Ness County Hospital

All Charges

Charge

Type

Setting

Price

DONNATAL 5 ML U.D. (PHENOBARB+HYCOSCY+ATROPINE+SCOP)

Facility

$170.00

Service Code	NDC 66689006310
Hospital Charge Code	2519585
Hospital Revenue Code	250
Min. Negotiated Rate	$78.54
Max. Negotiated Rate	$164.90
Rate for Payer: Cash Price	$127.57
Rate for Payer: Celtic Commercial/Exchange	$78.54
Rate for Payer: Health Partners Plans Commercial	$161.50
Rate for Payer: UnitedHealthcare Commercial	$164.90
Rate for Payer: WPPA Commercial	$142.80

DONNATAL 5 ML U.D. (PHENOBARB+HYCOSCY+ATROPINE+SCOP)

Facility

$170.00

Service Code	NDC 66689006310
Hospital Charge Code	2519585
Hospital Revenue Code	250
Min. Negotiated Rate	$139.40
Max. Negotiated Rate	$164.90
Rate for Payer: Cash Price	$127.57
Rate for Payer: Health Partners Plans Commercial	$161.50
Rate for Payer: UnitedHealthcare Commercial	$164.90
Rate for Payer: WPPA Commercial	$139.40

DOPAMINE PREMIX 400 mg/250ml

Facility

$70.00

Service Code	NDC 00338100702
Hospital Charge Code	2514230
Hospital Revenue Code	250
Min. Negotiated Rate	$57.40
Max. Negotiated Rate	$67.90
Rate for Payer: Cash Price	$53.21
Rate for Payer: Health Partners Plans Commercial	$66.50
Rate for Payer: UnitedHealthcare Commercial	$67.90
Rate for Payer: WPPA Commercial	$57.40

DOPAMINE PREMIX 400 mg/250ml

Facility

$70.00

Service Code	NDC 00338100702
Hospital Charge Code	2514230
Hospital Revenue Code	250
Min. Negotiated Rate	$32.34
Max. Negotiated Rate	$67.90
Rate for Payer: Cash Price	$53.21
Rate for Payer: Celtic Commercial/Exchange	$32.34
Rate for Payer: Health Partners Plans Commercial	$66.50
Rate for Payer: UnitedHealthcare Commercial	$67.90
Rate for Payer: WPPA Commercial	$58.80

DOT ELECTRODE 3 PK

Facility

$35.00

Hospital Charge Code	2700791
Hospital Revenue Code	272
Min. Negotiated Rate	$16.17
Max. Negotiated Rate	$33.95
Rate for Payer: Cash Price	$26.25
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

DOT ELECTRODE 3 PK

Facility

$35.00

Hospital Charge Code	2700791
Hospital Revenue Code	272
Min. Negotiated Rate	$28.70
Max. Negotiated Rate	$33.95
Rate for Payer: Cash Price	$26.25
Rate for Payer: Health Partners Plans Commercial	$33.25
Rate for Payer: UnitedHealthcare Commercial	$33.95
Rate for Payer: WPPA Commercial	$28.70

DRAINAGE ABSCESS/HEMATOMA,NASL

Facility

$250.00

Service Code	HCPCS 30000
Hospital Charge Code	3000000
Hospital Revenue Code	760
Min. Negotiated Rate	$205.00
Max. Negotiated Rate	$242.50
Rate for Payer: Cash Price	$187.50
Rate for Payer: Health Partners Plans Commercial	$237.50
Rate for Payer: UnitedHealthcare Commercial	$242.50
Rate for Payer: WPPA Commercial	$205.00

DRAINAGE ABSCESS/HEMATOMA,NASL

Facility

$250.00

Service Code	HCPCS 30000
Hospital Charge Code	3000000
Hospital Revenue Code	760
Min. Negotiated Rate	$115.50
Max. Negotiated Rate	$242.50
Rate for Payer: Cash Price	$187.50
Rate for Payer: Celtic Commercial/Exchange	$115.50
Rate for Payer: Health Partners Plans Commercial	$237.50
Rate for Payer: UnitedHealthcare Commercial	$242.50
Rate for Payer: WPPA Commercial	$210.00

DRAINAGE EXT EAR,ABSCESS/HEMAT

Facility

$684.00

Service Code	HCPCS 69000
Hospital Charge Code	6900000
Hospital Revenue Code	450
Min. Negotiated Rate	$560.88
Max. Negotiated Rate	$663.48
Rate for Payer: Cash Price	$513.00
Rate for Payer: Health Partners Plans Commercial	$649.80
Rate for Payer: UnitedHealthcare Commercial	$663.48
Rate for Payer: WPPA Commercial	$560.88

DRAINAGE EXT EAR,ABSCESS/HEMAT

Facility

$684.00

Service Code	HCPCS 69000
Hospital Charge Code	6900000
Hospital Revenue Code	450
Min. Negotiated Rate	$316.01
Max. Negotiated Rate	$879.49
Rate for Payer: BCBS Commercial	$879.49
Rate for Payer: Cash Price	$513.00
Rate for Payer: Cash Price	$513.00
Rate for Payer: Celtic Commercial/Exchange	$316.01
Rate for Payer: Health Partners Plans Commercial	$649.80
Rate for Payer: UnitedHealthcare Commercial	$663.48
Rate for Payer: WPPA Commercial	$574.56

DRAINAGE OF SKIN ABSCESS

Facility

$380.00

Service Code	HCPCS 10061
Hospital Charge Code	1006100
Hospital Revenue Code	450
Min. Negotiated Rate	$175.56
Max. Negotiated Rate	$499.41
Rate for Payer: BCBS Commercial	$499.41
Rate for Payer: Cash Price	$285.00
Rate for Payer: Cash Price	$285.00
Rate for Payer: Celtic Commercial/Exchange	$175.56
Rate for Payer: Health Partners Plans Commercial	$361.00
Rate for Payer: UnitedHealthcare Commercial	$368.60
Rate for Payer: WPPA Commercial	$319.20

DRAINAGE OF SKIN ABSCESS

Facility

$380.00

Service Code	HCPCS 10061
Hospital Charge Code	1006100
Hospital Revenue Code	450
Min. Negotiated Rate	$311.60
Max. Negotiated Rate	$368.60
Rate for Payer: Cash Price	$285.00
Rate for Payer: Health Partners Plans Commercial	$361.00
Rate for Payer: UnitedHealthcare Commercial	$368.60
Rate for Payer: WPPA Commercial	$311.60

DRAIN BLOOD FROM NAIL

Facility

$135.00

Service Code	HCPCS 11740
Hospital Charge Code	1174023
Hospital Revenue Code	761
Min. Negotiated Rate	$62.37
Max. Negotiated Rate	$161.13
Rate for Payer: BCBS Commercial	$161.13
Rate for Payer: Cash Price	$101.25
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

DRAIN BLOOD FROM NAIL

Facility

$135.00

Service Code	HCPCS 11740
Hospital Charge Code	1174023
Hospital Revenue Code	761
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

DRAIN PILONIDAL CYST-SIMPLE

Facility

$1,270.00

Service Code	HCPCS 10080
Hospital Charge Code	1008023
Hospital Revenue Code	761
Min. Negotiated Rate	$586.74
Max. Negotiated Rate	$1,231.90
Rate for Payer: BCBS Commercial	$982.73
Rate for Payer: Cash Price	$952.50
Rate for Payer: Cash Price	$952.50
Rate for Payer: Celtic Commercial/Exchange	$586.74
Rate for Payer: Health Partners Plans Commercial	$1,206.50
Rate for Payer: UnitedHealthcare Commercial	$1,231.90
Rate for Payer: WPPA Commercial	$1,066.80

DRAIN PILONIDAL CYST-SIMPLE

Facility

$1,270.00

Service Code	HCPCS 10080
Hospital Charge Code	1008023
Hospital Revenue Code	761
Min. Negotiated Rate	$1,041.40
Max. Negotiated Rate	$1,231.90
Rate for Payer: Cash Price	$952.50
Rate for Payer: Health Partners Plans Commercial	$1,206.50
Rate for Payer: UnitedHealthcare Commercial	$1,231.90
Rate for Payer: WPPA Commercial	$1,041.40

DRAIN SPONGE

Facility

$9.00

Hospital Charge Code	2720795
Hospital Revenue Code	272
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$6.75
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

DRAIN SPONGE

Facility

$9.00

Hospital Charge Code	2720795
Hospital Revenue Code	272
Min. Negotiated Rate	$7.38
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$6.75
Rate for Payer: Health Partners Plans Commercial	$8.55
Rate for Payer: UnitedHealthcare Commercial	$8.73
Rate for Payer: WPPA Commercial	$7.38

DRAMAMINE 50MG TABLET

Facility

$1.00

Hospital Charge Code	2502334
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

DRAMAMINE 50MG TABLET

Facility

$1.00

Hospital Charge Code	2502334
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

DRAWTEX HYDRO 4X4

Facility

$26.00

Hospital Charge Code	2721007
Hospital Revenue Code	272
Min. Negotiated Rate	$12.01
Max. Negotiated Rate	$25.22
Rate for Payer: Cash Price	$19.50
Rate for Payer: Celtic Commercial/Exchange	$12.01
Rate for Payer: Health Partners Plans Commercial	$24.70
Rate for Payer: UnitedHealthcare Commercial	$25.22
Rate for Payer: WPPA Commercial	$21.84

DRAWTEX HYDRO 4X4

Facility

$26.00

Hospital Charge Code	2721007
Hospital Revenue Code	272
Min. Negotiated Rate	$21.32
Max. Negotiated Rate	$25.22
Rate for Payer: Cash Price	$19.50
Rate for Payer: Health Partners Plans Commercial	$24.70
Rate for Payer: UnitedHealthcare Commercial	$25.22
Rate for Payer: WPPA Commercial	$21.32

DRESS CHG INC TOPICAL APP/

Facility

$201.00

Service Code	HCPCS 97602 GP
Hospital Charge Code	4202299
Hospital Revenue Code	421
Min. Negotiated Rate	$92.86
Max. Negotiated Rate	$200.20
Rate for Payer: BCBS Commercial	$200.20
Rate for Payer: Cash Price	$150.75
Rate for Payer: Cash Price	$150.75
Rate for Payer: Celtic Commercial/Exchange	$92.86
Rate for Payer: Health Partners Plans Commercial	$190.95
Rate for Payer: UnitedHealthcare Commercial	$194.97
Rate for Payer: WPPA Commercial	$168.84

DRESS CHG INC TOPICAL APP/

Facility

$201.00

Service Code	HCPCS 97602 GP
Hospital Charge Code	4202299
Hospital Revenue Code	421
Min. Negotiated Rate	$164.82
Max. Negotiated Rate	$194.97
Rate for Payer: Cash Price	$150.75
Rate for Payer: Health Partners Plans Commercial	$190.95
Rate for Payer: UnitedHealthcare Commercial	$194.97
Rate for Payer: WPPA Commercial	$164.82

DRESSING ADAPTIC N-ADH 3X8"

Facility

$9.00

Hospital Charge Code	2720862
Hospital Revenue Code	270
Min. Negotiated Rate	$7.38
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$6.75
Rate for Payer: Health Partners Plans Commercial	$8.55
Rate for Payer: UnitedHealthcare Commercial	$8.73
Rate for Payer: WPPA Commercial	$7.38

Know your out-of-pocket cost for care.

All Charges