Ness County Hospital

All Charges

Charge

Type

Setting

Price

GASTRIN

Facility

$120.00

Service Code	HCPCS 82941
Hospital Charge Code	8294101
Hospital Revenue Code	301
Min. Negotiated Rate	$98.40
Max. Negotiated Rate	$116.40
Rate for Payer: Cash Price	$90.00
Rate for Payer: Health Partners Plans Commercial	$114.00
Rate for Payer: UnitedHealthcare Commercial	$116.40
Rate for Payer: WPPA Commercial	$98.40

GASTRIN

Facility

$120.00

Service Code	HCPCS 82941
Hospital Charge Code	8294101
Hospital Revenue Code	301
Min. Negotiated Rate	$55.44
Max. Negotiated Rate	$116.40
Rate for Payer: BCBS Commercial	$68.24
Rate for Payer: Cash Price	$90.00
Rate for Payer: Cash Price	$90.00
Rate for Payer: Celtic Commercial/Exchange	$55.44
Rate for Payer: Health Partners Plans Commercial	$114.00
Rate for Payer: UnitedHealthcare Commercial	$116.40
Rate for Payer: WPPA Commercial	$100.80

Gastrografin 350-399 mg/ml, 90 ml

Facility

$140.00

Service Code	HCPCS Q9963
Hospital Charge Code	Q996300
Hospital Revenue Code	250
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

Gastrografin 350-399 mg/ml, 90 ml

Facility

$140.00

Service Code	HCPCS Q9963
Hospital Charge Code	Q996300
Hospital Revenue Code	250
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$135.80
Rate for Payer: BCBS Commercial	$0.91
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

GASTROINTESTINAL HEMORRHAGE WITH CC

Facility

$9,390.95

Service Code	MSDRG 378
Min. Negotiated Rate	$9,390.95
Max. Negotiated Rate	$9,390.95
Rate for Payer: BCBS Commercial	$9,390.95

GASTROINTESTINAL HEMORRHAGE WITH MCC

Facility

$15,986.55

Service Code	MSDRG 377
Min. Negotiated Rate	$15,986.55
Max. Negotiated Rate	$15,986.55
Rate for Payer: BCBS Commercial	$15,986.55

GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC

Facility

$5,655.46

Service Code	MSDRG 379
Min. Negotiated Rate	$5,655.46
Max. Negotiated Rate	$5,655.46
Rate for Payer: BCBS Commercial	$5,655.46

GASTROINTESTINAL OBSTRUCTION WITH CC

Facility

$8,090.69

Service Code	MSDRG 389
Min. Negotiated Rate	$8,090.69
Max. Negotiated Rate	$8,090.69
Rate for Payer: BCBS Commercial	$8,090.69

GASTROINTESTINAL OBSTRUCTION WITH MCC

Facility

$13,442.84

Service Code	MSDRG 388
Min. Negotiated Rate	$13,442.84
Max. Negotiated Rate	$13,442.84
Rate for Payer: BCBS Commercial	$13,442.84

GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC

Facility

$5,658.14

Service Code	MSDRG 390
Min. Negotiated Rate	$5,658.14
Max. Negotiated Rate	$5,658.14
Rate for Payer: BCBS Commercial	$5,658.14

GASTRONOMY FEEDING 18 FR

Facility

$109.00

Hospital Charge Code	2721977
Hospital Revenue Code	272
Min. Negotiated Rate	$89.38
Max. Negotiated Rate	$105.73
Rate for Payer: Cash Price	$81.75
Rate for Payer: Health Partners Plans Commercial	$103.55
Rate for Payer: UnitedHealthcare Commercial	$105.73
Rate for Payer: WPPA Commercial	$89.38

GASTRONOMY FEEDING 18 FR

Facility

$109.00

Hospital Charge Code	2721977
Hospital Revenue Code	272
Min. Negotiated Rate	$50.36
Max. Negotiated Rate	$105.73
Rate for Payer: Cash Price	$81.75
Rate for Payer: Celtic Commercial/Exchange	$50.36
Rate for Payer: Health Partners Plans Commercial	$103.55
Rate for Payer: UnitedHealthcare Commercial	$105.73
Rate for Payer: WPPA Commercial	$91.56

GASTRO REPLACEMENT BUTTON

Facility

$774.00

Hospital Charge Code	2706825
Hospital Revenue Code	270
Min. Negotiated Rate	$634.68
Max. Negotiated Rate	$750.78
Rate for Payer: Cash Price	$581.06
Rate for Payer: Health Partners Plans Commercial	$735.30
Rate for Payer: UnitedHealthcare Commercial	$750.78
Rate for Payer: WPPA Commercial	$634.68

GASTRO REPLACEMENT BUTTON

Facility

$774.00

Hospital Charge Code	2706825
Hospital Revenue Code	270
Min. Negotiated Rate	$357.59
Max. Negotiated Rate	$750.78
Rate for Payer: Cash Price	$581.06
Rate for Payer: Celtic Commercial/Exchange	$357.59
Rate for Payer: Health Partners Plans Commercial	$735.30
Rate for Payer: UnitedHealthcare Commercial	$750.78
Rate for Payer: WPPA Commercial	$650.16

GAUZE PACKING IODINE STRIP 1/2

Facility

$10.00

Hospital Charge Code	2720128
Hospital Revenue Code	270
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$8.06
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

GAUZE PACKING IODINE STRIP 1/2

Facility

$10.00

Hospital Charge Code	2720128
Hospital Revenue Code	270
Min. Negotiated Rate	$8.20
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$8.06
Rate for Payer: Health Partners Plans Commercial	$9.50
Rate for Payer: UnitedHealthcare Commercial	$9.70
Rate for Payer: WPPA Commercial	$8.20

GAUZE PACKING IODINE STRIPS 1"

Facility

$10.00

Hospital Charge Code	2720127
Hospital Revenue Code	270
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$8.06
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

GAUZE PACKING IODINE STRIPS 1"

Facility

$10.00

Hospital Charge Code	2720127
Hospital Revenue Code	270
Min. Negotiated Rate	$8.20
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$8.06
Rate for Payer: Health Partners Plans Commercial	$9.50
Rate for Payer: UnitedHealthcare Commercial	$9.70
Rate for Payer: WPPA Commercial	$8.20

GAUZE PACKING PLAIN STRIP 1/4"

Facility

$10.00

Hospital Charge Code	2720129
Hospital Revenue Code	270
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$8.06
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

GAUZE PACKING PLAIN STRIP 1/4"

Facility

$10.00

Hospital Charge Code	2720129
Hospital Revenue Code	270
Min. Negotiated Rate	$8.20
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$8.06
Rate for Payer: Health Partners Plans Commercial	$9.50
Rate for Payer: UnitedHealthcare Commercial	$9.70
Rate for Payer: WPPA Commercial	$8.20

GAUZE PLAIN PACKING STRIP 1/2"

Facility

$10.00

Hospital Charge Code	2720130
Hospital Revenue Code	270
Min. Negotiated Rate	$8.20
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$8.06
Rate for Payer: Health Partners Plans Commercial	$9.50
Rate for Payer: UnitedHealthcare Commercial	$9.70
Rate for Payer: WPPA Commercial	$8.20

GAUZE PLAIN PACKING STRIP 1/2"

Facility

$10.00

Hospital Charge Code	2720130
Hospital Revenue Code	270
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$8.06
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

GAUZE SPONGE

Facility

$9.00

Hospital Charge Code	2720829
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

GAUZE SPONGE

Facility

$9.00

Hospital Charge Code	2720829
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

GAUZE VASELINE 1/2X72" FOIL PK

Facility

$9.00

Hospital Charge Code	2720898
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