Ness County Hospital

All Charges

Charge

Type

Setting

Price

AMOXICILLIN 250 MG/5 ML 80 ML OS

Facility

$19.00

Service Code	NDC 00781604158
Hospital Charge Code	2500452
Hospital Revenue Code	250
Min. Negotiated Rate	$8.78
Max. Negotiated Rate	$18.43
Rate for Payer: Cash Price	$14.62
Rate for Payer: Celtic Commercial/Exchange	$8.78
Rate for Payer: Health Partners Plans Commercial	$18.05
Rate for Payer: UnitedHealthcare Commercial	$18.43
Rate for Payer: WPPA Commercial	$15.96

AMOXICILLIN 250 MG/5 ML 80 ML OS

Facility

$19.00

Service Code	NDC 00781604158
Hospital Charge Code	2500452
Hospital Revenue Code	250
Min. Negotiated Rate	$15.58
Max. Negotiated Rate	$18.43
Rate for Payer: Cash Price	$14.62
Rate for Payer: Health Partners Plans Commercial	$18.05
Rate for Payer: UnitedHealthcare Commercial	$18.43
Rate for Payer: WPPA Commercial	$15.58

AMOXICILLIN 250 MG CAP

Facility

$1.00

Service Code	NDC 00781202001
Hospital Charge Code	2500403
Hospital Revenue Code	250
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$1.42
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

AMOXICILLIN 250 MG CAP

Facility

$1.00

Service Code	NDC 00781202001
Hospital Charge Code	2500403
Hospital Revenue Code	250
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$1.42
Rate for Payer: Health Partners Plans Commercial	$0.95
Rate for Payer: UnitedHealthcare Commercial	$0.97
Rate for Payer: WPPA Commercial	$0.82

AMOXICILLIN 400 MG/5 ML 50 ML OS

Facility

$14.00

Service Code	NDC 00143988750
Hospital Charge Code	2519007
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 400 MG/5 ML 50 ML OS

Facility

$14.00

Service Code	NDC 00143988750
Hospital Charge Code	2519007
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

AMOXICILLIN CAP 500MG

Facility

$1.00

Hospital Charge Code	2513679
Hospital Revenue Code	250
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$1.12
Rate for Payer: Health Partners Plans Commercial	$0.95
Rate for Payer: UnitedHealthcare Commercial	$0.97
Rate for Payer: WPPA Commercial	$0.82

AMOXICILLIN CAP 500MG

Facility

$1.00

Hospital Charge Code	2513679
Hospital Revenue Code	250
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$1.12
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

AMPHETAMINES 5+ SCREEN

Facility

$271.00

Service Code	HCPCS 80326
Hospital Charge Code	8032600
Hospital Revenue Code	300
Min. Negotiated Rate	$55.71
Max. Negotiated Rate	$262.87
Rate for Payer: BCBS Commercial	$55.71
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

AMPHETAMINES 5+ SCREEN

Facility

$271.00

Service Code	HCPCS 80326
Hospital Charge Code	8032600
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

AMPICILLIN 1 GM ADV

Facility

$53.00

Service Code	NDC 00781941292
Hospital Charge Code	2505139
Hospital Revenue Code	250
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

AMPICILLIN 1 GM ADV

Facility

$53.00

Service Code	NDC 00781941292
Hospital Charge Code	2505139
Hospital Revenue Code	250
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

AMPICILLIN 2 GM ADV

Facility

$104.00

Service Code	NDC 00781341392
Hospital Charge Code	2505147
Hospital Revenue Code	250
Min. Negotiated Rate	$48.05
Max. Negotiated Rate	$100.88
Rate for Payer: Cash Price	$78.19
Rate for Payer: Celtic Commercial/Exchange	$48.05
Rate for Payer: Health Partners Plans Commercial	$98.80
Rate for Payer: UnitedHealthcare Commercial	$100.88
Rate for Payer: WPPA Commercial	$87.36

AMPICILLIN 2 GM ADV

Facility

$104.00

Service Code	NDC 00781341392
Hospital Charge Code	2505147
Hospital Revenue Code	250
Min. Negotiated Rate	$85.28
Max. Negotiated Rate	$100.88
Rate for Payer: Cash Price	$78.19
Rate for Payer: Health Partners Plans Commercial	$98.80
Rate for Payer: UnitedHealthcare Commercial	$100.88
Rate for Payer: WPPA Commercial	$85.28

AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC

Facility

$28,614.18

Service Code	MSDRG 240
Min. Negotiated Rate	$28,614.18
Max. Negotiated Rate	$28,614.18
Rate for Payer: BCBS Commercial	$28,614.18

AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC

Facility

$43,599.02

Service Code	MSDRG 239
Min. Negotiated Rate	$43,599.02
Max. Negotiated Rate	$43,599.02
Rate for Payer: BCBS Commercial	$43,599.02

AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC/MCC

Facility

$16,818.62

Service Code	MSDRG 241
Min. Negotiated Rate	$16,818.62
Max. Negotiated Rate	$16,818.62
Rate for Payer: BCBS Commercial	$16,818.62

AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC

Facility

$19,493.27

Service Code	MSDRG 475
Min. Negotiated Rate	$19,493.27
Max. Negotiated Rate	$19,493.27
Rate for Payer: BCBS Commercial	$19,493.27

AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC

Facility

$36,547.34

Service Code	MSDRG 474
Min. Negotiated Rate	$36,547.34
Max. Negotiated Rate	$36,547.34
Rate for Payer: BCBS Commercial	$36,547.34

AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC

Facility

$12,621.32

Service Code	MSDRG 476
Min. Negotiated Rate	$12,621.32
Max. Negotiated Rate	$12,621.32
Rate for Payer: BCBS Commercial	$12,621.32

AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC

Facility

$18,015.50

Service Code	MSDRG 617
Min. Negotiated Rate	$18,015.50
Max. Negotiated Rate	$18,015.50
Rate for Payer: BCBS Commercial	$18,015.50

AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC

Facility

$35,202.03

Service Code	MSDRG 616
Min. Negotiated Rate	$35,202.03
Max. Negotiated Rate	$35,202.03
Rate for Payer: BCBS Commercial	$35,202.03

AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC

Facility

$12,092.87

Service Code	MSDRG 618
Min. Negotiated Rate	$12,092.87
Max. Negotiated Rate	$12,092.87
Rate for Payer: BCBS Commercial	$12,092.87

AMYLASE

Facility

$88.00

Service Code	HCPCS 82150
Hospital Charge Code	8215000
Hospital Revenue Code	301
Min. Negotiated Rate	$25.05
Max. Negotiated Rate	$85.36
Rate for Payer: BCBS Commercial	$25.05
Rate for Payer: Cash Price	$66.00
Rate for Payer: Cash Price	$66.00
Rate for Payer: Celtic Commercial/Exchange	$40.66
Rate for Payer: Health Partners Plans Commercial	$83.60
Rate for Payer: UnitedHealthcare Commercial	$85.36
Rate for Payer: WPPA Commercial	$73.92

AMYLASE

Facility

$88.00

Service Code	HCPCS 82150
Hospital Charge Code	8215000
Hospital Revenue Code	301
Min. Negotiated Rate	$72.16
Max. Negotiated Rate	$85.36
Rate for Payer: Cash Price	$66.00
Rate for Payer: Health Partners Plans Commercial	$83.60
Rate for Payer: UnitedHealthcare Commercial	$85.36
Rate for Payer: WPPA Commercial	$72.16

Know your out-of-pocket cost for care.

All Charges