
Rate for Payer: Health Partners Plans Commercial	$206.15
Rate for Payer: UnitedHealthcare Commercial	$210.49
Rate for Payer: WPPA Commercial	$182.28

ALEVE CAP 220 MG (NAPROXEN SODIUM)

Facility

$1.00

Service Code	NDC 47682023733
Hospital Charge Code	2515682
Hospital Revenue Code	250
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$1.20
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

ALEVE CAP 220 MG (NAPROXEN SODIUM)

Facility

$1.00

Service Code	NDC 47682023733
Hospital Charge Code	2515682
Hospital Revenue Code	250
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$1.20
Rate for Payer: Health Partners Plans Commercial	$0.95
Rate for Payer: UnitedHealthcare Commercial	$0.97
Rate for Payer: WPPA Commercial	$0.82

Alfenta 1000 mcg/2ml amp(alfentanil)

Facility

$31.00

Service Code	NDC 17478006702
Hospital Charge Code	2514941
Hospital Revenue Code	250
Min. Negotiated Rate	$14.32
Max. Negotiated Rate	$30.07
Rate for Payer: Cash Price	$23.89
Rate for Payer: Celtic Commercial/Exchange	$14.32
Rate for Payer: Health Partners Plans Commercial	$29.45
Rate for Payer: UnitedHealthcare Commercial	$30.07
Rate for Payer: WPPA Commercial	$26.04

Alfenta 1000 mcg/2ml amp(alfentanil)

Facility

$31.00

Service Code	NDC 17478006702
Hospital Charge Code	2514941
Hospital Revenue Code	250
Min. Negotiated Rate	$25.42
Max. Negotiated Rate	$30.07
Rate for Payer: Cash Price	$23.89
Rate for Payer: Health Partners Plans Commercial	$29.45
Rate for Payer: UnitedHealthcare Commercial	$30.07
Rate for Payer: WPPA Commercial	$25.42

ALGIDEX AG 6X6

Facility

$53.00

Hospital Charge Code	2720686
Hospital Revenue Code	272
Min. Negotiated Rate	$24.49
Max. Negotiated Rate	$51.41
Rate for Payer: Cash Price	$40.31
Rate for Payer: Celtic Commercial/Exchange	$24.49
Rate for Payer: Health Partners Plans Commercial	$50.35
Rate for Payer: UnitedHealthcare Commercial	$51.41
Rate for Payer: WPPA Commercial	$44.52

ALGIDEX AG 6X6

Facility

$53.00

Hospital Charge Code	2720686
Hospital Revenue Code	272
Min. Negotiated Rate	$43.46
Max. Negotiated Rate	$51.41
Rate for Payer: Cash Price	$40.31
Rate for Payer: Health Partners Plans Commercial	$50.35
Rate for Payer: UnitedHealthcare Commercial	$51.41
Rate for Payer: WPPA Commercial	$43.46

ALGIDEX AG PASTE 10 CC

Facility

$55.00

Hospital Charge Code	2720678
Hospital Revenue Code	272
Min. Negotiated Rate	$25.41
Max. Negotiated Rate	$53.35
Rate for Payer: Cash Price	$41.25
Rate for Payer: Celtic Commercial/Exchange	$25.41
Rate for Payer: Health Partners Plans Commercial	$52.25
Rate for Payer: UnitedHealthcare Commercial	$53.35
Rate for Payer: WPPA Commercial	$46.20

ALGIDEX AG PASTE 10 CC

Facility

$55.00

Hospital Charge Code	2720678
Hospital Revenue Code	272
Min. Negotiated Rate	$45.10
Max. Negotiated Rate	$53.35
Rate for Payer: Cash Price	$41.25
Rate for Payer: Health Partners Plans Commercial	$52.25
Rate for Payer: UnitedHealthcare Commercial	$53.35
Rate for Payer: WPPA Commercial	$45.10

ALKALOIDS NOS

Facility

$271.00

Service Code	HCPCS 80323
Hospital Charge Code	8032300
Hospital Revenue Code	300
Min. Negotiated Rate	$36.06
Max. Negotiated Rate	$262.87
Rate for Payer: BCBS Commercial	$36.06
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

ALKALOIDS NOS

Facility

$271.00

Service Code	HCPCS 80323
Hospital Charge Code	8032300
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

ALLEGRA 180 MG TAB (FEXOFENADINE)

Facility

$8.00

Service Code	NDC 41167412002
Hospital Charge Code	2513844
Hospital Revenue Code	250
Min. Negotiated Rate	$6.56
Max. Negotiated Rate	$7.76
Rate for Payer: Cash Price	$6.64
Rate for Payer: Health Partners Plans Commercial	$7.60
Rate for Payer: UnitedHealthcare Commercial	$7.76
Rate for Payer: WPPA Commercial	$6.56

ALLEGRA 180 MG TAB (FEXOFENADINE)

Facility

$8.00

Service Code	NDC 41167412002
Hospital Charge Code	2513844
Hospital Revenue Code	250
Min. Negotiated Rate	$3.70
Max. Negotiated Rate	$7.76
Rate for Payer: Cash Price	$6.64
Rate for Payer: Celtic Commercial/Exchange	$3.70
Rate for Payer: Health Partners Plans Commercial	$7.60
Rate for Payer: UnitedHealthcare Commercial	$7.76
Rate for Payer: WPPA Commercial	$6.72

ALLEGRA 60 MG TAB (FEXOFENADINE)

Facility

$4.00

Service Code	NDC 41167413102
Hospital Charge Code	2510014
Hospital Revenue Code	250
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

ALLEGRA 60 MG TAB (FEXOFENADINE)

Facility

$4.00

Service Code	NDC 41167413102
Hospital Charge Code	2510014
Hospital Revenue Code	250
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

ALLERGEN SPECIFIC IGE QUANT.OR

Facility

$139.00

Service Code	HCPCS 86003
Hospital Charge Code	8600300
Hospital Revenue Code	302
Min. Negotiated Rate	$113.98
Max. Negotiated Rate	$134.83
Rate for Payer: Cash Price	$104.25
Rate for Payer: Health Partners Plans Commercial	$132.05
Rate for Payer: UnitedHealthcare Commercial	$134.83
Rate for Payer: WPPA Commercial	$113.98

ALLERGEN SPECIFIC IGE QUANT.OR

Facility

$139.00

Service Code	HCPCS 86003
Hospital Charge Code	8600300
Hospital Revenue Code	302
Min. Negotiated Rate	$15.51
Max. Negotiated Rate	$134.83
Rate for Payer: BCBS Commercial	$15.51
Rate for Payer: Cash Price	$104.25
Rate for Payer: Cash Price	$104.25
Rate for Payer: Celtic Commercial/Exchange	$64.22
Rate for Payer: Health Partners Plans Commercial	$132.05
Rate for Payer: UnitedHealthcare Commercial	$134.83
Rate for Payer: WPPA Commercial	$116.76

ALLERGEN SPEC IGE, (GLUTEN)

Facility

$28.00

Service Code	HCPCS 86003
Hospital Charge Code	8600301
Hospital Revenue Code	302
Min. Negotiated Rate	$12.94
Max. Negotiated Rate	$27.16
Rate for Payer: BCBS Commercial	$15.51
Rate for Payer: Cash Price	$21.00
Rate for Payer: Cash Price	$21.00
Rate for Payer: Celtic Commercial/Exchange	$12.94
Rate for Payer: Health Partners Plans Commercial	$26.60
Rate for Payer: UnitedHealthcare Commercial	$27.16
Rate for Payer: WPPA Commercial	$23.52

ALLERGEN SPEC IGE, (GLUTEN)

Facility

$28.00

Service Code	HCPCS 86003
Hospital Charge Code	8600301
Hospital Revenue Code	302
Min. Negotiated Rate	$22.96
Max. Negotiated Rate	$27.16
Rate for Payer: Cash Price	$21.00
Rate for Payer: Health Partners Plans Commercial	$26.60
Rate for Payer: UnitedHealthcare Commercial	$27.16
Rate for Payer: WPPA Commercial	$22.96

ALLERGEN SPEC. IGE (MILK)

Facility

$28.00

Service Code	HCPCS 86003
Hospital Charge Code	8600303
Hospital Revenue Code	302
Min. Negotiated Rate	$12.94
Max. Negotiated Rate	$27.16
Rate for Payer: BCBS Commercial	$15.51
Rate for Payer: Cash Price	$21.00
Rate for Payer: Cash Price	$21.00
Rate for Payer: Celtic Commercial/Exchange	$12.94
Rate for Payer: Health Partners Plans Commercial	$26.60
Rate for Payer: UnitedHealthcare Commercial	$27.16
Rate for Payer: WPPA Commercial	$23.52

ALLERGEN SPEC. IGE (MILK)

Facility

$28.00

Service Code	HCPCS 86003
Hospital Charge Code	8600303
Hospital Revenue Code	302
Min. Negotiated Rate	$22.96
Max. Negotiated Rate	$27.16
Rate for Payer: Cash Price	$21.00
Rate for Payer: Health Partners Plans Commercial	$26.60
Rate for Payer: UnitedHealthcare Commercial	$27.16
Rate for Payer: WPPA Commercial	$22.96

ALLERGEN SPEC. IGE QUAL,MULTI-

Facility

$90.00

Service Code	HCPCS 86005
Hospital Charge Code	8600500
Hospital Revenue Code	302
Min. Negotiated Rate	$41.58
Max. Negotiated Rate	$87.30
Rate for Payer: BCBS Commercial	$49.62
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cash Price	$67.50
Rate for Payer: Celtic Commercial/Exchange	$41.58
Rate for Payer: Health Partners Plans Commercial	$85.50
Rate for Payer: UnitedHealthcare Commercial	$87.30
Rate for Payer: WPPA Commercial	$75.60

ALLERGEN SPEC. IGE QUAL,MULTI-

Facility

$90.00

Service Code	HCPCS 86005
Hospital Charge Code	8600500
Hospital Revenue Code	302
Min. Negotiated Rate	$73.80
Max. Negotiated Rate	$87.30
Rate for Payer: Cash Price	$67.50
Rate for Payer: Health Partners Plans Commercial	$85.50
Rate for Payer: UnitedHealthcare Commercial	$87.30
Rate for Payer: WPPA Commercial	$73.80

ALLERGEN SPEC. IGE (RICE)

Facility

$28.00

Service Code	HCPCS 86003
Hospital Charge Code	8600302
Hospital Revenue Code	302
Min. Negotiated Rate	$22.96
Max. Negotiated Rate	$27.16
Rate for Payer: Cash Price	$21.00
Rate for Payer: Health Partners Plans Commercial	$26.60
Rate for Payer: UnitedHealthcare Commercial	$27.16
Rate for Payer: WPPA Commercial	$22.96

Know your out-of-pocket cost for care.

All Charges