Ness County Hospital

All Charges

Charge

Type

Setting

Price

AUGMENTIN ES 600 MG/5 ML 75 ML OS (AMOXICILLIN & CLAVULANATE POTASSIUM)

Facility

$155.00

Service Code	NDC 00781613957
Hospital Charge Code	2518306
Hospital Revenue Code	250
Min. Negotiated Rate	$127.10
Max. Negotiated Rate	$150.35
Rate for Payer: Cash Price	$116.62
Rate for Payer: Health Partners Plans Commercial	$147.25
Rate for Payer: UnitedHealthcare Commercial	$150.35
Rate for Payer: WPPA Commercial	$127.10

AUGMENTIN ES 600 MG/5 ML 75 ML OS (AMOXICILLIN & CLAVULANATE POTASSIUM)

Facility

$155.00

Service Code	NDC 00781613957
Hospital Charge Code	2518306
Hospital Revenue Code	250
Min. Negotiated Rate	$71.61
Max. Negotiated Rate	$150.35
Rate for Payer: Cash Price	$116.62
Rate for Payer: Celtic Commercial/Exchange	$71.61
Rate for Payer: Health Partners Plans Commercial	$147.25
Rate for Payer: UnitedHealthcare Commercial	$150.35
Rate for Payer: WPPA Commercial	$130.20

AUGMENTIN OS 125/5-75ML

Facility

$119.00

Hospital Charge Code	2513612
Hospital Revenue Code	250
Min. Negotiated Rate	$54.98
Max. Negotiated Rate	$115.43
Rate for Payer: Cash Price	$89.25
Rate for Payer: Celtic Commercial/Exchange	$54.98
Rate for Payer: Health Partners Plans Commercial	$113.05
Rate for Payer: UnitedHealthcare Commercial	$115.43
Rate for Payer: WPPA Commercial	$99.96

AUGMENTIN OS 125/5-75ML

Facility

$119.00

Hospital Charge Code	2513612
Hospital Revenue Code	250
Min. Negotiated Rate	$97.58
Max. Negotiated Rate	$115.43
Rate for Payer: Cash Price	$89.25
Rate for Payer: Health Partners Plans Commercial	$113.05
Rate for Payer: UnitedHealthcare Commercial	$115.43
Rate for Payer: WPPA Commercial	$97.58

AUTOLOGOUS BONE MARROW TRANSPLANT WITH CC/MCC

Facility

$66,892.80

Service Code	MSDRG 016
Min. Negotiated Rate	$66,892.80
Max. Negotiated Rate	$66,892.80
Rate for Payer: BCBS Commercial	$66,892.80

AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CC/MCC

Facility

$54,158.74

Service Code	MSDRG 017
Min. Negotiated Rate	$54,158.74
Max. Negotiated Rate	$54,158.74
Rate for Payer: BCBS Commercial	$54,158.74

AUTO PULSE LIFEBAND

Facility

$234.00

Hospital Charge Code	2705089
Hospital Revenue Code	270
Min. Negotiated Rate	$108.11
Max. Negotiated Rate	$226.98
Rate for Payer: Cash Price	$176.06
Rate for Payer: Celtic Commercial/Exchange	$108.11
Rate for Payer: Health Partners Plans Commercial	$222.30
Rate for Payer: UnitedHealthcare Commercial	$226.98
Rate for Payer: WPPA Commercial	$196.56

AUTO PULSE LIFEBAND

Facility

$234.00

Hospital Charge Code	2705089
Hospital Revenue Code	270
Min. Negotiated Rate	$191.88
Max. Negotiated Rate	$226.98
Rate for Payer: Cash Price	$176.06
Rate for Payer: Health Partners Plans Commercial	$222.30
Rate for Payer: UnitedHealthcare Commercial	$226.98
Rate for Payer: WPPA Commercial	$191.88

AVUL NAIL PLATE,PART/COMP,SMPL

Facility

$135.00

Service Code	HCPCS 11732
Hospital Charge Code	1173200
Hospital Revenue Code	450
Min. Negotiated Rate	$110.70
Max. Negotiated Rate	$130.95
Rate for Payer: Cash Price	$101.25
Rate for Payer: Health Partners Plans Commercial	$128.25
Rate for Payer: UnitedHealthcare Commercial	$130.95
Rate for Payer: WPPA Commercial	$110.70

AVUL NAIL PLATE,PART/COMP,SMPL

Facility

$135.00

Service Code	HCPCS 11732
Hospital Charge Code	1173200
Hospital Revenue Code	450
Min. Negotiated Rate	$62.37
Max. Negotiated Rate	$130.95
Rate for Payer: Cash Price	$101.25
Rate for Payer: Celtic Commercial/Exchange	$62.37
Rate for Payer: Health Partners Plans Commercial	$128.25
Rate for Payer: UnitedHealthcare Commercial	$130.95
Rate for Payer: WPPA Commercial	$113.40

AVULSION NAIL PLATE,PARTIAL OR

Facility

$203.00

Service Code	HCPCS 11730
Hospital Charge Code	1173000
Hospital Revenue Code	450
Min. Negotiated Rate	$93.79
Max. Negotiated Rate	$248.38
Rate for Payer: BCBS Commercial	$248.38
Rate for Payer: Cash Price	$152.25
Rate for Payer: Cash Price	$152.25
Rate for Payer: Celtic Commercial/Exchange	$93.79
Rate for Payer: Health Partners Plans Commercial	$192.85
Rate for Payer: UnitedHealthcare Commercial	$196.91
Rate for Payer: WPPA Commercial	$170.52

AVULSION NAIL PLATE,PARTIAL OR

Facility

$203.00

Service Code	HCPCS 11730
Hospital Charge Code	1173000
Hospital Revenue Code	450
Min. Negotiated Rate	$166.46
Max. Negotiated Rate	$196.91
Rate for Payer: Cash Price	$152.25
Rate for Payer: Health Partners Plans Commercial	$192.85
Rate for Payer: UnitedHealthcare Commercial	$196.91
Rate for Payer: WPPA Commercial	$166.46

AZILECT 0.5 MG TAB

Facility

$75.00

Hospital Charge Code	2515377
Hospital Revenue Code	250
Min. Negotiated Rate	$34.65
Max. Negotiated Rate	$72.75
Rate for Payer: Cash Price	$56.25
Rate for Payer: Celtic Commercial/Exchange	$34.65
Rate for Payer: Health Partners Plans Commercial	$71.25
Rate for Payer: UnitedHealthcare Commercial	$72.75
Rate for Payer: WPPA Commercial	$63.00

AZILECT 0.5 MG TAB

Facility

$75.00

Hospital Charge Code	2515377
Hospital Revenue Code	250
Min. Negotiated Rate	$61.50
Max. Negotiated Rate	$72.75
Rate for Payer: Cash Price	$56.25
Rate for Payer: Health Partners Plans Commercial	$71.25
Rate for Payer: UnitedHealthcare Commercial	$72.75
Rate for Payer: WPPA Commercial	$61.50

AZULFIDINE EC 500MG TAB(SULFASALAZINE DR)

Facility

$7.00

Service Code	NDC 00013010201
Hospital Charge Code	2516250
Hospital Revenue Code	250
Min. Negotiated Rate	$5.74
Max. Negotiated Rate	$6.79
Rate for Payer: Cash Price	$5.32
Rate for Payer: Health Partners Plans Commercial	$6.65
Rate for Payer: UnitedHealthcare Commercial	$6.79
Rate for Payer: WPPA Commercial	$5.74

AZULFIDINE EC 500MG TAB(SULFASALAZINE DR)

Facility

$7.00

Service Code	NDC 00013010201
Hospital Charge Code	2516250
Hospital Revenue Code	250
Min. Negotiated Rate	$3.23
Max. Negotiated Rate	$6.79
Rate for Payer: Cash Price	$5.32
Rate for Payer: Celtic Commercial/Exchange	$3.23
Rate for Payer: Health Partners Plans Commercial	$6.65
Rate for Payer: UnitedHealthcare Commercial	$6.79
Rate for Payer: WPPA Commercial	$5.88

BABY ASPIRIN CHEWABLE 81 MG TAB

Facility

$1.00

Service Code	NDC 00904679489
Hospital Charge Code	2500841
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

BABY ASPIRIN CHEWABLE 81 MG TAB

Facility

$1.00

Service Code	NDC 00904679489
Hospital Charge Code	2500841
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

BABY OIL

Facility

$5.00

Hospital Charge Code	2700052
Hospital Revenue Code	270
Min. Negotiated Rate	$4.10
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$4.31
Rate for Payer: Health Partners Plans Commercial	$4.75
Rate for Payer: UnitedHealthcare Commercial	$4.85
Rate for Payer: WPPA Commercial	$4.10

BABY OIL

Facility

$5.00

Hospital Charge Code	2700052
Hospital Revenue Code	270
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$4.31
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

Bacitracin 30 GM Top Ointment

Facility

$21.00

Service Code	NDC 24385006003
Hospital Charge Code	2500825
Hospital Revenue Code	250
Min. Negotiated Rate	$9.70
Max. Negotiated Rate	$20.37
Rate for Payer: Cash Price	$16.12
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

Bacitracin 30 GM Top Ointment

Facility

$21.00

Service Code	NDC 24385006003
Hospital Charge Code	2500825
Hospital Revenue Code	250
Min. Negotiated Rate	$17.22
Max. Negotiated Rate	$20.37
Rate for Payer: Cash Price	$16.12
Rate for Payer: Health Partners Plans Commercial	$19.95
Rate for Payer: UnitedHealthcare Commercial	$20.37
Rate for Payer: WPPA Commercial	$17.22

BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC

Facility

$17,395.99

Service Code	MSDRG 519
Min. Negotiated Rate	$17,395.99
Max. Negotiated Rate	$17,395.99
Rate for Payer: BCBS Commercial	$17,395.99

BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR

Facility

$31,835.56

Service Code	MSDRG 518
Min. Negotiated Rate	$31,835.56
Max. Negotiated Rate	$31,835.56
Rate for Payer: BCBS Commercial	$31,835.56

BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC

Facility

$12,691.34

Service Code	MSDRG 520
Min. Negotiated Rate	$12,691.34
Max. Negotiated Rate	$12,691.34
Rate for Payer: BCBS Commercial	$12,691.34

Know your out-of-pocket cost for care.

All Charges