Ness County Hospital

All Charges

Charge

Type

Setting

Price

DISPOZ-A-BAG

Facility

$32.00

Hospital Charge Code	2725054
Hospital Revenue Code	272
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

DISP RETRIEVER

Facility

$184.00

Hospital Charge Code	2706919
Hospital Revenue Code	270
Min. Negotiated Rate	$150.88
Max. Negotiated Rate	$178.48
Rate for Payer: Cash Price	$138.00
Rate for Payer: Health Partners Plans Commercial	$174.80
Rate for Payer: UnitedHealthcare Commercial	$178.48
Rate for Payer: WPPA Commercial	$150.88

DISP RETRIEVER

Facility

$184.00

Hospital Charge Code	2706919
Hospital Revenue Code	270
Min. Negotiated Rate	$85.01
Max. Negotiated Rate	$178.48
Rate for Payer: Cash Price	$138.00
Rate for Payer: Celtic Commercial/Exchange	$85.01
Rate for Payer: Health Partners Plans Commercial	$174.80
Rate for Payer: UnitedHealthcare Commercial	$178.48
Rate for Payer: WPPA Commercial	$154.56

DISP SURGICAL BLADE

Facility

$2.00

Hospital Charge Code	2721696
Hospital Revenue Code	272
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.88
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

DISP SURGICAL BLADE

Facility

$2.00

Hospital Charge Code	2721696
Hospital Revenue Code	272
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.88
Rate for Payer: Health Partners Plans Commercial	$1.90
Rate for Payer: UnitedHealthcare Commercial	$1.94
Rate for Payer: WPPA Commercial	$1.64

DISP SUTURE REMOVAL SET

Facility

$12.00

Hospital Charge Code	2700318
Hospital Revenue Code	270
Min. Negotiated Rate	$9.84
Max. Negotiated Rate	$11.64
Rate for Payer: Cash Price	$9.00
Rate for Payer: Health Partners Plans Commercial	$11.40
Rate for Payer: UnitedHealthcare Commercial	$11.64
Rate for Payer: WPPA Commercial	$9.84

DISP SUTURE REMOVAL SET

Facility

$12.00

Hospital Charge Code	2700318
Hospital Revenue Code	270
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$11.64
Rate for Payer: Cash Price	$9.00
Rate for Payer: Celtic Commercial/Exchange	$5.54
Rate for Payer: Health Partners Plans Commercial	$11.40
Rate for Payer: UnitedHealthcare Commercial	$11.64
Rate for Payer: WPPA Commercial	$10.08

DISP THERMOMETER

Facility

$3.00

Hospital Charge Code	2709284
Hospital Revenue Code	270
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.25
Rate for Payer: Health Partners Plans Commercial	$2.85
Rate for Payer: UnitedHealthcare Commercial	$2.91
Rate for Payer: WPPA Commercial	$2.46

DISP THERMOMETER

Facility

$3.00

Hospital Charge Code	2709284
Hospital Revenue Code	270
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.25
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

DISP VAGINAL SPECULUM

Facility

$10.00

Hospital Charge Code	2700730
Hospital Revenue Code	270
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

DISP VAGINAL SPECULUM

Facility

$10.00

Hospital Charge Code	2700730
Hospital Revenue Code	270
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

DISP VARICES INJECTOR

Facility

$244.00

Hospital Charge Code	2709356
Hospital Revenue Code	270
Min. Negotiated Rate	$112.73
Max. Negotiated Rate	$236.68
Rate for Payer: Cash Price	$183.00
Rate for Payer: Celtic Commercial/Exchange	$112.73
Rate for Payer: Health Partners Plans Commercial	$231.80
Rate for Payer: UnitedHealthcare Commercial	$236.68
Rate for Payer: WPPA Commercial	$204.96

DISP VARICES INJECTOR

Facility

$244.00

Hospital Charge Code	2709356
Hospital Revenue Code	270
Min. Negotiated Rate	$200.08
Max. Negotiated Rate	$236.68
Rate for Payer: Cash Price	$183.00
Rate for Payer: Health Partners Plans Commercial	$231.80
Rate for Payer: UnitedHealthcare Commercial	$236.68
Rate for Payer: WPPA Commercial	$200.08

DISP YANKAUER

Facility

$12.00

Hospital Charge Code	2702256
Hospital Revenue Code	270
Min. Negotiated Rate	$9.84
Max. Negotiated Rate	$11.64
Rate for Payer: Cash Price	$9.38
Rate for Payer: Health Partners Plans Commercial	$11.40
Rate for Payer: UnitedHealthcare Commercial	$11.64
Rate for Payer: WPPA Commercial	$9.84

DISP YANKAUER

Facility

$12.00

Hospital Charge Code	2702256
Hospital Revenue Code	270
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$11.64
Rate for Payer: Cash Price	$9.38
Rate for Payer: Celtic Commercial/Exchange	$5.54
Rate for Payer: Health Partners Plans Commercial	$11.40
Rate for Payer: UnitedHealthcare Commercial	$11.64
Rate for Payer: WPPA Commercial	$10.08

DITROPAN 5 MG TAB (OXYBUTYNIN CHLORIDE)

Facility

$9.00

Service Code	NDC 60687067011
Hospital Charge Code	2502268
Hospital Revenue Code	250
Min. Negotiated Rate	$7.38
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$6.98
Rate for Payer: Health Partners Plans Commercial	$8.55
Rate for Payer: UnitedHealthcare Commercial	$8.73
Rate for Payer: WPPA Commercial	$7.38

DITROPAN 5 MG TAB (OXYBUTYNIN CHLORIDE)

Facility

$9.00

Service Code	NDC 60687067011
Hospital Charge Code	2502268
Hospital Revenue Code	250
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$6.98
Rate for Payer: Celtic Commercial/Exchange	$4.16
Rate for Payer: Health Partners Plans Commercial	$8.55
Rate for Payer: UnitedHealthcare Commercial	$8.73
Rate for Payer: WPPA Commercial	$7.56

DITROPAN XL 5 MG TAB (OXYBUTYNIN CHLORIDE ER)

Facility

$10.00

Service Code	NDC 00904702761
Hospital Charge Code	2511350
Hospital Revenue Code	250
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$8.21
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

DITROPAN XL 5 MG TAB (OXYBUTYNIN CHLORIDE ER)

Facility

$10.00

Service Code	NDC 00904702761
Hospital Charge Code	2511350
Hospital Revenue Code	250
Min. Negotiated Rate	$8.20
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$8.21
Rate for Payer: Health Partners Plans Commercial	$9.50
Rate for Payer: UnitedHealthcare Commercial	$9.70
Rate for Payer: WPPA Commercial	$8.20

DNA ANTIB NATIVE/DBL STRANDED

Facility

$140.00

Service Code	HCPCS 86225
Hospital Charge Code	8622500
Hospital Revenue Code	302
Min. Negotiated Rate	$114.80
Max. Negotiated Rate	$135.80
Rate for Payer: Cash Price	$105.00
Rate for Payer: Health Partners Plans Commercial	$133.00
Rate for Payer: UnitedHealthcare Commercial	$135.80
Rate for Payer: WPPA Commercial	$114.80

DNA ANTIB NATIVE/DBL STRANDED

Facility

$140.00

Service Code	HCPCS 86225
Hospital Charge Code	8622500
Hospital Revenue Code	302
Min. Negotiated Rate	$60.75
Max. Negotiated Rate	$135.80
Rate for Payer: BCBS Commercial	$60.75
Rate for Payer: Cash Price	$105.00
Rate for Payer: Cash Price	$105.00
Rate for Payer: Celtic Commercial/Exchange	$64.68
Rate for Payer: Health Partners Plans Commercial	$133.00
Rate for Payer: UnitedHealthcare Commercial	$135.80
Rate for Payer: WPPA Commercial	$117.60

DNA (DS)ANTIBODY,CRITHIDIA IFA

Facility

$93.00

Service Code	HCPCS 86255
Hospital Charge Code	8625502
Hospital Revenue Code	302
Min. Negotiated Rate	$42.97
Max. Negotiated Rate	$90.21
Rate for Payer: BCBS Commercial	$49.98
Rate for Payer: Cash Price	$69.75
Rate for Payer: Cash Price	$69.75
Rate for Payer: Celtic Commercial/Exchange	$42.97
Rate for Payer: Health Partners Plans Commercial	$88.35
Rate for Payer: UnitedHealthcare Commercial	$90.21
Rate for Payer: WPPA Commercial	$78.12

DNA (DS)ANTIBODY,CRITHIDIA IFA

Facility

$93.00

Service Code	HCPCS 86255
Hospital Charge Code	8625502
Hospital Revenue Code	302
Min. Negotiated Rate	$76.26
Max. Negotiated Rate	$90.21
Rate for Payer: Cash Price	$69.75
Rate for Payer: Health Partners Plans Commercial	$88.35
Rate for Payer: UnitedHealthcare Commercial	$90.21
Rate for Payer: WPPA Commercial	$76.26

Dobutamine 250 mg Premix inj.

Facility

$69.00

Service Code	NDC 00409234632
Hospital Charge Code	2515047
Hospital Revenue Code	250
Min. Negotiated Rate	$31.88
Max. Negotiated Rate	$66.93
Rate for Payer: Cash Price	$51.97
Rate for Payer: Celtic Commercial/Exchange	$31.88
Rate for Payer: Health Partners Plans Commercial	$65.55
Rate for Payer: UnitedHealthcare Commercial	$66.93
Rate for Payer: WPPA Commercial	$57.96

Dobutamine 250 mg Premix inj.

Facility

$69.00

Service Code	NDC 00409234632
Hospital Charge Code	2515047
Hospital Revenue Code	250
Min. Negotiated Rate	$56.58
Max. Negotiated Rate	$66.93
Rate for Payer: Cash Price	$51.97
Rate for Payer: Health Partners Plans Commercial	$65.55
Rate for Payer: UnitedHealthcare Commercial	$66.93
Rate for Payer: WPPA Commercial	$56.58

Know your out-of-pocket cost for care.

All Charges