Ness County Hospital

All Charges

Charge

Type

Setting

Price

ATHEROSCLEROSIS WITHOUT MCC

Facility

$6,014.04

Service Code	MSDRG 303
Min. Negotiated Rate	$6,014.04
Max. Negotiated Rate	$6,014.04
Rate for Payer: BCBS Commercial	$6,014.04

ATIVAN 0.5 MG TAB(LORAZEPAM)

Facility

$2.00

Service Code	NDC 60687040101
Hospital Charge Code	2500726
Hospital Revenue Code	250
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.80
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

ATIVAN 0.5 MG TAB(LORAZEPAM)

Facility

$2.00

Service Code	NDC 60687040101
Hospital Charge Code	2500726
Hospital Revenue Code	250
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.80
Rate for Payer: Health Partners Plans Commercial	$1.90
Rate for Payer: UnitedHealthcare Commercial	$1.94
Rate for Payer: WPPA Commercial	$1.64

ATIVAN 1 MG TAB (LORAZEPAM)

Facility

$2.00

Service Code	NDC 00093342601
Hospital Charge Code	2500734
Hospital Revenue Code	250
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$2.17
Rate for Payer: Health Partners Plans Commercial	$1.90
Rate for Payer: UnitedHealthcare Commercial	$1.94
Rate for Payer: WPPA Commercial	$1.64

ATIVAN 1 MG TAB (LORAZEPAM)

Facility

$2.00

Service Code	NDC 00093342601
Hospital Charge Code	2500734
Hospital Revenue Code	250
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$2.17
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

ATIVAN 2MG/ML INJ.(LORAZEPAM)

Facility

$39.00

Service Code	NDC 00641604801
Hospital Charge Code	2500742
Hospital Revenue Code	250
Min. Negotiated Rate	$18.02
Max. Negotiated Rate	$37.83
Rate for Payer: Cash Price	$29.92
Rate for Payer: Celtic Commercial/Exchange	$18.02
Rate for Payer: Health Partners Plans Commercial	$37.05
Rate for Payer: UnitedHealthcare Commercial	$37.83
Rate for Payer: WPPA Commercial	$32.76

ATIVAN 2MG/ML INJ.(LORAZEPAM)

Facility

$39.00

Service Code	NDC 00641604801
Hospital Charge Code	2500742
Hospital Revenue Code	250
Min. Negotiated Rate	$31.98
Max. Negotiated Rate	$37.83
Rate for Payer: Cash Price	$29.92
Rate for Payer: Health Partners Plans Commercial	$37.05
Rate for Payer: UnitedHealthcare Commercial	$37.83
Rate for Payer: WPPA Commercial	$31.98

ATIVAN-INTENSOL(LORAZEPAM) 2MG/ML OS

Facility

$4.00

Service Code	NDC 00054353244
Hospital Charge Code	2510683
Hospital Revenue Code	250
Min. Negotiated Rate	$3.28
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$3.64
Rate for Payer: Health Partners Plans Commercial	$3.80
Rate for Payer: UnitedHealthcare Commercial	$3.88
Rate for Payer: WPPA Commercial	$3.28

ATIVAN-INTENSOL(LORAZEPAM) 2MG/ML OS

Facility

$4.00

Service Code	NDC 00054353244
Hospital Charge Code	2510683
Hospital Revenue Code	250
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$3.64
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

ATRIUM EXPRESS CHEST DRAIN

Facility

$165.00

Hospital Charge Code	4100326
Hospital Revenue Code	272
Min. Negotiated Rate	$76.23
Max. Negotiated Rate	$160.05
Rate for Payer: Cash Price	$123.75
Rate for Payer: Celtic Commercial/Exchange	$76.23
Rate for Payer: Health Partners Plans Commercial	$156.75
Rate for Payer: UnitedHealthcare Commercial	$160.05
Rate for Payer: WPPA Commercial	$138.60

ATRIUM EXPRESS CHEST DRAIN

Facility

$165.00

Hospital Charge Code	4100326
Hospital Revenue Code	272
Min. Negotiated Rate	$135.30
Max. Negotiated Rate	$160.05
Rate for Payer: Cash Price	$123.75
Rate for Payer: Health Partners Plans Commercial	$156.75
Rate for Payer: UnitedHealthcare Commercial	$160.05
Rate for Payer: WPPA Commercial	$135.30

ATROPINE 0.1mg/ml - 10 ml syringe

Facility

$90.00

Service Code	NDC 76329334001
Hospital Charge Code	2500775
Hospital Revenue Code	250
Min. Negotiated Rate	$73.80
Max. Negotiated Rate	$87.30
Rate for Payer: Cash Price	$67.76
Rate for Payer: Health Partners Plans Commercial	$85.50
Rate for Payer: UnitedHealthcare Commercial	$87.30
Rate for Payer: WPPA Commercial	$73.80

ATROPINE 0.1mg/ml - 10 ml syringe

Facility

$90.00

Service Code	NDC 76329334001
Hospital Charge Code	2500775
Hospital Revenue Code	250
Min. Negotiated Rate	$41.58
Max. Negotiated Rate	$87.30
Rate for Payer: Cash Price	$67.76
Rate for Payer: Celtic Commercial/Exchange	$41.58
Rate for Payer: Health Partners Plans Commercial	$85.50
Rate for Payer: UnitedHealthcare Commercial	$87.30
Rate for Payer: WPPA Commercial	$75.60

ATROPINE 1% EYE DROPS

Facility

$143.00

Service Code	NDC 17478021502
Hospital Charge Code	2510162
Hospital Revenue Code	250
Min. Negotiated Rate	$117.26
Max. Negotiated Rate	$138.71
Rate for Payer: Cash Price	$107.70
Rate for Payer: Health Partners Plans Commercial	$135.85
Rate for Payer: UnitedHealthcare Commercial	$138.71
Rate for Payer: WPPA Commercial	$117.26

ATROPINE 1% EYE DROPS

Facility

$143.00

Service Code	NDC 17478021502
Hospital Charge Code	2510162
Hospital Revenue Code	250
Min. Negotiated Rate	$66.07
Max. Negotiated Rate	$138.71
Rate for Payer: Cash Price	$107.70
Rate for Payer: Celtic Commercial/Exchange	$66.07
Rate for Payer: Health Partners Plans Commercial	$135.85
Rate for Payer: UnitedHealthcare Commercial	$138.71
Rate for Payer: WPPA Commercial	$120.12

ATROPINE O.4MG/ml inj.

Facility

$35.00

Service Code	NDC 00641600610
Hospital Charge Code	2500767
Hospital Revenue Code	250
Min. Negotiated Rate	$28.70
Max. Negotiated Rate	$33.95
Rate for Payer: Cash Price	$26.42
Rate for Payer: Health Partners Plans Commercial	$33.25
Rate for Payer: UnitedHealthcare Commercial	$33.95
Rate for Payer: WPPA Commercial	$28.70

ATROPINE O.4MG/ml inj.

Facility

$35.00

Service Code	NDC 00641600610
Hospital Charge Code	2500767
Hospital Revenue Code	250
Min. Negotiated Rate	$16.17
Max. Negotiated Rate	$33.95
Rate for Payer: Cash Price	$26.42
Rate for Payer: Celtic Commercial/Exchange	$16.17
Rate for Payer: Health Partners Plans Commercial	$33.25
Rate for Payer: UnitedHealthcare Commercial	$33.95
Rate for Payer: WPPA Commercial	$29.40

ATROVENT 0.06% - NASAL SPRAY 15ML(IPRATROPIUM BROMIDE)

Facility

$349.00

Service Code	NDC 00054004641
Hospital Charge Code	2512960
Hospital Revenue Code	250
Min. Negotiated Rate	$161.24
Max. Negotiated Rate	$338.53
Rate for Payer: Cash Price	$262.27
Rate for Payer: Celtic Commercial/Exchange	$161.24
Rate for Payer: Health Partners Plans Commercial	$331.55
Rate for Payer: UnitedHealthcare Commercial	$338.53
Rate for Payer: WPPA Commercial	$293.16

ATROVENT 0.06% - NASAL SPRAY 15ML(IPRATROPIUM BROMIDE)

Facility

$349.00

Service Code	NDC 00054004641
Hospital Charge Code	2512960
Hospital Revenue Code	250
Min. Negotiated Rate	$286.18
Max. Negotiated Rate	$338.53
Rate for Payer: Cash Price	$262.27
Rate for Payer: Health Partners Plans Commercial	$331.55
Rate for Payer: UnitedHealthcare Commercial	$338.53
Rate for Payer: WPPA Commercial	$286.18

AUGMENTIN 250 MG/5 ML OS 75 ML (AMOXICILLIN & CLAVULANATE POTASSIUM)

Facility

$339.00

Service Code	NDC 60432006575
Hospital Charge Code	2516748
Hospital Revenue Code	250
Min. Negotiated Rate	$156.62
Max. Negotiated Rate	$328.83
Rate for Payer: Cash Price	$254.85
Rate for Payer: Celtic Commercial/Exchange	$156.62
Rate for Payer: Health Partners Plans Commercial	$322.05
Rate for Payer: UnitedHealthcare Commercial	$328.83
Rate for Payer: WPPA Commercial	$284.76

AUGMENTIN 250 MG/5 ML OS 75 ML (AMOXICILLIN & CLAVULANATE POTASSIUM)

Facility

$339.00

Service Code	NDC 60432006575
Hospital Charge Code	2516748
Hospital Revenue Code	250
Min. Negotiated Rate	$277.98
Max. Negotiated Rate	$328.83
Rate for Payer: Cash Price	$254.85
Rate for Payer: Health Partners Plans Commercial	$322.05
Rate for Payer: UnitedHealthcare Commercial	$328.83
Rate for Payer: WPPA Commercial	$277.98

AUGMENTIN 500 MG TAB (AMOXICILLIN & CLAVULANATE POTASSIUM)

Facility

$17.00

Service Code	NDC 66685100200
Hospital Charge Code	2511715
Hospital Revenue Code	250
Min. Negotiated Rate	$13.94
Max. Negotiated Rate	$16.49
Rate for Payer: Cash Price	$12.82
Rate for Payer: Health Partners Plans Commercial	$16.15
Rate for Payer: UnitedHealthcare Commercial	$16.49
Rate for Payer: WPPA Commercial	$13.94

AUGMENTIN 500 MG TAB (AMOXICILLIN & CLAVULANATE POTASSIUM)

Facility

$17.00

Service Code	NDC 66685100200
Hospital Charge Code	2511715
Hospital Revenue Code	250
Min. Negotiated Rate	$7.85
Max. Negotiated Rate	$16.49
Rate for Payer: Cash Price	$12.82
Rate for Payer: Celtic Commercial/Exchange	$7.85
Rate for Payer: Health Partners Plans Commercial	$16.15
Rate for Payer: UnitedHealthcare Commercial	$16.49
Rate for Payer: WPPA Commercial	$14.28

AUGMENTIN 875 MG TAB (AMOXICILLIN & CLAVULANATE POTASSIUM)

Facility

$16.00

Service Code	NDC 65862050320
Hospital Charge Code	2514321
Hospital Revenue Code	250
Min. Negotiated Rate	$7.39
Max. Negotiated Rate	$15.52
Rate for Payer: Cash Price	$12.64
Rate for Payer: Celtic Commercial/Exchange	$7.39
Rate for Payer: Health Partners Plans Commercial	$15.20
Rate for Payer: UnitedHealthcare Commercial	$15.52
Rate for Payer: WPPA Commercial	$13.44

AUGMENTIN 875 MG TAB (AMOXICILLIN & CLAVULANATE POTASSIUM)

Facility

$16.00

Service Code	NDC 65862050320
Hospital Charge Code	2514321
Hospital Revenue Code	250
Min. Negotiated Rate	$13.12
Max. Negotiated Rate	$15.52
Rate for Payer: Cash Price	$12.64
Rate for Payer: Health Partners Plans Commercial	$15.20
Rate for Payer: UnitedHealthcare Commercial	$15.52
Rate for Payer: WPPA Commercial	$13.12

Know your out-of-pocket cost for care.

All Charges