Ness County Hospital

All Charges

Charge

Type

Setting

Price

DRESSING TELFA 3X4

Facility

$9.00

Hospital Charge Code	2720845
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

DRESSING TELFA 3X4

Facility

$9.00

Hospital Charge Code	2720845LTC
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

DRESSING TELFA 3X4

Facility

$9.00

Hospital Charge Code	2720845
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

DRESSING TELFA 4X8

Facility

$9.00

Hospital Charge Code	2720846
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

DRESSING TELFA 4X8

Facility

$9.00

Hospital Charge Code	2720846
Hospital Revenue Code	270
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

Dressing Telfa 4x8 LTC

Facility

$9.00

Hospital Charge Code	2720846LTC
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

Dressing Telfa 4x8 LTC

Facility

$9.00

Hospital Charge Code	2720846LTC
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

DRESSING TELFA 8X3

Facility

$9.00

Hospital Charge Code	2720847
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

DRESSING TELFA 8X3

Facility

$9.00

Hospital Charge Code	2720847LTC
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

DRESSING TELFA 8X3

Facility

$9.00

Hospital Charge Code	2720847
Hospital Revenue Code	270
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

DRESSING TELFA 8X3

Facility

$9.00

Hospital Charge Code	2720847LTC
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

DRESSING TRAUMA 10X30

Facility

$15.00

Hospital Charge Code	2726922LTC
Hospital Revenue Code	272
Min. Negotiated Rate	$12.30
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$11.25
Rate for Payer: Health Partners Plans Commercial	$14.25
Rate for Payer: UnitedHealthcare Commercial	$14.55
Rate for Payer: WPPA Commercial	$12.30

DRESSING TRAUMA 10X30

Facility

$15.00

Hospital Charge Code	2726922LTC
Hospital Revenue Code	272
Min. Negotiated Rate	$6.93
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$11.25
Rate for Payer: Celtic Commercial/Exchange	$6.93
Rate for Payer: Health Partners Plans Commercial	$14.25
Rate for Payer: UnitedHealthcare Commercial	$14.55
Rate for Payer: WPPA Commercial	$12.60

DRESSING XTRASORB

Facility

$12.00

Hospital Charge Code	2720865
Hospital Revenue Code	272
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

DRESSING XTRASORB

Facility

$12.00

Hospital Charge Code	2720865
Hospital Revenue Code	272
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

DRS OPTIFOAM GENTLE EX 4X4

Facility

$9.00

Hospital Charge Code	2723145
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

DRS OPTIFOAM GENTLE EX 4X4

Facility

$9.00

Hospital Charge Code	2723145
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

DRUG MONITORING,BARBITURATES

Facility

$157.00

Service Code	HCPCS 80345
Hospital Charge Code	8034500
Hospital Revenue Code	300
Min. Negotiated Rate	$55.41
Max. Negotiated Rate	$152.29
Rate for Payer: BCBS Commercial	$55.41
Rate for Payer: Cash Price	$117.75
Rate for Payer: Cash Price	$117.75
Rate for Payer: Celtic Commercial/Exchange	$72.53
Rate for Payer: Health Partners Plans Commercial	$149.15
Rate for Payer: UnitedHealthcare Commercial	$152.29
Rate for Payer: WPPA Commercial	$131.88

DRUG MONITORING,BARBITURATES

Facility

$157.00

Service Code	HCPCS 80345
Hospital Charge Code	8034500
Hospital Revenue Code	300
Min. Negotiated Rate	$128.74
Max. Negotiated Rate	$152.29
Rate for Payer: Cash Price	$117.75
Rate for Payer: Health Partners Plans Commercial	$149.15
Rate for Payer: UnitedHealthcare Commercial	$152.29
Rate for Payer: WPPA Commercial	$128.74

DRUG MONITORING,PHENCYCLIDINE

Facility

$157.00

Service Code	HCPCS 83992
Hospital Charge Code	8399200
Hospital Revenue Code	301
Min. Negotiated Rate	$128.74
Max. Negotiated Rate	$152.29
Rate for Payer: Cash Price	$117.75
Rate for Payer: Health Partners Plans Commercial	$149.15
Rate for Payer: UnitedHealthcare Commercial	$152.29
Rate for Payer: WPPA Commercial	$128.74

DRUG MONITORING,PHENCYCLIDINE

Facility

$157.00

Service Code	HCPCS 83992
Hospital Charge Code	8399200
Hospital Revenue Code	301
Min. Negotiated Rate	$56.17
Max. Negotiated Rate	$152.29
Rate for Payer: BCBS Commercial	$56.17
Rate for Payer: Cash Price	$117.75
Rate for Payer: Cash Price	$117.75
Rate for Payer: Celtic Commercial/Exchange	$72.53
Rate for Payer: Health Partners Plans Commercial	$149.15
Rate for Payer: UnitedHealthcare Commercial	$152.29
Rate for Payer: WPPA Commercial	$131.88

DRUG MONITOR PANEL1,SCREEN,URI

Facility

$193.00

Service Code	HCPCS 80307
Hospital Charge Code	8030702
Hospital Revenue Code	300
Min. Negotiated Rate	$89.17
Max. Negotiated Rate	$187.21
Rate for Payer: BCBS Commercial	$150.08
Rate for Payer: Cash Price	$144.75
Rate for Payer: Cash Price	$144.75
Rate for Payer: Celtic Commercial/Exchange	$89.17
Rate for Payer: Health Partners Plans Commercial	$183.35
Rate for Payer: UnitedHealthcare Commercial	$187.21
Rate for Payer: WPPA Commercial	$162.12

DRUG MONITOR PANEL1,SCREEN,URI

Facility

$193.00

Service Code	HCPCS 80307
Hospital Charge Code	8030702
Hospital Revenue Code	300
Min. Negotiated Rate	$158.26
Max. Negotiated Rate	$187.21
Rate for Payer: Cash Price	$144.75
Rate for Payer: Health Partners Plans Commercial	$183.35
Rate for Payer: UnitedHealthcare Commercial	$187.21
Rate for Payer: WPPA Commercial	$158.26

DRUG SCREEN, IN HOUSE

Facility

$137.00

Service Code	HCPCS 80305
Hospital Charge Code	8030500
Hospital Revenue Code	301
Min. Negotiated Rate	$112.34
Max. Negotiated Rate	$132.89
Rate for Payer: Cash Price	$102.75
Rate for Payer: Health Partners Plans Commercial	$130.15
Rate for Payer: UnitedHealthcare Commercial	$132.89
Rate for Payer: WPPA Commercial	$112.34

DRUG SCREEN, IN HOUSE

Facility

$137.00

Service Code	HCPCS 80305
Hospital Charge Code	8030500
Hospital Revenue Code	301
Min. Negotiated Rate	$28.15
Max. Negotiated Rate	$132.89
Rate for Payer: BCBS Commercial	$28.15
Rate for Payer: Cash Price	$102.75
Rate for Payer: Cash Price	$102.75
Rate for Payer: Celtic Commercial/Exchange	$63.29
Rate for Payer: Health Partners Plans Commercial	$130.15
Rate for Payer: UnitedHealthcare Commercial	$132.89
Rate for Payer: WPPA Commercial	$115.08

Know your out-of-pocket cost for care.

All Charges