Ness County Hospital

All Charges

Charge

Type

Setting

Price

MYCOSTATIN 500,000 U TAB (NYSTATIN)

Facility

$4.00

Service Code	NDC 23155005101
Hospital Charge Code	2515500
Hospital Revenue Code	250
Min. Negotiated Rate	$3.28
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$3.22
Rate for Payer: Health Partners Plans Commercial	$3.80
Rate for Payer: UnitedHealthcare Commercial	$3.88
Rate for Payer: WPPA Commercial	$3.28

MYCOSTATIN 500,000 U TAB (NYSTATIN)

Facility

$4.00

Service Code	NDC 23155005101
Hospital Charge Code	2515500
Hospital Revenue Code	250
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$3.22
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

MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC

Facility

$16,413.07

Service Code	MSDRG 827
Min. Negotiated Rate	$16,413.07
Max. Negotiated Rate	$16,413.07
Rate for Payer: BCBS Commercial	$16,413.07

MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC

Facility

$47,000.71

Service Code	MSDRG 826
Min. Negotiated Rate	$47,000.71
Max. Negotiated Rate	$47,000.71
Rate for Payer: BCBS Commercial	$47,000.71

MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC

Facility

$15,374.07

Service Code	MSDRG 828
Min. Negotiated Rate	$15,374.07
Max. Negotiated Rate	$15,374.07
Rate for Payer: BCBS Commercial	$15,374.07

MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC

Facility

$32,014.39

Service Code	MSDRG 829
Min. Negotiated Rate	$32,014.39
Max. Negotiated Rate	$32,014.39
Rate for Payer: BCBS Commercial	$32,014.39

MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC

Facility

$14,454.99

Service Code	MSDRG 830
Min. Negotiated Rate	$14,454.99
Max. Negotiated Rate	$14,454.99
Rate for Payer: BCBS Commercial	$14,454.99

MYLANTA DS LIQUID (LIQUID ANTACID)

Facility

$1.00

Service Code	NDC 46122043140
Hospital Charge Code	2504645
Hospital Revenue Code	250
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$1.05
Rate for Payer: Health Partners Plans Commercial	$0.95
Rate for Payer: UnitedHealthcare Commercial	$0.97
Rate for Payer: WPPA Commercial	$0.82

MYLANTA DS LIQUID (LIQUID ANTACID)

Facility

$1.00

Service Code	NDC 46122043140
Hospital Charge Code	2504645
Hospital Revenue Code	250
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$1.05
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

MYLICON 80 MG CHEWABLE TAB (SIMETHICONE)

Facility

$1.00

Service Code	NDC 77333081225
Hospital Charge Code	2504652
Hospital Revenue Code	250
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.75
Rate for Payer: Health Partners Plans Commercial	$0.95
Rate for Payer: UnitedHealthcare Commercial	$0.97
Rate for Payer: WPPA Commercial	$0.82

MYLICON 80 MG CHEWABLE TAB (SIMETHICONE)

Facility

$1.00

Service Code	NDC 77333081225
Hospital Charge Code	2504652
Hospital Revenue Code	250
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.75
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

MYLICON DROPS 20 MG/0.3 ML (SIMETHICONE PEDIATRIC)

Facility

$27.00

Service Code	NDC 69618005951
Hospital Charge Code	2504660
Hospital Revenue Code	250
Min. Negotiated Rate	$12.47
Max. Negotiated Rate	$26.19
Rate for Payer: Cash Price	$20.25
Rate for Payer: Celtic Commercial/Exchange	$12.47
Rate for Payer: Health Partners Plans Commercial	$25.65
Rate for Payer: UnitedHealthcare Commercial	$26.19
Rate for Payer: WPPA Commercial	$22.68

MYLICON DROPS 20 MG/0.3 ML (SIMETHICONE PEDIATRIC)

Facility

$27.00

Service Code	NDC 69618005951
Hospital Charge Code	2504660
Hospital Revenue Code	250
Min. Negotiated Rate	$22.14
Max. Negotiated Rate	$26.19
Rate for Payer: Cash Price	$20.25
Rate for Payer: Health Partners Plans Commercial	$25.65
Rate for Payer: UnitedHealthcare Commercial	$26.19
Rate for Payer: WPPA Commercial	$22.14

MYOGLOBIN

Facility

$84.00

Service Code	HCPCS 83874
Hospital Charge Code	8387490
Hospital Revenue Code	301
Min. Negotiated Rate	$68.88
Max. Negotiated Rate	$81.48
Rate for Payer: Cash Price	$63.00
Rate for Payer: Health Partners Plans Commercial	$79.80
Rate for Payer: UnitedHealthcare Commercial	$81.48
Rate for Payer: WPPA Commercial	$68.88

MYOGLOBIN

Facility

$84.00

Service Code	HCPCS 83874
Hospital Charge Code	8387490
Hospital Revenue Code	301
Min. Negotiated Rate	$38.81
Max. Negotiated Rate	$81.48
Rate for Payer: BCBS Commercial	$47.66
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cash Price	$63.00
Rate for Payer: Celtic Commercial/Exchange	$38.81
Rate for Payer: Health Partners Plans Commercial	$79.80
Rate for Payer: UnitedHealthcare Commercial	$81.48
Rate for Payer: WPPA Commercial	$70.56

NAMENDA 10 MG TAB (MEMANTINE)

Facility

$20.00

Service Code	NDC 60687018457
Hospital Charge Code	2514537
Hospital Revenue Code	250
Min. Negotiated Rate	$9.24
Max. Negotiated Rate	$19.40
Rate for Payer: Cash Price	$15.26
Rate for Payer: Celtic Commercial/Exchange	$9.24
Rate for Payer: Health Partners Plans Commercial	$19.00
Rate for Payer: UnitedHealthcare Commercial	$19.40
Rate for Payer: WPPA Commercial	$16.80

NAMENDA 10 MG TAB (MEMANTINE)

Facility

$20.00

Service Code	NDC 60687018457
Hospital Charge Code	2514537
Hospital Revenue Code	250
Min. Negotiated Rate	$16.40
Max. Negotiated Rate	$19.40
Rate for Payer: Cash Price	$15.26
Rate for Payer: Health Partners Plans Commercial	$19.00
Rate for Payer: UnitedHealthcare Commercial	$19.40
Rate for Payer: WPPA Commercial	$16.40

NAPROSYN 500 MG TAB (NAPROXEN)

Facility

$4.00

Service Code	NDC 60687049111
Hospital Charge Code	2519973
Hospital Revenue Code	250
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

NAPROSYN 500 MG TAB (NAPROXEN)

Facility

$4.00

Service Code	NDC 60687049111
Hospital Charge Code	2519973
Hospital Revenue Code	250
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

NARCAN 0.4 MG/ML INJ. (NALOXONE)

Facility

$71.00

Service Code	NDC 70069007110
Hospital Charge Code	2504694
Hospital Revenue Code	250
Min. Negotiated Rate	$58.22
Max. Negotiated Rate	$68.87
Rate for Payer: Cash Price	$53.36
Rate for Payer: Health Partners Plans Commercial	$67.45
Rate for Payer: UnitedHealthcare Commercial	$68.87
Rate for Payer: WPPA Commercial	$58.22

NARCAN 0.4 MG/ML INJ. (NALOXONE)

Facility

$71.00

Service Code	NDC 70069007110
Hospital Charge Code	2504694
Hospital Revenue Code	250
Min. Negotiated Rate	$32.80
Max. Negotiated Rate	$68.87
Rate for Payer: Cash Price	$53.36
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

NASAL BONES 3V MINIMUM

Facility

$294.00

Service Code	HCPCS 70160
Hospital Charge Code	3260024
Hospital Revenue Code	320
Min. Negotiated Rate	$241.08
Max. Negotiated Rate	$285.18
Rate for Payer: Cash Price	$220.50
Rate for Payer: Health Partners Plans Commercial	$279.30
Rate for Payer: UnitedHealthcare Commercial	$285.18
Rate for Payer: WPPA Commercial	$241.08

NASAL BONES 3V MINIMUM

Facility

$294.00

Service Code	HCPCS 70160
Hospital Charge Code	3260024
Hospital Revenue Code	320
Min. Negotiated Rate	$135.83
Max. Negotiated Rate	$285.18
Rate for Payer: BCBS Commercial	$147.74
Rate for Payer: Cash Price	$220.50
Rate for Payer: Cash Price	$220.50
Rate for Payer: Celtic Commercial/Exchange	$135.83
Rate for Payer: Health Partners Plans Commercial	$279.30
Rate for Payer: UnitedHealthcare Commercial	$285.18
Rate for Payer: WPPA Commercial	$246.96

NASAL CANNULA 7 PED

Facility

$4.00

Hospital Charge Code	4100178LTC
Hospital Revenue Code	272
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

NASAL CANNULA 7 PED

Facility

$4.00

Hospital Charge Code	4100178LTC
Hospital Revenue Code	272
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

Know your out-of-pocket cost for care.

All Charges