Ness County Hospital

All Charges

Charge

Type

Setting

Price

BD ANGIOCATH

Facility

$103.00

Hospital Charge Code	2727455
Hospital Revenue Code	270
Min. Negotiated Rate	$47.59
Max. Negotiated Rate	$99.91
Rate for Payer: Cash Price	$77.25
Rate for Payer: Celtic Commercial/Exchange	$47.59
Rate for Payer: Health Partners Plans Commercial	$97.85
Rate for Payer: UnitedHealthcare Commercial	$99.91
Rate for Payer: WPPA Commercial	$86.52

BEBRIDE NAILS >5

Facility

$400.00

Service Code	HCPCS 11721
Hospital Charge Code	1172123
Hospital Revenue Code	761
Min. Negotiated Rate	$69.46
Max. Negotiated Rate	$388.00
Rate for Payer: BCBS Commercial	$69.46
Rate for Payer: Cash Price	$300.00
Rate for Payer: Cash Price	$300.00
Rate for Payer: Celtic Commercial/Exchange	$184.80
Rate for Payer: Health Partners Plans Commercial	$380.00
Rate for Payer: UnitedHealthcare Commercial	$388.00
Rate for Payer: WPPA Commercial	$336.00

BEBRIDE NAILS >5

Facility

$400.00

Service Code	HCPCS 11721
Hospital Charge Code	1172123
Hospital Revenue Code	761
Min. Negotiated Rate	$328.00
Max. Negotiated Rate	$388.00
Rate for Payer: Cash Price	$300.00
Rate for Payer: Health Partners Plans Commercial	$380.00
Rate for Payer: UnitedHealthcare Commercial	$388.00
Rate for Payer: WPPA Commercial	$328.00

BED ALARM PAD 20X30

Facility

$100.00

Hospital Charge Code	9991364
Hospital Revenue Code	990
Min. Negotiated Rate	$82.00
Max. Negotiated Rate	$97.00
Rate for Payer: Cash Price	$75.00
Rate for Payer: Health Partners Plans Commercial	$95.00
Rate for Payer: UnitedHealthcare Commercial	$97.00
Rate for Payer: WPPA Commercial	$82.00

BED ALARM PAD 20X30

Facility

$100.00

Hospital Charge Code	9991364
Hospital Revenue Code	990
Min. Negotiated Rate	$46.20
Max. Negotiated Rate	$97.00
Rate for Payer: Cash Price	$75.00
Rate for Payer: Celtic Commercial/Exchange	$46.20
Rate for Payer: Health Partners Plans Commercial	$95.00
Rate for Payer: UnitedHealthcare Commercial	$97.00
Rate for Payer: WPPA Commercial	$84.00

BEHAVIORAL AND DEVELOPMENTAL DISORDERS

Facility

$13,574.40

Service Code	MSDRG 886
Min. Negotiated Rate	$13,574.40
Max. Negotiated Rate	$13,574.40
Rate for Payer: BCBS Commercial	$13,574.40

BENADRYL 25MG CAP(DIPHENHYDRAMINE)

Facility

$2.00

Service Code	NDC 24385047978
Hospital Charge Code	2500874
Hospital Revenue Code	250
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.50
Rate for Payer: Health Partners Plans Commercial	$1.90
Rate for Payer: UnitedHealthcare Commercial	$1.94
Rate for Payer: WPPA Commercial	$1.64

BENADRYL 25MG CAP(DIPHENHYDRAMINE)

Facility

$2.00

Service Code	NDC 24385047978
Hospital Charge Code	2500874
Hospital Revenue Code	250
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.50
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

BENADRYL 50 MG/ML INJ. (DIPHENHYDRAMINE HCL)

Facility

$25.00

Service Code	NDC 00641037621
Hospital Charge Code	2500890
Hospital Revenue Code	250
Min. Negotiated Rate	$20.50
Max. Negotiated Rate	$24.25
Rate for Payer: Cash Price	$18.75
Rate for Payer: Health Partners Plans Commercial	$23.75
Rate for Payer: UnitedHealthcare Commercial	$24.25
Rate for Payer: WPPA Commercial	$20.50

BENADRYL 50 MG/ML INJ. (DIPHENHYDRAMINE HCL)

Facility

$25.00

Service Code	NDC 00641037621
Hospital Charge Code	2500890
Hospital Revenue Code	250
Min. Negotiated Rate	$11.55
Max. Negotiated Rate	$24.25
Rate for Payer: Cash Price	$18.75
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

BENADRYL CREAM 30 GM TUBE (ANTI-ITCH CREAM) (BANOPHEN)

Facility

$13.00

Service Code	NDC 00904535431
Hospital Charge Code	2500908
Hospital Revenue Code	250
Min. Negotiated Rate	$10.66
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$9.79
Rate for Payer: Health Partners Plans Commercial	$12.35
Rate for Payer: UnitedHealthcare Commercial	$12.61
Rate for Payer: WPPA Commercial	$10.66

BENADRYL CREAM 30 GM TUBE (ANTI-ITCH CREAM) (BANOPHEN)

Facility

$13.00

Service Code	NDC 00904535431
Hospital Charge Code	2500908
Hospital Revenue Code	250
Min. Negotiated Rate	$6.01
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$9.79
Rate for Payer: Celtic Commercial/Exchange	$6.01
Rate for Payer: Health Partners Plans Commercial	$12.35
Rate for Payer: UnitedHealthcare Commercial	$12.61
Rate for Payer: WPPA Commercial	$10.92

BENADRYL ELIXIR 25 MG/10 ML U.D. (DIPHENHYDRAMINE)

Facility

$8.00

Service Code	NDC 00121173030
Hospital Charge Code	2516664
Hospital Revenue Code	250
Min. Negotiated Rate	$6.56
Max. Negotiated Rate	$7.76
Rate for Payer: Cash Price	$6.56
Rate for Payer: Health Partners Plans Commercial	$7.60
Rate for Payer: UnitedHealthcare Commercial	$7.76
Rate for Payer: WPPA Commercial	$6.56

BENADRYL ELIXIR 25 MG/10 ML U.D. (DIPHENHYDRAMINE)

Facility

$8.00

Service Code	NDC 00121173030
Hospital Charge Code	2516664
Hospital Revenue Code	250
Min. Negotiated Rate	$3.70
Max. Negotiated Rate	$7.76
Rate for Payer: Cash Price	$6.56
Rate for Payer: Celtic Commercial/Exchange	$3.70
Rate for Payer: Health Partners Plans Commercial	$7.60
Rate for Payer: UnitedHealthcare Commercial	$7.76
Rate for Payer: WPPA Commercial	$6.72

BENICAR 5 MG TAB (OLMESARTAN)

Facility

$17.00

Service Code	NDC 68462043630
Hospital Charge Code	2518819
Hospital Revenue Code	250
Min. Negotiated Rate	$13.94
Max. Negotiated Rate	$16.49
Rate for Payer: Cash Price	$12.75
Rate for Payer: Health Partners Plans Commercial	$16.15
Rate for Payer: UnitedHealthcare Commercial	$16.49
Rate for Payer: WPPA Commercial	$13.94

BENICAR 5 MG TAB (OLMESARTAN)

Facility

$17.00

Service Code	NDC 68462043630
Hospital Charge Code	2518819
Hospital Revenue Code	250
Min. Negotiated Rate	$7.85
Max. Negotiated Rate	$16.49
Rate for Payer: Cash Price	$12.75
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

BENIGN LESION DIAMETER-1.1-2.0

Facility

$636.00

Service Code	HCPCS 11402
Hospital Charge Code	1140200
Hospital Revenue Code	761
Min. Negotiated Rate	$521.52
Max. Negotiated Rate	$616.92
Rate for Payer: Cash Price	$477.00
Rate for Payer: Health Partners Plans Commercial	$604.20
Rate for Payer: UnitedHealthcare Commercial	$616.92
Rate for Payer: WPPA Commercial	$521.52

BENIGN LESION DIAMETER-1.1-2.0

Facility

$636.00

Service Code	HCPCS 11402
Hospital Charge Code	1140200
Hospital Revenue Code	761
Min. Negotiated Rate	$293.83
Max. Negotiated Rate	$879.49
Rate for Payer: BCBS Commercial	$879.49
Rate for Payer: Cash Price	$477.00
Rate for Payer: Cash Price	$477.00
Rate for Payer: Celtic Commercial/Exchange	$293.83
Rate for Payer: Health Partners Plans Commercial	$604.20
Rate for Payer: UnitedHealthcare Commercial	$616.92
Rate for Payer: WPPA Commercial	$534.24

BENIGN PROSTATIC HYPERTROPHY WITH MCC

Facility

$11,409.45

Service Code	MSDRG 725
Min. Negotiated Rate	$11,409.45
Max. Negotiated Rate	$11,409.45
Rate for Payer: BCBS Commercial	$11,409.45

BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC

Facility

$6,609.58

Service Code	MSDRG 726
Min. Negotiated Rate	$6,609.58
Max. Negotiated Rate	$6,609.58
Rate for Payer: BCBS Commercial	$6,609.58

BENTYL 10 MG CAP (DICYCLOMINE)

Facility

$4.00

Service Code	NDC 60687036901
Hospital Charge Code	2500932
Hospital Revenue Code	250
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$3.22
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

BENTYL 10 MG CAP (DICYCLOMINE)

Facility

$4.00

Service Code	NDC 60687036901
Hospital Charge Code	2500932
Hospital Revenue Code	250
Min. Negotiated Rate	$3.28
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$3.22
Rate for Payer: Health Partners Plans Commercial	$3.80
Rate for Payer: UnitedHealthcare Commercial	$3.88
Rate for Payer: WPPA Commercial	$3.28

BENTYL 20 MG/2 ML INJ. (DICYCLOMINE HCL)

Facility

$302.00

Service Code	NDC 58914008052
Hospital Charge Code	2500940
Hospital Revenue Code	250
Min. Negotiated Rate	$247.64
Max. Negotiated Rate	$292.94
Rate for Payer: Cash Price	$227.02
Rate for Payer: Health Partners Plans Commercial	$286.90
Rate for Payer: UnitedHealthcare Commercial	$292.94
Rate for Payer: WPPA Commercial	$247.64

BENTYL 20 MG/2 ML INJ. (DICYCLOMINE HCL)

Facility

$302.00

Service Code	NDC 58914008052
Hospital Charge Code	2500940
Hospital Revenue Code	250
Min. Negotiated Rate	$139.52
Max. Negotiated Rate	$292.94
Rate for Payer: Cash Price	$227.02
Rate for Payer: Celtic Commercial/Exchange	$139.52
Rate for Payer: Health Partners Plans Commercial	$286.90
Rate for Payer: UnitedHealthcare Commercial	$292.94
Rate for Payer: WPPA Commercial	$253.68

BENZOIN SEPPS TOPICAL

Facility

$4.00

Hospital Charge Code	2500957
Hospital Revenue Code	270
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

Know your out-of-pocket cost for care.

All Charges