Ness County Hospital

All Charges

Charge

Type

Setting

Price

AMBU COLLAR ADULT

Facility

$37.00

Hospital Charge Code	2704319
Hospital Revenue Code	270
Min. Negotiated Rate	$30.34
Max. Negotiated Rate	$35.89
Rate for Payer: Cash Price	$28.05
Rate for Payer: Health Partners Plans Commercial	$35.15
Rate for Payer: UnitedHealthcare Commercial	$35.89
Rate for Payer: WPPA Commercial	$30.34

AMBU COLLAR INFANT-PED

Facility

$55.00

Hospital Charge Code	2704466
Hospital Revenue Code	270
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

AMBU COLLAR INFANT-PED

Facility

$55.00

Hospital Charge Code	2704466
Hospital Revenue Code	270
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

AMBU DURACLEAR MASK

Facility

$15.00

Hospital Charge Code	2709312
Hospital Revenue Code	270
Min. Negotiated Rate	$12.30
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$11.77
Rate for Payer: Health Partners Plans Commercial	$14.25
Rate for Payer: UnitedHealthcare Commercial	$14.55
Rate for Payer: WPPA Commercial	$12.30

AMBU DURACLEAR MASK

Facility

$15.00

Hospital Charge Code	2709312
Hospital Revenue Code	270
Min. Negotiated Rate	$6.93
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$11.77
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

AMBU MINI COLLAR

Facility

$34.00

Hospital Charge Code	2701165
Hospital Revenue Code	270
Min. Negotiated Rate	$15.71
Max. Negotiated Rate	$32.98
Rate for Payer: Cash Price	$25.50
Rate for Payer: Celtic Commercial/Exchange	$15.71
Rate for Payer: Health Partners Plans Commercial	$32.30
Rate for Payer: UnitedHealthcare Commercial	$32.98
Rate for Payer: WPPA Commercial	$28.56

AMBU MINI COLLAR

Facility

$34.00

Hospital Charge Code	2701165
Hospital Revenue Code	270
Min. Negotiated Rate	$27.88
Max. Negotiated Rate	$32.98
Rate for Payer: Cash Price	$25.50
Rate for Payer: Health Partners Plans Commercial	$32.30
Rate for Payer: UnitedHealthcare Commercial	$32.98
Rate for Payer: WPPA Commercial	$27.88

AMICILLIN 500 MG CAPSULE

Facility

$3.00

Service Code	NDC 00781214501
Hospital Charge Code	2519924
Hospital Revenue Code	250
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.33
Rate for Payer: Health Partners Plans Commercial	$2.85
Rate for Payer: UnitedHealthcare Commercial	$2.91
Rate for Payer: WPPA Commercial	$2.46

AMICILLIN 500 MG CAPSULE

Facility

$3.00

Service Code	NDC 00781214501
Hospital Charge Code	2519924
Hospital Revenue Code	250
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.33
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

Amidate 20mg/10ml vial (etomidate)

Facility

$55.00

Service Code	NDC 00143950610
Hospital Charge Code	2502156
Hospital Revenue Code	250
Min. Negotiated Rate	$25.41
Max. Negotiated Rate	$53.35
Rate for Payer: Cash Price	$41.36
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

Amidate 20mg/10ml vial (etomidate)

Facility

$55.00

Service Code	NDC 00143950610
Hospital Charge Code	2502156
Hospital Revenue Code	250
Min. Negotiated Rate	$45.10
Max. Negotiated Rate	$53.35
Rate for Payer: Cash Price	$41.36
Rate for Payer: Health Partners Plans Commercial	$52.25
Rate for Payer: UnitedHealthcare Commercial	$53.35
Rate for Payer: WPPA Commercial	$45.10

AMINOLEVULINIC ACID,DELTA(ALA)

Facility

$92.00

Service Code	HCPCS 82135
Hospital Charge Code	8213500
Hospital Revenue Code	301
Min. Negotiated Rate	$75.44
Max. Negotiated Rate	$89.24
Rate for Payer: Cash Price	$69.00
Rate for Payer: Health Partners Plans Commercial	$87.40
Rate for Payer: UnitedHealthcare Commercial	$89.24
Rate for Payer: WPPA Commercial	$75.44

AMINOLEVULINIC ACID,DELTA(ALA)

Facility

$92.00

Service Code	HCPCS 82135
Hospital Charge Code	8213500
Hospital Revenue Code	301
Min. Negotiated Rate	$42.50
Max. Negotiated Rate	$89.24
Rate for Payer: BCBS Commercial	$50.63
Rate for Payer: Cash Price	$69.00
Rate for Payer: Cash Price	$69.00
Rate for Payer: Celtic Commercial/Exchange	$42.50
Rate for Payer: Health Partners Plans Commercial	$87.40
Rate for Payer: UnitedHealthcare Commercial	$89.24
Rate for Payer: WPPA Commercial	$77.28

AMIODARONE

Facility

$108.00

Service Code	HCPCS 80299
Hospital Charge Code	8029913
Hospital Revenue Code	301
Min. Negotiated Rate	$88.56
Max. Negotiated Rate	$104.76
Rate for Payer: Cash Price	$81.00
Rate for Payer: Health Partners Plans Commercial	$102.60
Rate for Payer: UnitedHealthcare Commercial	$104.76
Rate for Payer: WPPA Commercial	$88.56

AMIODARONE

Facility

$108.00

Service Code	HCPCS 80299
Hospital Charge Code	8029913
Hospital Revenue Code	301
Min. Negotiated Rate	$49.90
Max. Negotiated Rate	$104.76
Rate for Payer: BCBS Commercial	$65.71
Rate for Payer: Cash Price	$81.00
Rate for Payer: Cash Price	$81.00
Rate for Payer: Celtic Commercial/Exchange	$49.90
Rate for Payer: Health Partners Plans Commercial	$102.60
Rate for Payer: UnitedHealthcare Commercial	$104.76
Rate for Payer: WPPA Commercial	$90.72

AMIODARONE 150MG/3ML INJ

Facility

$50.00

Service Code	NDC 63323061603
Hospital Charge Code	2513968
Hospital Revenue Code	250
Min. Negotiated Rate	$41.00
Max. Negotiated Rate	$48.50
Rate for Payer: Cash Price	$37.58
Rate for Payer: Health Partners Plans Commercial	$47.50
Rate for Payer: UnitedHealthcare Commercial	$48.50
Rate for Payer: WPPA Commercial	$41.00

AMIODARONE 150MG/3ML INJ

Facility

$50.00

Service Code	NDC 63323061603
Hospital Charge Code	2513968
Hospital Revenue Code	250
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$48.50
Rate for Payer: Cash Price	$37.58
Rate for Payer: Celtic Commercial/Exchange	$23.10
Rate for Payer: Health Partners Plans Commercial	$47.50
Rate for Payer: UnitedHealthcare Commercial	$48.50
Rate for Payer: WPPA Commercial	$42.00

AMITRIPTYLINE

Facility

$86.00

Service Code	HCPCS 80335
Hospital Charge Code	8033500
Hospital Revenue Code	301
Min. Negotiated Rate	$39.73
Max. Negotiated Rate	$83.42
Rate for Payer: BCBS Commercial	$62.47
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

AMITRIPTYLINE

Facility

$86.00

Service Code	HCPCS 80335
Hospital Charge Code	8033500
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

AMMONIA

Facility

$131.00

Service Code	HCPCS 82140
Hospital Charge Code	8214000
Hospital Revenue Code	301
Min. Negotiated Rate	$107.42
Max. Negotiated Rate	$127.07
Rate for Payer: Cash Price	$98.25
Rate for Payer: Health Partners Plans Commercial	$124.45
Rate for Payer: UnitedHealthcare Commercial	$127.07
Rate for Payer: WPPA Commercial	$107.42

AMMONIA

Facility

$131.00

Service Code	HCPCS 82140
Hospital Charge Code	8214000
Hospital Revenue Code	301
Min. Negotiated Rate	$49.38
Max. Negotiated Rate	$127.07
Rate for Payer: BCBS Commercial	$49.38
Rate for Payer: Cash Price	$98.25
Rate for Payer: Cash Price	$98.25
Rate for Payer: Celtic Commercial/Exchange	$60.52
Rate for Payer: Health Partners Plans Commercial	$124.45
Rate for Payer: UnitedHealthcare Commercial	$127.07
Rate for Payer: WPPA Commercial	$110.04

AMMONIA AROMATIC

Facility

$4.00

Service Code	NDC 00395007392
Hospital Charge Code	2500379
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

AMMONIA AROMATIC

Facility

$4.00

Service Code	NDC 00395007392
Hospital Charge Code	2500379
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

AMOXICILLIN 125 MG/5 ML 100 ML OS

Facility

$14.00

Service Code	NDC 00143988801
Hospital Charge Code	2509602
Hospital Revenue Code	250
Min. Negotiated Rate	$11.48
Max. Negotiated Rate	$13.58
Rate for Payer: Cash Price	$11.02
Rate for Payer: Health Partners Plans Commercial	$13.30
Rate for Payer: UnitedHealthcare Commercial	$13.58
Rate for Payer: WPPA Commercial	$11.48

AMOXICILLIN 125 MG/5 ML 100 ML OS

Facility

$14.00

Service Code	NDC 00143988801
Hospital Charge Code	2509602
Hospital Revenue Code	250
Min. Negotiated Rate	$6.47
Max. Negotiated Rate	$13.58
Rate for Payer: Cash Price	$11.02
Rate for Payer: Celtic Commercial/Exchange	$6.47
Rate for Payer: Health Partners Plans Commercial	$13.30
Rate for Payer: UnitedHealthcare Commercial	$13.58
Rate for Payer: WPPA Commercial	$11.76

Know your out-of-pocket cost for care.

All Charges