Ness County Hospital

All Charges

Charge

Type

Setting

Price

TUMS 500 MG TAB (CALCIUM CARBONATE)

Facility

$2.00

Service Code	NDC 66553000401
Hospital Charge Code	2515146
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

TUMS 500 MG TAB (CALCIUM CARBONATE)

Facility

$2.00

Service Code	NDC 66553000401
Hospital Charge Code	2515146
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

Tussionex Susp. ER (chlorpheniramine-hydrocodone)

Facility

$22.00

Service Code	NDC 27808008601
Hospital Charge Code	2510907
Hospital Revenue Code	250
Min. Negotiated Rate	$10.16
Max. Negotiated Rate	$21.34
Rate for Payer: Cash Price	$16.84
Rate for Payer: Celtic Commercial/Exchange	$10.16
Rate for Payer: Health Partners Plans Commercial	$20.90
Rate for Payer: UnitedHealthcare Commercial	$21.34
Rate for Payer: WPPA Commercial	$18.48

Tussionex Susp. ER (chlorpheniramine-hydrocodone)

Facility

$22.00

Service Code	NDC 27808008601
Hospital Charge Code	2510907
Hospital Revenue Code	250
Min. Negotiated Rate	$18.04
Max. Negotiated Rate	$21.34
Rate for Payer: Cash Price	$16.84
Rate for Payer: Health Partners Plans Commercial	$20.90
Rate for Payer: UnitedHealthcare Commercial	$21.34
Rate for Payer: WPPA Commercial	$18.04

Tussionex Susp. ER (chlorpheniramine-hydrocodone)

Facility

$22.00

Service Code	NDC 62542030104
Hospital Charge Code	2510907
Hospital Revenue Code	250
Min. Negotiated Rate	$18.04
Max. Negotiated Rate	$21.34
Rate for Payer: Cash Price	$16.84
Rate for Payer: Health Partners Plans Commercial	$20.90
Rate for Payer: UnitedHealthcare Commercial	$21.34
Rate for Payer: WPPA Commercial	$18.04

Tussionex Susp. ER (chlorpheniramine-hydrocodone)

Facility

$22.00

Service Code	NDC 62542030104
Hospital Charge Code	2510907
Hospital Revenue Code	250
Min. Negotiated Rate	$10.16
Max. Negotiated Rate	$21.34
Rate for Payer: Cash Price	$16.84
Rate for Payer: Celtic Commercial/Exchange	$10.16
Rate for Payer: Health Partners Plans Commercial	$20.90
Rate for Payer: UnitedHealthcare Commercial	$21.34
Rate for Payer: WPPA Commercial	$18.48

TWIN-SITE EXT SET

Facility

$50.00

Hospital Charge Code	2580802
Hospital Revenue Code	270
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$48.50
Rate for Payer: Cash Price	$37.50
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

TWIN-SITE EXT SET

Facility

$50.00

Hospital Charge Code	2580802
Hospital Revenue Code	270
Min. Negotiated Rate	$41.00
Max. Negotiated Rate	$48.50
Rate for Payer: Cash Price	$37.50
Rate for Payer: Health Partners Plans Commercial	$47.50
Rate for Payer: UnitedHealthcare Commercial	$48.50
Rate for Payer: WPPA Commercial	$41.00

TX CLOSED ELBOW DISLOCATION

Facility

$323.00

Service Code	HCPCS 24600
Hospital Charge Code	2460000
Hospital Revenue Code	450
Min. Negotiated Rate	$264.86
Max. Negotiated Rate	$313.31
Rate for Payer: Cash Price	$242.25
Rate for Payer: Health Partners Plans Commercial	$306.85
Rate for Payer: UnitedHealthcare Commercial	$313.31
Rate for Payer: WPPA Commercial	$264.86

TX CLOSED ELBOW DISLOCATION

Facility

$323.00

Service Code	HCPCS 24600
Hospital Charge Code	2460000
Hospital Revenue Code	450
Min. Negotiated Rate	$149.23
Max. Negotiated Rate	$809.01
Rate for Payer: BCBS Commercial	$809.01
Rate for Payer: Cash Price	$242.25
Rate for Payer: Cash Price	$242.25
Rate for Payer: Celtic Commercial/Exchange	$149.23
Rate for Payer: Health Partners Plans Commercial	$306.85
Rate for Payer: UnitedHealthcare Commercial	$313.31
Rate for Payer: WPPA Commercial	$271.32

TX CLSD ELBOW DSLCTN REQ ANES

Facility

$1,435.00

Service Code	HCPCS 24605
Hospital Charge Code	2460500
Hospital Revenue Code	761
Min. Negotiated Rate	$1,176.70
Max. Negotiated Rate	$1,391.95
Rate for Payer: Cash Price	$1,076.25
Rate for Payer: Health Partners Plans Commercial	$1,363.25
Rate for Payer: UnitedHealthcare Commercial	$1,391.95
Rate for Payer: WPPA Commercial	$1,176.70

TX CLSD ELBOW DSLCTN REQ ANES

Facility

$1,435.00

Service Code	HCPCS 24605
Hospital Charge Code	2460500
Hospital Revenue Code	761
Min. Negotiated Rate	$662.97
Max. Negotiated Rate	$1,391.95
Rate for Payer: BCBS Commercial	$1,117.06
Rate for Payer: Cash Price	$1,076.25
Rate for Payer: Cash Price	$1,076.25
Rate for Payer: Celtic Commercial/Exchange	$662.97
Rate for Payer: Health Partners Plans Commercial	$1,363.25
Rate for Payer: UnitedHealthcare Commercial	$1,391.95
Rate for Payer: WPPA Commercial	$1,205.40

TX CLSD SHLDR DISC W/MAN ANES

Facility

$1,935.00

Service Code	HCPCS 23655
Hospital Charge Code	2365500
Hospital Revenue Code	450
Min. Negotiated Rate	$1,586.70
Max. Negotiated Rate	$1,876.95
Rate for Payer: Cash Price	$1,451.25
Rate for Payer: Health Partners Plans Commercial	$1,838.25
Rate for Payer: UnitedHealthcare Commercial	$1,876.95
Rate for Payer: WPPA Commercial	$1,586.70

TX CLSD SHLDR DISC W/MAN ANES

Facility

$1,935.00

Service Code	HCPCS 23655
Hospital Charge Code	2365500
Hospital Revenue Code	450
Min. Negotiated Rate	$809.01
Max. Negotiated Rate	$1,876.95
Rate for Payer: BCBS Commercial	$809.01
Rate for Payer: Cash Price	$1,451.25
Rate for Payer: Cash Price	$1,451.25
Rate for Payer: Celtic Commercial/Exchange	$893.97
Rate for Payer: Health Partners Plans Commercial	$1,838.25
Rate for Payer: UnitedHealthcare Commercial	$1,876.95
Rate for Payer: WPPA Commercial	$1,625.40

TYLENOL 1000 MG PREMIX (ACETAMINOPHEN / OFIRMEV)

Facility

$43.00

Service Code	NDC 25021070587
Hospital Charge Code	2512093
Hospital Revenue Code	250
Min. Negotiated Rate	$19.87
Max. Negotiated Rate	$41.71
Rate for Payer: Cash Price	$32.44
Rate for Payer: Celtic Commercial/Exchange	$19.87
Rate for Payer: Health Partners Plans Commercial	$40.85
Rate for Payer: UnitedHealthcare Commercial	$41.71
Rate for Payer: WPPA Commercial	$36.12

TYLENOL 1000 MG PREMIX (ACETAMINOPHEN / OFIRMEV)

Facility

$43.00

Service Code	NDC 25021070587
Hospital Charge Code	2512093
Hospital Revenue Code	250
Min. Negotiated Rate	$35.26
Max. Negotiated Rate	$41.71
Rate for Payer: Cash Price	$32.44
Rate for Payer: Health Partners Plans Commercial	$40.85
Rate for Payer: UnitedHealthcare Commercial	$41.71
Rate for Payer: WPPA Commercial	$35.26

TYLENOL 325 MG TAB (ACETAMINOPHEN)

Facility

$1.00

Service Code	NDC 71399102503
Hospital Charge Code	2507564
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

TYLENOL 325 MG TAB (ACETAMINOPHEN)

Facility

$1.00

Service Code	NDC 71399102503
Hospital Charge Code	2507564
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

TYLENOL #3 ELIXIR 5 ML U.D. (ACETAMINOPHEN / CODEINE)

Facility

$4.00

Service Code	NDC 50383007906
Hospital Charge Code	2507598
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

TYLENOL #3 ELIXIR 5 ML U.D. (ACETAMINOPHEN / CODEINE)

Facility

$4.00

Service Code	NDC 50383007906
Hospital Charge Code	2507598
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

TYLENOL #3 TAB (ACETAMINOPHEN / CODEINE)

Facility

$3.00

Service Code	NDC 00406048462
Hospital Charge Code	2507580
Hospital Revenue Code	250
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.25
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

TYLENOL #3 TAB (ACETAMINOPHEN / CODEINE)

Facility

$3.00

Service Code	NDC 00406048462
Hospital Charge Code	2507580
Hospital Revenue Code	250
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.25
Rate for Payer: Health Partners Plans Commercial	$2.85
Rate for Payer: UnitedHealthcare Commercial	$2.91
Rate for Payer: WPPA Commercial	$2.46

TYLENOL CHEWABLE 80 MG TAB (ACETAMINOPHEN)

Facility

$1.00

Service Code	NDC 00904579146
Hospital Charge Code	2507556
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

TYLENOL CHEWABLE 80 MG TAB (ACETAMINOPHEN)

Facility

$1.00

Service Code	NDC 00904579146
Hospital Charge Code	2507556
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

TYLENOL ES 500 MG CAP (ACETAMINOPHEN)

Facility

$1.00

Service Code	NDC 50580045711
Hospital Charge Code	2507549
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

Know your out-of-pocket cost for care.

All Charges