Ness County Hospital

All Charges

Charge

Type

Setting

Price

DRUG SCREEN,OTHER THAN CHROMO

Facility

$288.00

Service Code	HCPCS 80305
Hospital Charge Code	G043400
Hospital Revenue Code	301
Min. Negotiated Rate	$236.16
Max. Negotiated Rate	$279.36
Rate for Payer: Cash Price	$216.00
Rate for Payer: Health Partners Plans Commercial	$273.60
Rate for Payer: UnitedHealthcare Commercial	$279.36
Rate for Payer: WPPA Commercial	$236.16

DRUG SCREEN,OTHER THAN CHROMO

Facility

$288.00

Service Code	HCPCS 80305
Hospital Charge Code	G043400
Hospital Revenue Code	301
Min. Negotiated Rate	$28.15
Max. Negotiated Rate	$279.36
Rate for Payer: BCBS Commercial	$28.15
Rate for Payer: Cash Price	$216.00
Rate for Payer: Cash Price	$216.00
Rate for Payer: Celtic Commercial/Exchange	$133.06
Rate for Payer: Health Partners Plans Commercial	$273.60
Rate for Payer: UnitedHealthcare Commercial	$279.36
Rate for Payer: WPPA Commercial	$241.92

DRUGS/SUBSTANCES DEFIN, QUAL

Facility

$170.00

Service Code	HCPCS 80377
Hospital Charge Code	8037700
Hospital Revenue Code	300
Min. Negotiated Rate	$139.40
Max. Negotiated Rate	$164.90
Rate for Payer: Cash Price	$127.50
Rate for Payer: Health Partners Plans Commercial	$161.50
Rate for Payer: UnitedHealthcare Commercial	$164.90
Rate for Payer: WPPA Commercial	$139.40

DRUGS/SUBSTANCES DEFIN, QUAL

Facility

$170.00

Service Code	HCPCS 80377
Hospital Charge Code	8037700
Hospital Revenue Code	300
Min. Negotiated Rate	$78.54
Max. Negotiated Rate	$164.90
Rate for Payer: BCBS Commercial	$85.39
Rate for Payer: Cash Price	$127.50
Rate for Payer: Cash Price	$127.50
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

DRUG TEST-DEFINITIVE-ID METHOD

Facility

$115.00

Service Code	HCPCS G0480
Hospital Charge Code	G048000
Hospital Revenue Code	301
Min. Negotiated Rate	$94.30
Max. Negotiated Rate	$111.55
Rate for Payer: Cash Price	$86.25
Rate for Payer: Health Partners Plans Commercial	$109.25
Rate for Payer: UnitedHealthcare Commercial	$111.55
Rate for Payer: WPPA Commercial	$94.30

DRUG TEST-DEFINITIVE-ID METHOD

Facility

$115.00

Service Code	HCPCS G0480
Hospital Charge Code	G048000
Hospital Revenue Code	301
Min. Negotiated Rate	$53.13
Max. Negotiated Rate	$111.55
Rate for Payer: BCBS Commercial	$73.42
Rate for Payer: Cash Price	$86.25
Rate for Payer: Cash Price	$86.25
Rate for Payer: Celtic Commercial/Exchange	$53.13
Rate for Payer: Health Partners Plans Commercial	$109.25
Rate for Payer: UnitedHealthcare Commercial	$111.55
Rate for Payer: WPPA Commercial	$96.60

DRUG TEST PANEL OF 22+ CLASSES

Facility

$250.00

Service Code	HCPCS G0483
Hospital Charge Code	G048300
Hospital Revenue Code	300
Min. Negotiated Rate	$115.50
Max. Negotiated Rate	$242.50
Rate for Payer: BCBS Commercial	$197.70
Rate for Payer: Cash Price	$187.50
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

DRUG TEST PANEL OF 22+ CLASSES

Facility

$250.00

Service Code	HCPCS G0483
Hospital Charge Code	G048300
Hospital Revenue Code	300
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

DUCANTO

Facility

$14.00

Hospital Charge Code	2709521
Hospital Revenue Code	272
Min. Negotiated Rate	$11.48
Max. Negotiated Rate	$13.58
Rate for Payer: Cash Price	$10.50
Rate for Payer: Health Partners Plans Commercial	$13.30
Rate for Payer: UnitedHealthcare Commercial	$13.58
Rate for Payer: WPPA Commercial	$11.48

DUCANTO

Facility

$14.00

Hospital Charge Code	2709521
Hospital Revenue Code	272
Min. Negotiated Rate	$6.47
Max. Negotiated Rate	$13.58
Rate for Payer: Cash Price	$10.50
Rate for Payer: Celtic Commercial/Exchange	$6.47
Rate for Payer: Health Partners Plans Commercial	$13.30
Rate for Payer: UnitedHealthcare Commercial	$13.58
Rate for Payer: WPPA Commercial	$11.76

DULCOLAX 5 MG TAB (BISACODYL)

Facility

$1.00

Service Code	NDC 00904640761
Hospital Charge Code	2502375
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

DULCOLAX 5 MG TAB (BISACODYL)

Facility

$1.00

Service Code	NDC 00904640761
Hospital Charge Code	2502375
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

DULCOLAX SUPP 10 MG (BISACODYL)

Facility

$4.00

Service Code	NDC 00574705012
Hospital Charge Code	2502367
Hospital Revenue Code	250
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

DULCOLAX SUPP 10 MG (BISACODYL)

Facility

$4.00

Service Code	NDC 00574705012
Hospital Charge Code	2502367
Hospital Revenue Code	250
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

DUO DERM

Facility

$9.00

Hospital Charge Code	2723151
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

DUO DERM

Facility

$9.00

Hospital Charge Code	2723151
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

DuoDERM XT 4 X 4

Facility

$17.00

Service Code	NDC 68455010691
Hospital Charge Code	2511624
Hospital Revenue Code	270
Min. Negotiated Rate	$7.85
Max. Negotiated Rate	$16.49
Rate for Payer: Cash Price	$12.94
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

DuoDERM XT 4 X 4

Facility

$17.00

Service Code	NDC 68455010691
Hospital Charge Code	2511624
Hospital Revenue Code	270
Min. Negotiated Rate	$13.94
Max. Negotiated Rate	$16.49
Rate for Payer: Cash Price	$12.94
Rate for Payer: Health Partners Plans Commercial	$16.15
Rate for Payer: UnitedHealthcare Commercial	$16.49
Rate for Payer: WPPA Commercial	$13.94

DUO THERM HEATING PADS

Facility

$50.00

Hospital Charge Code	2700656
Hospital Revenue Code	270
Min. Negotiated Rate	$41.00
Max. Negotiated Rate	$48.50
Rate for Payer: Cash Price	$37.69
Rate for Payer: Health Partners Plans Commercial	$47.50
Rate for Payer: UnitedHealthcare Commercial	$48.50
Rate for Payer: WPPA Commercial	$41.00

DUO THERM HEATING PADS

Facility

$50.00

Hospital Charge Code	2700656
Hospital Revenue Code	270
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$48.50
Rate for Payer: Cash Price	$37.69
Rate for Payer: Celtic Commercial/Exchange	$23.10
Rate for Payer: Health Partners Plans Commercial	$47.50
Rate for Payer: UnitedHealthcare Commercial	$48.50
Rate for Payer: WPPA Commercial	$42.00

DURAGESIC 12 MCG PATCH (FENTANYL)

Facility

$60.00

Service Code	NDC 00406911276
Hospital Charge Code	2513539
Hospital Revenue Code	250
Min. Negotiated Rate	$49.20
Max. Negotiated Rate	$58.20
Rate for Payer: Cash Price	$45.71
Rate for Payer: Health Partners Plans Commercial	$57.00
Rate for Payer: UnitedHealthcare Commercial	$58.20
Rate for Payer: WPPA Commercial	$49.20

DURAGESIC 12 MCG PATCH (FENTANYL)

Facility

$60.00

Service Code	NDC 00406911276
Hospital Charge Code	2513539
Hospital Revenue Code	250
Min. Negotiated Rate	$27.72
Max. Negotiated Rate	$58.20
Rate for Payer: Cash Price	$45.71
Rate for Payer: Celtic Commercial/Exchange	$27.72
Rate for Payer: Health Partners Plans Commercial	$57.00
Rate for Payer: UnitedHealthcare Commercial	$58.20
Rate for Payer: WPPA Commercial	$50.40

DURAGESIC 25 MCG PATCH (FENTANYL)

Facility

$63.00

Service Code	NDC 00378912116
Hospital Charge Code	2513190
Hospital Revenue Code	250
Min. Negotiated Rate	$51.66
Max. Negotiated Rate	$61.11
Rate for Payer: Cash Price	$47.85
Rate for Payer: Health Partners Plans Commercial	$59.85
Rate for Payer: UnitedHealthcare Commercial	$61.11
Rate for Payer: WPPA Commercial	$51.66

DURAGESIC 25 MCG PATCH (FENTANYL)

Facility

$63.00

Service Code	NDC 00378912116
Hospital Charge Code	2513190
Hospital Revenue Code	250
Min. Negotiated Rate	$29.11
Max. Negotiated Rate	$61.11
Rate for Payer: Cash Price	$47.85
Rate for Payer: Celtic Commercial/Exchange	$29.11
Rate for Payer: Health Partners Plans Commercial	$59.85
Rate for Payer: UnitedHealthcare Commercial	$61.11
Rate for Payer: WPPA Commercial	$52.92

DURAGESIC 50 MCG PATCH (FENTANYL)

Facility

$116.00

Service Code	NDC 00406915076
Hospital Charge Code	2511533
Hospital Revenue Code	250
Min. Negotiated Rate	$95.12
Max. Negotiated Rate	$112.52
Rate for Payer: Cash Price	$87.49
Rate for Payer: Health Partners Plans Commercial	$110.20
Rate for Payer: UnitedHealthcare Commercial	$112.52
Rate for Payer: WPPA Commercial	$95.12

Know your out-of-pocket cost for care.

All Charges