Ness County Hospital

All Charges

Charge

Type

Setting

Price

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

DURICEF 250 MG/5 ML OS (CEFADROXIL)

Facility

$182.00

Service Code	NDC 57237009701
Hospital Charge Code	2513240
Hospital Revenue Code	250
Min. Negotiated Rate	$149.24
Max. Negotiated Rate	$176.54
Rate for Payer: Cash Price	$136.80
Rate for Payer: Health Partners Plans Commercial	$172.90
Rate for Payer: UnitedHealthcare Commercial	$176.54
Rate for Payer: WPPA Commercial	$149.24

DURICEF 250 MG/5 ML OS (CEFADROXIL)

Facility

$182.00

Service Code	NDC 57237009701
Hospital Charge Code	2513240
Hospital Revenue Code	250
Min. Negotiated Rate	$84.08
Max. Negotiated Rate	$176.54
Rate for Payer: Cash Price	$136.80
Rate for Payer: Celtic Commercial/Exchange	$84.08
Rate for Payer: Health Partners Plans Commercial	$172.90
Rate for Payer: UnitedHealthcare Commercial	$176.54
Rate for Payer: WPPA Commercial	$152.88

DURICEF 500 MG CAP (CEFADROXIL)

Facility

$11.00

Service Code	NDC 68180018008
Hospital Charge Code	2514966
Hospital Revenue Code	250
Min. Negotiated Rate	$5.08
Max. Negotiated Rate	$10.67
Rate for Payer: Cash Price	$8.70
Rate for Payer: Celtic Commercial/Exchange	$5.08
Rate for Payer: Health Partners Plans Commercial	$10.45
Rate for Payer: UnitedHealthcare Commercial	$10.67
Rate for Payer: WPPA Commercial	$9.24

DURICEF 500 MG CAP (CEFADROXIL)

Facility

$11.00

Service Code	NDC 68180018008
Hospital Charge Code	2514966
Hospital Revenue Code	250
Min. Negotiated Rate	$9.02
Max. Negotiated Rate	$10.67
Rate for Payer: Cash Price	$8.70
Rate for Payer: Health Partners Plans Commercial	$10.45
Rate for Payer: UnitedHealthcare Commercial	$10.67
Rate for Payer: WPPA Commercial	$9.02

Durolane (hyaluronate sodium, stabilized) IAtc syringe

Facility

$3,870.00

Service Code	NDC 89130202001
Hospital Charge Code	2510543
Hospital Revenue Code	250
Min. Negotiated Rate	$3,173.40
Max. Negotiated Rate	$3,753.90
Rate for Payer: Cash Price	$2,902.50
Rate for Payer: Health Partners Plans Commercial	$3,676.50
Rate for Payer: UnitedHealthcare Commercial	$3,753.90
Rate for Payer: WPPA Commercial	$3,173.40

Durolane (hyaluronate sodium, stabilized) IAtc syringe

Facility

$3,870.00

Service Code	NDC 89130202001
Hospital Charge Code	2510543
Hospital Revenue Code	250
Min. Negotiated Rate	$1,787.94
Max. Negotiated Rate	$3,753.90
Rate for Payer: Cash Price	$2,902.50
Rate for Payer: Celtic Commercial/Exchange	$1,787.94
Rate for Payer: Health Partners Plans Commercial	$3,676.50
Rate for Payer: UnitedHealthcare Commercial	$3,753.90
Rate for Payer: WPPA Commercial	$3,250.80

DX SPINAL PUNCTURE LUMBAR

Facility

$685.00

Service Code	HCPCS 62270
Hospital Charge Code	6227000
Hospital Revenue Code	761
Min. Negotiated Rate	$561.70
Max. Negotiated Rate	$664.45
Rate for Payer: Cash Price	$513.75
Rate for Payer: Health Partners Plans Commercial	$650.75
Rate for Payer: UnitedHealthcare Commercial	$664.45
Rate for Payer: WPPA Commercial	$561.70

DX SPINAL PUNCTURE LUMBAR

Facility

$685.00

Service Code	HCPCS 62270
Hospital Charge Code	6227000
Hospital Revenue Code	761
Min. Negotiated Rate	$316.47
Max. Negotiated Rate	$664.45
Rate for Payer: BCBS Commercial	$433.29
Rate for Payer: Cash Price	$513.75
Rate for Payer: Cash Price	$513.75
Rate for Payer: Celtic Commercial/Exchange	$316.47
Rate for Payer: Health Partners Plans Commercial	$650.75
Rate for Payer: UnitedHealthcare Commercial	$664.45
Rate for Payer: WPPA Commercial	$575.40

DYRENIUM 50 MG CAP (triamterene)

Facility

$39.00

Service Code	NDC 59212000201
Hospital Charge Code	2516128
Hospital Revenue Code	250
Min. Negotiated Rate	$31.98
Max. Negotiated Rate	$37.83
Rate for Payer: Cash Price	$29.85
Rate for Payer: Health Partners Plans Commercial	$37.05
Rate for Payer: UnitedHealthcare Commercial	$37.83
Rate for Payer: WPPA Commercial	$31.98

DYRENIUM 50 MG CAP (triamterene)

Facility

$39.00

Service Code	NDC 59212000201
Hospital Charge Code	2516128
Hospital Revenue Code	250
Min. Negotiated Rate	$18.02
Max. Negotiated Rate	$37.83
Rate for Payer: Cash Price	$29.85
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

DYRENIUM 50 MG CAP (triamterene)

Facility

$39.00

Service Code	NDC 59212000201
Hospital Charge Code	2516128
Hospital Revenue Code	250
Min. Negotiated Rate	$31.98
Max. Negotiated Rate	$37.83
Rate for Payer: Cash Price	$29.85
Rate for Payer: Health Partners Plans Commercial	$37.05
Rate for Payer: UnitedHealthcare Commercial	$37.83
Rate for Payer: WPPA Commercial	$31.98

DYRENIUM 50 MG CAP (triamterene)

Facility

$39.00

Service Code	NDC 59212000201
Hospital Charge Code	2516128
Hospital Revenue Code	250
Min. Negotiated Rate	$18.02
Max. Negotiated Rate	$37.83
Rate for Payer: Cash Price	$29.85
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

DYSEQUILIBRIUM

Facility

$6,541.24

Service Code	MSDRG 149
Min. Negotiated Rate	$6,541.24
Max. Negotiated Rate	$6,541.24
Rate for Payer: BCBS Commercial	$6,541.24

EACH ADDIONAL 5CM OR LESS

Facility

$269.00

Service Code	HCPCS 13153
Hospital Charge Code	1315300
Hospital Revenue Code	450
Min. Negotiated Rate	$124.28
Max. Negotiated Rate	$260.93
Rate for Payer: Cash Price	$201.75
Rate for Payer: Celtic Commercial/Exchange	$124.28
Rate for Payer: Health Partners Plans Commercial	$255.55
Rate for Payer: UnitedHealthcare Commercial	$260.93
Rate for Payer: WPPA Commercial	$225.96

EACH ADDIONAL 5CM OR LESS

Facility

$269.00

Service Code	HCPCS 13153
Hospital Charge Code	1315300
Hospital Revenue Code	450
Min. Negotiated Rate	$220.58
Max. Negotiated Rate	$260.93
Rate for Payer: Cash Price	$201.75
Rate for Payer: Health Partners Plans Commercial	$255.55
Rate for Payer: UnitedHealthcare Commercial	$260.93
Rate for Payer: WPPA Commercial	$220.58

EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC

Facility

$12,009.55

Service Code	MSDRG 147
Min. Negotiated Rate	$12,009.55
Max. Negotiated Rate	$12,009.55
Rate for Payer: BCBS Commercial	$12,009.55

EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC

Facility

$18,897.37

Service Code	MSDRG 146
Min. Negotiated Rate	$18,897.37
Max. Negotiated Rate	$18,897.37
Rate for Payer: BCBS Commercial	$18,897.37

EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CC/MCC

Facility

$8,608.90

Service Code	MSDRG 148
Min. Negotiated Rate	$8,608.90
Max. Negotiated Rate	$8,608.90
Rate for Payer: BCBS Commercial	$8,608.90

EAR PROTECTOR

Facility

$4.00

Hospital Charge Code	4100286
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

EAR PROTECTOR

Facility

$4.00

Hospital Charge Code	4100286
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

EAR/ULCER SYRINGES

Facility

$10.00

Hospital Charge Code	2720076
Hospital Revenue Code	272
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$7.88
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

EAR/ULCER SYRINGES

Facility

$10.00

Hospital Charge Code	2720076
Hospital Revenue Code	272
Min. Negotiated Rate	$8.20
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$7.88
Rate for Payer: Health Partners Plans Commercial	$9.50
Rate for Payer: UnitedHealthcare Commercial	$9.70
Rate for Payer: WPPA Commercial	$8.20

ECG 12 LEAD TRACING ONLY

Facility

$229.00

Service Code	HCPCS 93005
Hospital Charge Code	7200002
Hospital Revenue Code	730
Min. Negotiated Rate	$187.78
Max. Negotiated Rate	$222.13
Rate for Payer: Cash Price	$171.75
Rate for Payer: Health Partners Plans Commercial	$217.55
Rate for Payer: UnitedHealthcare Commercial	$222.13
Rate for Payer: WPPA Commercial	$187.78

ECG 12 LEAD TRACING ONLY

Facility

$229.00

Service Code	HCPCS 93005
Hospital Charge Code	7200002
Hospital Revenue Code	730
Min. Negotiated Rate	$105.80
Max. Negotiated Rate	$222.13
Rate for Payer: BCBS Commercial	$164.48
Rate for Payer: Cash Price	$171.75
Rate for Payer: Cash Price	$171.75
Rate for Payer: Celtic Commercial/Exchange	$105.80
Rate for Payer: Health Partners Plans Commercial	$217.55
Rate for Payer: UnitedHealthcare Commercial	$222.13
Rate for Payer: WPPA Commercial	$192.36

Know your out-of-pocket cost for care.

All Charges