Ness County Hospital

All Charges

Charge

Type

Setting

Price

TYLENOL ES 500 MG CAP (ACETAMINOPHEN)

Facility

$1.00

Service Code	NDC 50580045711
Hospital Charge Code	2507549
Hospital Revenue Code	250
Min. Negotiated Rate	$0.46
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 EX STRENGTH LIQ 15ML

Facility

$1.00

Hospital Charge Code	2509644
Hospital Revenue Code	250
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.86
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 EX STRENGTH LIQ 15ML

Facility

$1.00

Hospital Charge Code	2509644
Hospital Revenue Code	250
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.86
Rate for Payer: Health Partners Plans Commercial	$0.95
Rate for Payer: UnitedHealthcare Commercial	$0.97
Rate for Payer: WPPA Commercial	$0.82

TYLENOL INFANT DROPS 160MG/5ML

Facility

$3.00

Hospital Charge Code	2508240
Hospital Revenue Code	250
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.47
Rate for Payer: Health Partners Plans Commercial	$2.85
Rate for Payer: UnitedHealthcare Commercial	$2.91
Rate for Payer: WPPA Commercial	$2.46

TYLENOL INFANT DROPS 160MG/5ML

Facility

$3.00

Hospital Charge Code	2508240
Hospital Revenue Code	250
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.47
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 PM TAB

Facility

$1.00

Hospital Charge Code	2516292
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 PM TAB

Facility

$1.00

Hospital Charge Code	2516292
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 SUPP 120 MG (ACETAMINOPHEN)

Facility

$4.00

Service Code	NDC 45802073230
Hospital Charge Code	2500056
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

TYLENOL SUPP 120 MG (ACETAMINOPHEN)

Facility

$4.00

Service Code	NDC 45802073230
Hospital Charge Code	2500056
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

TYLENOL SUPP 325 MG (ACETAMINOPHEN)

Facility

$4.00

Service Code	NDC 51672211602
Hospital Charge Code	2514669
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

TYLENOL SUPP 325 MG (ACETAMINOPHEN)

Facility

$4.00

Service Code	NDC 51672211602
Hospital Charge Code	2514669
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

TYLENOL SUPP 650MG (ACETAMINOPHEN)

Facility

$4.00

Service Code	NDC 45802073030
Hospital Charge Code	2514677
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

TYLENOL SUPP 650MG (ACETAMINOPHEN)

Facility

$4.00

Service Code	NDC 45802073030
Hospital Charge Code	2514677
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

UA COLLECTION BAG-NEW BORN

Facility

$10.00

Hospital Charge Code	2720274
Hospital Revenue Code	272
Min. Negotiated Rate	$8.20
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$7.69
Rate for Payer: Health Partners Plans Commercial	$9.50
Rate for Payer: UnitedHealthcare Commercial	$9.70
Rate for Payer: WPPA Commercial	$8.20

UA COLLECTION BAG-NEW BORN

Facility

$10.00

Hospital Charge Code	2720274
Hospital Revenue Code	272
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$7.69
Rate for Payer: Celtic Commercial/Exchange	$4.62
Rate for Payer: Health Partners Plans Commercial	$9.50
Rate for Payer: UnitedHealthcare Commercial	$9.70
Rate for Payer: WPPA Commercial	$8.40

UA,DIP STICK,NON AUTO,W/MICRO

Facility

$51.00

Service Code	HCPCS 81000
Hospital Charge Code	8100000
Hospital Revenue Code	307
Min. Negotiated Rate	$15.54
Max. Negotiated Rate	$49.47
Rate for Payer: BCBS Commercial	$15.54
Rate for Payer: Cash Price	$38.25
Rate for Payer: Cash Price	$38.25
Rate for Payer: Celtic Commercial/Exchange	$23.56
Rate for Payer: Health Partners Plans Commercial	$48.45
Rate for Payer: UnitedHealthcare Commercial	$49.47
Rate for Payer: WPPA Commercial	$42.84

UA,DIP STICK,NON AUTO,W/MICRO

Facility

$51.00

Service Code	HCPCS 81000
Hospital Charge Code	8100000
Hospital Revenue Code	307
Min. Negotiated Rate	$41.82
Max. Negotiated Rate	$49.47
Rate for Payer: Cash Price	$38.25
Rate for Payer: Health Partners Plans Commercial	$48.45
Rate for Payer: UnitedHealthcare Commercial	$49.47
Rate for Payer: WPPA Commercial	$41.82

UA,DIPSTICK NON-AUTO,W/O MICRO

Facility

$24.00

Service Code	HCPCS 81002
Hospital Charge Code	8100200
Hospital Revenue Code	307
Min. Negotiated Rate	$19.68
Max. Negotiated Rate	$23.28
Rate for Payer: Cash Price	$18.00
Rate for Payer: Health Partners Plans Commercial	$22.80
Rate for Payer: UnitedHealthcare Commercial	$23.28
Rate for Payer: WPPA Commercial	$19.68

UA,DIPSTICK NON-AUTO,W/O MICRO

Facility

$24.00

Service Code	HCPCS 81002
Hospital Charge Code	8100200
Hospital Revenue Code	307
Min. Negotiated Rate	$10.36
Max. Negotiated Rate	$23.28
Rate for Payer: BCBS Commercial	$10.36
Rate for Payer: Cash Price	$18.00
Rate for Payer: Cash Price	$18.00
Rate for Payer: Celtic Commercial/Exchange	$11.09
Rate for Payer: Health Partners Plans Commercial	$22.80
Rate for Payer: UnitedHealthcare Commercial	$23.28
Rate for Payer: WPPA Commercial	$20.16

UA PREG TEST,COLOR COMP MTHODS

Facility

$66.00

Service Code	HCPCS 81025
Hospital Charge Code	8102500
Hospital Revenue Code	307
Min. Negotiated Rate	$27.14
Max. Negotiated Rate	$64.02
Rate for Payer: BCBS Commercial	$27.14
Rate for Payer: Cash Price	$49.50
Rate for Payer: Cash Price	$49.50
Rate for Payer: Celtic Commercial/Exchange	$30.49
Rate for Payer: Health Partners Plans Commercial	$62.70
Rate for Payer: UnitedHealthcare Commercial	$64.02
Rate for Payer: WPPA Commercial	$55.44

UA PREG TEST,COLOR COMP MTHODS

Facility

$66.00

Service Code	HCPCS 81025
Hospital Charge Code	8102500
Hospital Revenue Code	307
Min. Negotiated Rate	$54.12
Max. Negotiated Rate	$64.02
Rate for Payer: Cash Price	$49.50
Rate for Payer: Health Partners Plans Commercial	$62.70
Rate for Payer: UnitedHealthcare Commercial	$64.02
Rate for Payer: WPPA Commercial	$54.12

UA, QUAL/SEMIQUAN,MICROSCOPIC

Facility

$32.00

Service Code	HCPCS 81015
Hospital Charge Code	8101500
Hospital Revenue Code	307
Min. Negotiated Rate	$9.76
Max. Negotiated Rate	$31.04
Rate for Payer: BCBS Commercial	$9.76
Rate for Payer: Cash Price	$24.00
Rate for Payer: Cash Price	$24.00
Rate for Payer: Celtic Commercial/Exchange	$14.78
Rate for Payer: Health Partners Plans Commercial	$30.40
Rate for Payer: UnitedHealthcare Commercial	$31.04
Rate for Payer: WPPA Commercial	$26.88

UA, QUAL/SEMIQUAN,MICROSCOPIC

Facility

$32.00

Service Code	HCPCS 81015
Hospital Charge Code	8101500
Hospital Revenue Code	307
Min. Negotiated Rate	$26.24
Max. Negotiated Rate	$31.04
Rate for Payer: Cash Price	$24.00
Rate for Payer: Health Partners Plans Commercial	$30.40
Rate for Payer: UnitedHealthcare Commercial	$31.04
Rate for Payer: WPPA Commercial	$26.24

UA, VOL MSRMNT, TIMD COLL EACH

Facility

$21.00

Service Code	HCPCS 81050
Hospital Charge Code	8105000
Hospital Revenue Code	307
Min. Negotiated Rate	$17.22
Max. Negotiated Rate	$20.37
Rate for Payer: Cash Price	$15.75
Rate for Payer: Health Partners Plans Commercial	$19.95
Rate for Payer: UnitedHealthcare Commercial	$20.37
Rate for Payer: WPPA Commercial	$17.22

UA, VOL MSRMNT, TIMD COLL EACH

Facility

$21.00

Service Code	HCPCS 81050
Hospital Charge Code	8105000
Hospital Revenue Code	307
Min. Negotiated Rate	$9.70
Max. Negotiated Rate	$20.37
Rate for Payer: BCBS Commercial	$10.59
Rate for Payer: Cash Price	$15.75
Rate for Payer: Cash Price	$15.75
Rate for Payer: Celtic Commercial/Exchange	$9.70
Rate for Payer: Health Partners Plans Commercial	$19.95
Rate for Payer: UnitedHealthcare Commercial	$20.37
Rate for Payer: WPPA Commercial	$17.64

Know your out-of-pocket cost for care.

All Charges