Ness County Hospital

All Charges

Charge

Type

Setting

Price

BENZOIN SEPPS TOPICAL

Facility

$4.00

Hospital Charge Code	2500957
Hospital Revenue Code	270
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

BERRY BREEZE SUPPLEMENT-8 OZ

Facility

$1.00

Hospital Charge Code	9998900
Hospital Revenue Code	271
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.94
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

BERRY BREEZE SUPPLEMENT-8 OZ

Facility

$1.00

Hospital Charge Code	9998900
Hospital Revenue Code	271
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.94
Rate for Payer: Health Partners Plans Commercial	$0.95
Rate for Payer: UnitedHealthcare Commercial	$0.97
Rate for Payer: WPPA Commercial	$0.82

BETA 2 GLYCOPROTEIN I ANTIBODY

Facility

$207.00

Service Code	HCPCS 86146
Hospital Charge Code	8614600
Hospital Revenue Code	301
Min. Negotiated Rate	$169.74
Max. Negotiated Rate	$200.79
Rate for Payer: Cash Price	$155.25
Rate for Payer: Health Partners Plans Commercial	$196.65
Rate for Payer: UnitedHealthcare Commercial	$200.79
Rate for Payer: WPPA Commercial	$169.74

BETA 2 GLYCOPROTEIN I ANTIBODY

Facility

$207.00

Service Code	HCPCS 86146
Hospital Charge Code	8614600
Hospital Revenue Code	301
Min. Negotiated Rate	$56.77
Max. Negotiated Rate	$200.79
Rate for Payer: BCBS Commercial	$56.77
Rate for Payer: Cash Price	$155.25
Rate for Payer: Cash Price	$155.25
Rate for Payer: Celtic Commercial/Exchange	$95.63
Rate for Payer: Health Partners Plans Commercial	$196.65
Rate for Payer: UnitedHealthcare Commercial	$200.79
Rate for Payer: WPPA Commercial	$173.88

BETA-2 MICROGLOBULIN

Facility

$103.00

Service Code	HCPCS 82232
Hospital Charge Code	8223200
Hospital Revenue Code	301
Min. Negotiated Rate	$84.46
Max. Negotiated Rate	$99.91
Rate for Payer: Cash Price	$77.25
Rate for Payer: Health Partners Plans Commercial	$97.85
Rate for Payer: UnitedHealthcare Commercial	$99.91
Rate for Payer: WPPA Commercial	$84.46

BETA-2 MICROGLOBULIN

Facility

$103.00

Service Code	HCPCS 82232
Hospital Charge Code	8223200
Hospital Revenue Code	301
Min. Negotiated Rate	$42.33
Max. Negotiated Rate	$99.91
Rate for Payer: BCBS Commercial	$42.33
Rate for Payer: Cash Price	$77.25
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

BETADINE OINTMENT 1 OZ tube(POVIDINE IODINE)

Facility

$19.00

Service Code	NDC 00904110231
Hospital Charge Code	2500965
Hospital Revenue Code	250
Min. Negotiated Rate	$15.58
Max. Negotiated Rate	$18.43
Rate for Payer: Cash Price	$14.48
Rate for Payer: Health Partners Plans Commercial	$18.05
Rate for Payer: UnitedHealthcare Commercial	$18.43
Rate for Payer: WPPA Commercial	$15.58

BETADINE OINTMENT 1 OZ tube(POVIDINE IODINE)

Facility

$19.00

Service Code	NDC 00904110231
Hospital Charge Code	2500965
Hospital Revenue Code	250
Min. Negotiated Rate	$8.78
Max. Negotiated Rate	$18.43
Rate for Payer: Cash Price	$14.48
Rate for Payer: Celtic Commercial/Exchange	$8.78
Rate for Payer: Health Partners Plans Commercial	$18.05
Rate for Payer: UnitedHealthcare Commercial	$18.43
Rate for Payer: WPPA Commercial	$15.96

Betadine Solution 8 oz. bottle (povidone-iodine)

Facility

$39.00

Service Code	NDC 00904110309
Hospital Charge Code	2501005
Hospital Revenue Code	270
Min. Negotiated Rate	$18.02
Max. Negotiated Rate	$37.83
Rate for Payer: Cash Price	$29.25
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

Betadine Solution 8 oz. bottle (povidone-iodine)

Facility

$39.00

Service Code	NDC 00904110309
Hospital Charge Code	2501005
Hospital Revenue Code	270
Min. Negotiated Rate	$31.98
Max. Negotiated Rate	$37.83
Rate for Payer: Cash Price	$29.25
Rate for Payer: Health Partners Plans Commercial	$37.05
Rate for Payer: UnitedHealthcare Commercial	$37.83
Rate for Payer: WPPA Commercial	$31.98

Betadine Swabsticks - 1 per Pkg (Povidine Iodine)

Facility

$1.00

Service Code	NDC 52380110104
Hospital Charge Code	2500809
Hospital Revenue Code	270
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$1.05
Rate for Payer: Health Partners Plans Commercial	$0.95
Rate for Payer: UnitedHealthcare Commercial	$0.97
Rate for Payer: WPPA Commercial	$0.82

Betadine Swabsticks - 1 per Pkg (Povidine Iodine)

Facility

$1.00

Service Code	NDC 52380110104
Hospital Charge Code	2500809
Hospital Revenue Code	270
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$1.05
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

Betadine Swabsticks (povidone-iodine) - 3 per Pkg

Facility

$4.00

Service Code	NDC 67618015303
Hospital Charge Code	2501039
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

Betadine Swabsticks (povidone-iodine) - 3 per Pkg

Facility

$4.00

Service Code	NDC 67618015303
Hospital Charge Code	2501039
Hospital Revenue Code	270
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

BETAPACE 80 MG TAB (SOTALOL/SORNIE)

Facility

$7.00

Service Code	NDC 68084065411
Hospital Charge Code	2515690
Hospital Revenue Code	250
Min. Negotiated Rate	$3.23
Max. Negotiated Rate	$6.79
Rate for Payer: Cash Price	$5.89
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

BETAPACE 80 MG TAB (SOTALOL/SORNIE)

Facility

$7.00

Service Code	NDC 68084065411
Hospital Charge Code	2515690
Hospital Revenue Code	250
Min. Negotiated Rate	$5.74
Max. Negotiated Rate	$6.79
Rate for Payer: Cash Price	$5.89
Rate for Payer: Health Partners Plans Commercial	$6.65
Rate for Payer: UnitedHealthcare Commercial	$6.79
Rate for Payer: WPPA Commercial	$5.74

BIAXIN 125 MG/5 ML 50ML OS (CLARITHROMYCIN)

Facility

$220.00

Service Code	NDC 00781602252
Hospital Charge Code	2514628
Hospital Revenue Code	250
Min. Negotiated Rate	$101.64
Max. Negotiated Rate	$213.40
Rate for Payer: Cash Price	$165.64
Rate for Payer: Celtic Commercial/Exchange	$101.64
Rate for Payer: Health Partners Plans Commercial	$209.00
Rate for Payer: UnitedHealthcare Commercial	$213.40
Rate for Payer: WPPA Commercial	$184.80

BIAXIN 125 MG/5 ML 50ML OS (CLARITHROMYCIN)

Facility

$220.00

Service Code	NDC 00781602252
Hospital Charge Code	2514628
Hospital Revenue Code	250
Min. Negotiated Rate	$180.40
Max. Negotiated Rate	$213.40
Rate for Payer: Cash Price	$165.64
Rate for Payer: Health Partners Plans Commercial	$209.00
Rate for Payer: UnitedHealthcare Commercial	$213.40
Rate for Payer: WPPA Commercial	$180.40

BIAXIN 250 MG/5 ML OS 50ML (CLARITHROMYCIN)

Facility

$321.00

Service Code	NDC 00781602352
Hospital Charge Code	2501054
Hospital Revenue Code	250
Min. Negotiated Rate	$148.30
Max. Negotiated Rate	$311.37
Rate for Payer: Cash Price	$241.09
Rate for Payer: Celtic Commercial/Exchange	$148.30
Rate for Payer: Health Partners Plans Commercial	$304.95
Rate for Payer: UnitedHealthcare Commercial	$311.37
Rate for Payer: WPPA Commercial	$269.64

BIAXIN 250 MG/5 ML OS 50ML (CLARITHROMYCIN)

Facility

$321.00

Service Code	NDC 00781602352
Hospital Charge Code	2501054
Hospital Revenue Code	250
Min. Negotiated Rate	$263.22
Max. Negotiated Rate	$311.37
Rate for Payer: Cash Price	$241.09
Rate for Payer: Health Partners Plans Commercial	$304.95
Rate for Payer: UnitedHealthcare Commercial	$311.37
Rate for Payer: WPPA Commercial	$263.22

BIAXIN 250 MG TAB

Facility

$18.00

Hospital Charge Code	2514347
Hospital Revenue Code	250
Min. Negotiated Rate	$14.76
Max. Negotiated Rate	$17.46
Rate for Payer: Cash Price	$13.54
Rate for Payer: Health Partners Plans Commercial	$17.10
Rate for Payer: UnitedHealthcare Commercial	$17.46
Rate for Payer: WPPA Commercial	$14.76

BIAXIN 250 MG TAB

Facility

$18.00

Hospital Charge Code	2514347
Hospital Revenue Code	250
Min. Negotiated Rate	$8.32
Max. Negotiated Rate	$17.46
Rate for Payer: Cash Price	$13.54
Rate for Payer: Celtic Commercial/Exchange	$8.32
Rate for Payer: Health Partners Plans Commercial	$17.10
Rate for Payer: UnitedHealthcare Commercial	$17.46
Rate for Payer: WPPA Commercial	$15.12

Bicillin L-A (penicillin G benzathine) IM syringe

Facility

$681.00

Service Code	NDC 60793070010
Hospital Charge Code	2519387
Hospital Revenue Code	250
Min. Negotiated Rate	$558.42
Max. Negotiated Rate	$660.57
Rate for Payer: Cash Price	$511.31
Rate for Payer: Health Partners Plans Commercial	$646.95
Rate for Payer: UnitedHealthcare Commercial	$660.57
Rate for Payer: WPPA Commercial	$558.42

Bicillin L-A (penicillin G benzathine) IM syringe

Facility

$681.00

Service Code	NDC 60793070010
Hospital Charge Code	2519387
Hospital Revenue Code	250
Min. Negotiated Rate	$314.62
Max. Negotiated Rate	$660.57
Rate for Payer: Cash Price	$511.31
Rate for Payer: Celtic Commercial/Exchange	$314.62
Rate for Payer: Health Partners Plans Commercial	$646.95
Rate for Payer: UnitedHealthcare Commercial	$660.57
Rate for Payer: WPPA Commercial	$572.04

Know your out-of-pocket cost for care.

All Charges