Ness County Hospital

All Charges

Charge

Type

Setting

Price

GONADOTROPIN, CHORIONIC (HCG)

Facility

$111.00

Service Code	HCPCS 84703
Hospital Charge Code	8470300
Hospital Revenue Code	301
Min. Negotiated Rate	$34.32
Max. Negotiated Rate	$107.67
Rate for Payer: BCBS Commercial	$34.32
Rate for Payer: Cash Price	$83.25
Rate for Payer: Cash Price	$83.25
Rate for Payer: Celtic Commercial/Exchange	$51.28
Rate for Payer: Health Partners Plans Commercial	$105.45
Rate for Payer: UnitedHealthcare Commercial	$107.67
Rate for Payer: WPPA Commercial	$93.24

GONADOTROPIN, CHORIONIC (HCG)

Facility

$111.00

Service Code	HCPCS 84703
Hospital Charge Code	8470300
Hospital Revenue Code	301
Min. Negotiated Rate	$91.02
Max. Negotiated Rate	$107.67
Rate for Payer: Cash Price	$83.25
Rate for Payer: Health Partners Plans Commercial	$105.45
Rate for Payer: UnitedHealthcare Commercial	$107.67
Rate for Payer: WPPA Commercial	$91.02

GONADOTROPIN,CHORIONIC (HCG)

Facility

$133.00

Service Code	HCPCS 84702
Hospital Charge Code	8470200
Hospital Revenue Code	301
Min. Negotiated Rate	$60.36
Max. Negotiated Rate	$129.01
Rate for Payer: BCBS Commercial	$60.36
Rate for Payer: Cash Price	$99.75
Rate for Payer: Cash Price	$99.75
Rate for Payer: Celtic Commercial/Exchange	$61.45
Rate for Payer: Health Partners Plans Commercial	$126.35
Rate for Payer: UnitedHealthcare Commercial	$129.01
Rate for Payer: WPPA Commercial	$111.72

GONADOTROPIN,CHORIONIC (HCG)

Facility

$133.00

Service Code	HCPCS 84702
Hospital Charge Code	8470200
Hospital Revenue Code	301
Min. Negotiated Rate	$109.06
Max. Negotiated Rate	$129.01
Rate for Payer: Cash Price	$99.75
Rate for Payer: Health Partners Plans Commercial	$126.35
Rate for Payer: UnitedHealthcare Commercial	$129.01
Rate for Payer: WPPA Commercial	$109.06

GONADOTROPIN LUTEINIZING HORM.

Facility

$145.00

Service Code	HCPCS 83002
Hospital Charge Code	8300200
Hospital Revenue Code	301
Min. Negotiated Rate	$66.99
Max. Negotiated Rate	$140.65
Rate for Payer: BCBS Commercial	$69.56
Rate for Payer: Cash Price	$108.75
Rate for Payer: Cash Price	$108.75
Rate for Payer: Celtic Commercial/Exchange	$66.99
Rate for Payer: Health Partners Plans Commercial	$137.75
Rate for Payer: UnitedHealthcare Commercial	$140.65
Rate for Payer: WPPA Commercial	$121.80

GONADOTROPIN LUTEINIZING HORM.

Facility

$145.00

Service Code	HCPCS 83002
Hospital Charge Code	8300200
Hospital Revenue Code	301
Min. Negotiated Rate	$118.90
Max. Negotiated Rate	$140.65
Rate for Payer: Cash Price	$108.75
Rate for Payer: Health Partners Plans Commercial	$137.75
Rate for Payer: UnitedHealthcare Commercial	$140.65
Rate for Payer: WPPA Commercial	$118.90

GONODOTROPIN FOLLICL STIM HORM

Facility

$157.00

Service Code	HCPCS 83001
Hospital Charge Code	8300100
Hospital Revenue Code	301
Min. Negotiated Rate	$71.29
Max. Negotiated Rate	$152.29
Rate for Payer: BCBS Commercial	$71.29
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

GONODOTROPIN FOLLICL STIM HORM

Facility

$157.00

Service Code	HCPCS 83001
Hospital Charge Code	8300100
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

GRADUATED TUMBLER 30OZ

Facility

$4.00

Hospital Charge Code	2700748LTC
Hospital Revenue Code	270
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$3.19
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

GRADUATED TUMBLER 30OZ

Facility

$4.00

Hospital Charge Code	2700748LTC
Hospital Revenue Code	270
Min. Negotiated Rate	$3.28
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$3.19
Rate for Payer: Health Partners Plans Commercial	$3.80
Rate for Payer: UnitedHealthcare Commercial	$3.88
Rate for Payer: WPPA Commercial	$3.28

GRANUFOAM SILVER DRESSING

Facility

$109.00

Hospital Charge Code	2722573
Hospital Revenue Code	272
Min. Negotiated Rate	$89.38
Max. Negotiated Rate	$105.73
Rate for Payer: Cash Price	$82.28
Rate for Payer: Health Partners Plans Commercial	$103.55
Rate for Payer: UnitedHealthcare Commercial	$105.73
Rate for Payer: WPPA Commercial	$89.38

GRANUFOAM SILVER DRESSING

Facility

$109.00

Hospital Charge Code	2722573
Hospital Revenue Code	272
Min. Negotiated Rate	$50.36
Max. Negotiated Rate	$105.73
Rate for Payer: Cash Price	$82.28
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

GROWTH HORMONE-HUMAN (HGH)

Facility

$101.00

Service Code	HCPCS 83003
Hospital Charge Code	8300300
Hospital Revenue Code	301
Min. Negotiated Rate	$82.82
Max. Negotiated Rate	$97.97
Rate for Payer: Cash Price	$75.75
Rate for Payer: Health Partners Plans Commercial	$95.95
Rate for Payer: UnitedHealthcare Commercial	$97.97
Rate for Payer: WPPA Commercial	$82.82

GROWTH HORMONE-HUMAN (HGH)

Facility

$101.00

Service Code	HCPCS 83003
Hospital Charge Code	8300300
Hospital Revenue Code	301
Min. Negotiated Rate	$46.66
Max. Negotiated Rate	$97.97
Rate for Payer: BCBS Commercial	$58.95
Rate for Payer: Cash Price	$75.75
Rate for Payer: Cash Price	$75.75
Rate for Payer: Celtic Commercial/Exchange	$46.66
Rate for Payer: Health Partners Plans Commercial	$95.95
Rate for Payer: UnitedHealthcare Commercial	$97.97
Rate for Payer: WPPA Commercial	$84.84

HAEMOPHILUS INFLUENZAE TYPE B

Facility

$61.00

Service Code	HCPCS 86684
Hospital Charge Code	8668400
Hospital Revenue Code	302
Min. Negotiated Rate	$28.18
Max. Negotiated Rate	$59.17
Rate for Payer: BCBS Commercial	$36.90
Rate for Payer: Cash Price	$45.75
Rate for Payer: Cash Price	$45.75
Rate for Payer: Celtic Commercial/Exchange	$28.18
Rate for Payer: Health Partners Plans Commercial	$57.95
Rate for Payer: UnitedHealthcare Commercial	$59.17
Rate for Payer: WPPA Commercial	$51.24

HAEMOPHILUS INFLUENZAE TYPE B

Facility

$61.00

Service Code	HCPCS 86684
Hospital Charge Code	8668400
Hospital Revenue Code	302
Min. Negotiated Rate	$50.02
Max. Negotiated Rate	$59.17
Rate for Payer: Cash Price	$45.75
Rate for Payer: Health Partners Plans Commercial	$57.95
Rate for Payer: UnitedHealthcare Commercial	$59.17
Rate for Payer: WPPA Commercial	$50.02

HALDOL 0.5 MG TAB (HALOPERIDOL)

Facility

$1.00

Service Code	NDC 51079073320
Hospital Charge Code	2508174
Hospital Revenue Code	250
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.90
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

HALDOL 0.5 MG TAB (HALOPERIDOL)

Facility

$1.00

Service Code	NDC 51079073320
Hospital Charge Code	2508174
Hospital Revenue Code	250
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.90
Rate for Payer: Health Partners Plans Commercial	$0.95
Rate for Payer: UnitedHealthcare Commercial	$0.97
Rate for Payer: WPPA Commercial	$0.82

HALDOL 5 MG/ML INJ. (HALOPERIDOL)

Facility

$44.00

Service Code	NDC 76045073710
Hospital Charge Code	2503084
Hospital Revenue Code	250
Min. Negotiated Rate	$20.33
Max. Negotiated Rate	$42.68
Rate for Payer: Cash Price	$33.15
Rate for Payer: Celtic Commercial/Exchange	$20.33
Rate for Payer: Health Partners Plans Commercial	$41.80
Rate for Payer: UnitedHealthcare Commercial	$42.68
Rate for Payer: WPPA Commercial	$36.96

HALDOL 5 MG/ML INJ. (HALOPERIDOL)

Facility

$44.00

Service Code	NDC 76045073710
Hospital Charge Code	2503084
Hospital Revenue Code	250
Min. Negotiated Rate	$36.08
Max. Negotiated Rate	$42.68
Rate for Payer: Cash Price	$33.15
Rate for Payer: Health Partners Plans Commercial	$41.80
Rate for Payer: UnitedHealthcare Commercial	$42.68
Rate for Payer: WPPA Commercial	$36.08

HAND CONE

Facility

$30.00

Hospital Charge Code	2700440
Hospital Revenue Code	272
Min. Negotiated Rate	$13.86
Max. Negotiated Rate	$29.10
Rate for Payer: Cash Price	$22.50
Rate for Payer: Celtic Commercial/Exchange	$13.86
Rate for Payer: Health Partners Plans Commercial	$28.50
Rate for Payer: UnitedHealthcare Commercial	$29.10
Rate for Payer: WPPA Commercial	$25.20

HAND CONE

Facility

$30.00

Hospital Charge Code	2700440
Hospital Revenue Code	272
Min. Negotiated Rate	$24.60
Max. Negotiated Rate	$29.10
Rate for Payer: Cash Price	$22.50
Rate for Payer: Health Partners Plans Commercial	$28.50
Rate for Payer: UnitedHealthcare Commercial	$29.10
Rate for Payer: WPPA Commercial	$24.60

HANDLING FEE-LAB

Facility

$20.00

Service Code	HCPCS 99001
Hospital Charge Code	9900100
Hospital Revenue Code	300
Min. Negotiated Rate	$16.40
Max. Negotiated Rate	$19.40
Rate for Payer: Cash Price	$15.00
Rate for Payer: Health Partners Plans Commercial	$19.00
Rate for Payer: UnitedHealthcare Commercial	$19.40
Rate for Payer: WPPA Commercial	$16.40

HANDLING FEE-LAB

Facility

$20.00

Service Code	HCPCS 99001
Hospital Charge Code	9900100
Hospital Revenue Code	300
Min. Negotiated Rate	$9.24
Max. Negotiated Rate	$19.40
Rate for Payer: BCBS Commercial	$10.85
Rate for Payer: Cash Price	$15.00
Rate for Payer: Cash Price	$15.00
Rate for Payer: Celtic Commercial/Exchange	$9.24
Rate for Payer: Health Partners Plans Commercial	$19.00
Rate for Payer: UnitedHealthcare Commercial	$19.40
Rate for Payer: WPPA Commercial	$16.80

HANDLING FEE-SPECIMAN-REF LAB

Facility

$20.00

Service Code	HCPCS 99000
Hospital Charge Code	9900000
Hospital Revenue Code	309
Min. Negotiated Rate	$9.24
Max. Negotiated Rate	$19.40
Rate for Payer: BCBS Commercial	$10.85
Rate for Payer: Cash Price	$15.00
Rate for Payer: Cash Price	$15.00
Rate for Payer: Celtic Commercial/Exchange	$9.24
Rate for Payer: Health Partners Plans Commercial	$19.00
Rate for Payer: UnitedHealthcare Commercial	$19.40
Rate for Payer: WPPA Commercial	$16.80

Know your out-of-pocket cost for care.

All Charges