Ness County Hospital

All Charges

Charge

Type

Setting

Price

OXCARBAZEPINE

Facility

$148.00

Service Code	HCPCS 80183
Hospital Charge Code	8018300
Hospital Revenue Code	301
Min. Negotiated Rate	$36.08
Max. Negotiated Rate	$143.56
Rate for Payer: BCBS Commercial	$36.08
Rate for Payer: Cash Price	$111.00
Rate for Payer: Cash Price	$111.00
Rate for Payer: Celtic Commercial/Exchange	$68.38
Rate for Payer: Health Partners Plans Commercial	$140.60
Rate for Payer: UnitedHealthcare Commercial	$143.56
Rate for Payer: WPPA Commercial	$124.32

OXCARBAZEPINE

Facility

$148.00

Service Code	HCPCS 80183
Hospital Charge Code	8018300
Hospital Revenue Code	301
Min. Negotiated Rate	$121.36
Max. Negotiated Rate	$143.56
Rate for Payer: Cash Price	$111.00
Rate for Payer: Health Partners Plans Commercial	$140.60
Rate for Payer: UnitedHealthcare Commercial	$143.56
Rate for Payer: WPPA Commercial	$121.36

OXYCARBAZEPINE METABOLITE

Facility

$108.00

Service Code	HCPCS 80299
Hospital Charge Code	8029905
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

OXYCARBAZEPINE METABOLITE

Facility

$108.00

Service Code	HCPCS 80299
Hospital Charge Code	8029905
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

OXYCODONE 5 MG TAB

Facility

$2.00

Service Code	NDC 68084035411
Hospital Charge Code	2511988
Hospital Revenue Code	250
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.99
Rate for Payer: Health Partners Plans Commercial	$1.90
Rate for Payer: UnitedHealthcare Commercial	$1.94
Rate for Payer: WPPA Commercial	$1.64

OXYCODONE 5 MG TAB

Facility

$2.00

Service Code	NDC 68084035411
Hospital Charge Code	2511988
Hospital Revenue Code	250
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.99
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

OXYCODONE 5 MG TAB

Facility

$2.00

Service Code	NDC 68084035401
Hospital Charge Code	2511988
Hospital Revenue Code	250
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.99
Rate for Payer: Health Partners Plans Commercial	$1.90
Rate for Payer: UnitedHealthcare Commercial	$1.94
Rate for Payer: WPPA Commercial	$1.64

OXYCODONE 5 MG TAB

Facility

$2.00

Service Code	NDC 68084035401
Hospital Charge Code	2511988
Hospital Revenue Code	250
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.99
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

OXYCONTIN SR 10 MG TAB

Facility

$15.00

Service Code	NDC 59011041020
Hospital Charge Code	2515245
Hospital Revenue Code	250
Min. Negotiated Rate	$12.30
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$11.25
Rate for Payer: Health Partners Plans Commercial	$14.25
Rate for Payer: UnitedHealthcare Commercial	$14.55
Rate for Payer: WPPA Commercial	$12.30

OXYCONTIN SR 10 MG TAB

Facility

$15.00

Service Code	NDC 59011041020
Hospital Charge Code	2515245
Hospital Revenue Code	250
Min. Negotiated Rate	$6.93
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$11.25
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

OXYGEN ADM BY CONCENTRATOR

Facility

$180.00

Hospital Charge Code	4120009
Hospital Revenue Code	270
Min. Negotiated Rate	$147.60
Max. Negotiated Rate	$174.60
Rate for Payer: Cash Price	$135.00
Rate for Payer: Health Partners Plans Commercial	$171.00
Rate for Payer: UnitedHealthcare Commercial	$174.60
Rate for Payer: WPPA Commercial	$147.60

OXYGEN ADM BY CONCENTRATOR

Facility

$180.00

Hospital Charge Code	4120009
Hospital Revenue Code	270
Min. Negotiated Rate	$83.16
Max. Negotiated Rate	$174.60
Rate for Payer: Cash Price	$135.00
Rate for Payer: Celtic Commercial/Exchange	$83.16
Rate for Payer: Health Partners Plans Commercial	$171.00
Rate for Payer: UnitedHealthcare Commercial	$174.60
Rate for Payer: WPPA Commercial	$151.20

OXYGEN TANK 4 HRS

Facility

$25.00

Hospital Charge Code	4120000
Hospital Revenue Code	270
Min. Negotiated Rate	$11.55
Max. Negotiated Rate	$24.25
Rate for Payer: Cash Price	$18.90
Rate for Payer: Celtic Commercial/Exchange	$11.55
Rate for Payer: Health Partners Plans Commercial	$23.75
Rate for Payer: UnitedHealthcare Commercial	$24.25
Rate for Payer: WPPA Commercial	$21.00

OXYGEN TANK 4 HRS

Facility

$25.00

Hospital Charge Code	4120000
Hospital Revenue Code	270
Min. Negotiated Rate	$20.50
Max. Negotiated Rate	$24.25
Rate for Payer: Cash Price	$18.90
Rate for Payer: Health Partners Plans Commercial	$23.75
Rate for Payer: UnitedHealthcare Commercial	$24.25
Rate for Payer: WPPA Commercial	$20.50

OXYGEN TUBING CONNECTOR

Facility

$5.00

Hospital Charge Code	4100502
Hospital Revenue Code	270
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$3.75
Rate for Payer: Celtic Commercial/Exchange	$2.31
Rate for Payer: Health Partners Plans Commercial	$4.75
Rate for Payer: UnitedHealthcare Commercial	$4.85
Rate for Payer: WPPA Commercial	$4.20

OXYGEN TUBING CONNECTOR

Facility

$5.00

Hospital Charge Code	4100502
Hospital Revenue Code	270
Min. Negotiated Rate	$4.10
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$3.75
Rate for Payer: Health Partners Plans Commercial	$4.75
Rate for Payer: UnitedHealthcare Commercial	$4.85
Rate for Payer: WPPA Commercial	$4.10

OXYMASK

Facility

$14.00

Hospital Charge Code	2701007
Hospital Revenue Code	272
Min. Negotiated Rate	$11.48
Max. Negotiated Rate	$13.58
Rate for Payer: Cash Price	$10.50
Rate for Payer: Health Partners Plans Commercial	$13.30
Rate for Payer: UnitedHealthcare Commercial	$13.58
Rate for Payer: WPPA Commercial	$11.48

OXYMASK

Facility

$14.00

Hospital Charge Code	2701007
Hospital Revenue Code	272
Min. Negotiated Rate	$6.47
Max. Negotiated Rate	$13.58
Rate for Payer: Cash Price	$10.50
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

PAIN MGMNT PROFL 5 W/CONF URIN

Facility

$197.00

Service Code	HCPCS 80307
Hospital Charge Code	8030700
Hospital Revenue Code	300
Min. Negotiated Rate	$91.01
Max. Negotiated Rate	$191.09
Rate for Payer: BCBS Commercial	$150.08
Rate for Payer: Cash Price	$147.75
Rate for Payer: Cash Price	$147.75
Rate for Payer: Celtic Commercial/Exchange	$91.01
Rate for Payer: Health Partners Plans Commercial	$187.15
Rate for Payer: UnitedHealthcare Commercial	$191.09
Rate for Payer: WPPA Commercial	$165.48

PAIN MGMNT PROFL 5 W/CONF URIN

Facility

$197.00

Service Code	HCPCS 80307
Hospital Charge Code	8030700
Hospital Revenue Code	300
Min. Negotiated Rate	$161.54
Max. Negotiated Rate	$191.09
Rate for Payer: Cash Price	$147.75
Rate for Payer: Health Partners Plans Commercial	$187.15
Rate for Payer: UnitedHealthcare Commercial	$191.09
Rate for Payer: WPPA Commercial	$161.54

PAIN MNGMENT INFUSION SUPPLIES

Facility

$115.00

Hospital Charge Code	2517761
Hospital Revenue Code	270
Min. Negotiated Rate	$53.13
Max. Negotiated Rate	$111.55
Rate for Payer: Cash Price	$86.81
Rate for Payer: Celtic Commercial/Exchange	$53.13
Rate for Payer: Health Partners Plans Commercial	$109.25
Rate for Payer: UnitedHealthcare Commercial	$111.55
Rate for Payer: WPPA Commercial	$96.60

PAIN MNGMENT INFUSION SUPPLIES

Facility

$115.00

Hospital Charge Code	2517761
Hospital Revenue Code	270
Min. Negotiated Rate	$94.30
Max. Negotiated Rate	$111.55
Rate for Payer: Cash Price	$86.81
Rate for Payer: Health Partners Plans Commercial	$109.25
Rate for Payer: UnitedHealthcare Commercial	$111.55
Rate for Payer: WPPA Commercial	$94.30

PANCREASE 3,000 UNITS CAP (CREON) (PANCRELIPASE) (LIPASE-PROTEASE-AMYLASE)

Facility

$5.00

Service Code	NDC 00032120370
Hospital Charge Code	2509420
Hospital Revenue Code	250
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$4.05
Rate for Payer: Celtic Commercial/Exchange	$2.31
Rate for Payer: Health Partners Plans Commercial	$4.75
Rate for Payer: UnitedHealthcare Commercial	$4.85
Rate for Payer: WPPA Commercial	$4.20

PANCREASE 3,000 UNITS CAP (CREON) (PANCRELIPASE) (LIPASE-PROTEASE-AMYLASE)

Facility

$5.00

Service Code	NDC 00032120370
Hospital Charge Code	2509420
Hospital Revenue Code	250
Min. Negotiated Rate	$4.10
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$4.05
Rate for Payer: Health Partners Plans Commercial	$4.75
Rate for Payer: UnitedHealthcare Commercial	$4.85
Rate for Payer: WPPA Commercial	$4.10

PANCREAS, LIVER AND SHUNT PROCEDURES WITH CC

Facility

$27,266.68

Service Code	MSDRG 406
Min. Negotiated Rate	$27,266.68
Max. Negotiated Rate	$27,266.68
Rate for Payer: BCBS Commercial	$27,266.68

Know your out-of-pocket cost for care.

All Charges