Ness County Hospital

All Charges

Charge

Type

Setting

Price

IA-2 ANTIBODY

Facility

$104.00

Service Code	HCPCS 86341
Hospital Charge Code	8634102
Hospital Revenue Code	302
Min. Negotiated Rate	$48.05
Max. Negotiated Rate	$100.88
Rate for Payer: BCBS Commercial	$79.87
Rate for Payer: Cash Price	$78.00
Rate for Payer: Cash Price	$78.00
Rate for Payer: Celtic Commercial/Exchange	$48.05
Rate for Payer: Health Partners Plans Commercial	$98.80
Rate for Payer: UnitedHealthcare Commercial	$100.88
Rate for Payer: WPPA Commercial	$87.36

ICE PACK LARGE

Facility

$10.00

Hospital Charge Code	2700680
Hospital Revenue Code	270
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$7.69
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

ICE PACK LARGE

Facility

$10.00

Hospital Charge Code	2700680
Hospital Revenue Code	270
Min. Negotiated Rate	$8.20
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$7.69
Rate for Payer: Health Partners Plans Commercial	$9.50
Rate for Payer: UnitedHealthcare Commercial	$9.70
Rate for Payer: WPPA Commercial	$8.20

ICE PACK SMALL

Facility

$9.00

Hospital Charge Code	2700698
Hospital Revenue Code	270
Min. Negotiated Rate	$7.38
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$6.94
Rate for Payer: Health Partners Plans Commercial	$8.55
Rate for Payer: UnitedHealthcare Commercial	$8.73
Rate for Payer: WPPA Commercial	$7.38

ICE PACK SMALL

Facility

$9.00

Hospital Charge Code	2700698
Hospital Revenue Code	270
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$6.94
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

ICE POUCH LARGE

Facility

$16.00

Hospital Charge Code	2700664
Hospital Revenue Code	270
Min. Negotiated Rate	$13.12
Max. Negotiated Rate	$15.52
Rate for Payer: Cash Price	$12.00
Rate for Payer: Health Partners Plans Commercial	$15.20
Rate for Payer: UnitedHealthcare Commercial	$15.52
Rate for Payer: WPPA Commercial	$13.12

ICE POUCH LARGE

Facility

$16.00

Hospital Charge Code	2700664
Hospital Revenue Code	270
Min. Negotiated Rate	$7.39
Max. Negotiated Rate	$15.52
Rate for Payer: Cash Price	$12.00
Rate for Payer: Celtic Commercial/Exchange	$7.39
Rate for Payer: Health Partners Plans Commercial	$15.20
Rate for Payer: UnitedHealthcare Commercial	$15.52
Rate for Payer: WPPA Commercial	$13.44

I&D OF ABSCESS SIMPLE OR SING

Facility

$821.00

Service Code	HCPCS 10060
Hospital Charge Code	1006000
Hospital Revenue Code	761
Min. Negotiated Rate	$673.22
Max. Negotiated Rate	$796.37
Rate for Payer: Cash Price	$615.75
Rate for Payer: Health Partners Plans Commercial	$779.95
Rate for Payer: UnitedHealthcare Commercial	$796.37
Rate for Payer: WPPA Commercial	$673.22

I&D OF ABSCESS SIMPLE OR SING

Facility

$821.00

Service Code	HCPCS 10060
Hospital Charge Code	1006000
Hospital Revenue Code	761
Min. Negotiated Rate	$248.38
Max. Negotiated Rate	$796.37
Rate for Payer: BCBS Commercial	$248.38
Rate for Payer: Cash Price	$615.75
Rate for Payer: Cash Price	$615.75
Rate for Payer: Celtic Commercial/Exchange	$379.30
Rate for Payer: Health Partners Plans Commercial	$779.95
Rate for Payer: UnitedHealthcare Commercial	$796.37
Rate for Payer: WPPA Commercial	$689.64

I&D OF SUBMUCOSAL ABSCESS RECT

Facility

$2,150.00

Service Code	HCPCS 45005
Hospital Charge Code	4500500
Hospital Revenue Code	450
Min. Negotiated Rate	$1,763.00
Max. Negotiated Rate	$2,085.50
Rate for Payer: Cash Price	$1,612.50
Rate for Payer: Health Partners Plans Commercial	$2,042.50
Rate for Payer: UnitedHealthcare Commercial	$2,085.50
Rate for Payer: WPPA Commercial	$1,763.00

I&D OF SUBMUCOSAL ABSCESS RECT

Facility

$2,150.00

Service Code	HCPCS 45005
Hospital Charge Code	4500500
Hospital Revenue Code	450
Min. Negotiated Rate	$651.00
Max. Negotiated Rate	$2,085.50
Rate for Payer: BCBS Commercial	$651.00
Rate for Payer: Cash Price	$1,612.50
Rate for Payer: Cash Price	$1,612.50
Rate for Payer: Celtic Commercial/Exchange	$993.30
Rate for Payer: Health Partners Plans Commercial	$2,042.50
Rate for Payer: UnitedHealthcare Commercial	$2,085.50
Rate for Payer: WPPA Commercial	$1,806.00

IGA

Facility

$85.00

Service Code	HCPCS 82784
Hospital Charge Code	8278404
Hospital Revenue Code	301
Min. Negotiated Rate	$69.70
Max. Negotiated Rate	$82.45
Rate for Payer: Cash Price	$63.75
Rate for Payer: Health Partners Plans Commercial	$80.75
Rate for Payer: UnitedHealthcare Commercial	$82.45
Rate for Payer: WPPA Commercial	$69.70

IGA

Facility

$85.00

Service Code	HCPCS 82784
Hospital Charge Code	8278404
Hospital Revenue Code	301
Min. Negotiated Rate	$39.27
Max. Negotiated Rate	$82.45
Rate for Payer: BCBS Commercial	$49.24
Rate for Payer: Cash Price	$63.75
Rate for Payer: Cash Price	$63.75
Rate for Payer: Celtic Commercial/Exchange	$39.27
Rate for Payer: Health Partners Plans Commercial	$80.75
Rate for Payer: UnitedHealthcare Commercial	$82.45
Rate for Payer: WPPA Commercial	$71.40

IGEL

Facility

$49.00

Hospital Charge Code	2700665
Hospital Revenue Code	272
Min. Negotiated Rate	$22.64
Max. Negotiated Rate	$47.53
Rate for Payer: Cash Price	$36.75
Rate for Payer: Celtic Commercial/Exchange	$22.64
Rate for Payer: Health Partners Plans Commercial	$46.55
Rate for Payer: UnitedHealthcare Commercial	$47.53
Rate for Payer: WPPA Commercial	$41.16

IGEL

Facility

$49.00

Hospital Charge Code	2700665
Hospital Revenue Code	272
Min. Negotiated Rate	$40.18
Max. Negotiated Rate	$47.53
Rate for Payer: Cash Price	$36.75
Rate for Payer: Health Partners Plans Commercial	$46.55
Rate for Payer: UnitedHealthcare Commercial	$47.53
Rate for Payer: WPPA Commercial	$40.18

IGG

Facility

$85.00

Service Code	HCPCS 82784
Hospital Charge Code	8278405
Hospital Revenue Code	301
Min. Negotiated Rate	$69.70
Max. Negotiated Rate	$82.45
Rate for Payer: Cash Price	$63.75
Rate for Payer: Health Partners Plans Commercial	$80.75
Rate for Payer: UnitedHealthcare Commercial	$82.45
Rate for Payer: WPPA Commercial	$69.70

IGG

Facility

$85.00

Service Code	HCPCS 82784
Hospital Charge Code	8278405
Hospital Revenue Code	301
Min. Negotiated Rate	$39.27
Max. Negotiated Rate	$82.45
Rate for Payer: BCBS Commercial	$49.24
Rate for Payer: Cash Price	$63.75
Rate for Payer: Cash Price	$63.75
Rate for Payer: Celtic Commercial/Exchange	$39.27
Rate for Payer: Health Partners Plans Commercial	$80.75
Rate for Payer: UnitedHealthcare Commercial	$82.45
Rate for Payer: WPPA Commercial	$71.40

IGM

Facility

$90.00

Service Code	HCPCS 82784
Hospital Charge Code	8278402
Hospital Revenue Code	301
Min. Negotiated Rate	$73.80
Max. Negotiated Rate	$87.30
Rate for Payer: Cash Price	$67.50
Rate for Payer: Health Partners Plans Commercial	$85.50
Rate for Payer: UnitedHealthcare Commercial	$87.30
Rate for Payer: WPPA Commercial	$73.80

IGM

Facility

$90.00

Service Code	HCPCS 82784
Hospital Charge Code	8278402
Hospital Revenue Code	301
Min. Negotiated Rate	$41.58
Max. Negotiated Rate	$87.30
Rate for Payer: BCBS Commercial	$49.24
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cash Price	$67.50
Rate for Payer: Celtic Commercial/Exchange	$41.58
Rate for Payer: Health Partners Plans Commercial	$85.50
Rate for Payer: UnitedHealthcare Commercial	$87.30
Rate for Payer: WPPA Commercial	$75.60

IMDUR 30 MG TAB (ISOSORBIDE MONONITRATE ER)

Facility

$21.00

Service Code	NDC 00904644961
Hospital Charge Code	2515385
Hospital Revenue Code	250
Min. Negotiated Rate	$17.22
Max. Negotiated Rate	$20.37
Rate for Payer: Cash Price	$15.98
Rate for Payer: Health Partners Plans Commercial	$19.95
Rate for Payer: UnitedHealthcare Commercial	$20.37
Rate for Payer: WPPA Commercial	$17.22

IMDUR 30 MG TAB (ISOSORBIDE MONONITRATE ER)

Facility

$21.00

Service Code	NDC 00904644961
Hospital Charge Code	2515385
Hospital Revenue Code	250
Min. Negotiated Rate	$9.70
Max. Negotiated Rate	$20.37
Rate for Payer: Cash Price	$15.98
Rate for Payer: Celtic Commercial/Exchange	$9.70
Rate for Payer: Health Partners Plans Commercial	$19.95
Rate for Payer: UnitedHealthcare Commercial	$20.37
Rate for Payer: WPPA Commercial	$17.64

IMITREX 50 MG TAB (SUMATRIPTAN SUCCINATE)

Facility

$77.00

Service Code	NDC 55111029209
Hospital Charge Code	2512259
Hospital Revenue Code	250
Min. Negotiated Rate	$63.14
Max. Negotiated Rate	$74.69
Rate for Payer: Cash Price	$57.86
Rate for Payer: Health Partners Plans Commercial	$73.15
Rate for Payer: UnitedHealthcare Commercial	$74.69
Rate for Payer: WPPA Commercial	$63.14

IMITREX 50 MG TAB (SUMATRIPTAN SUCCINATE)

Facility

$77.00

Service Code	NDC 55111029209
Hospital Charge Code	2512259
Hospital Revenue Code	250
Min. Negotiated Rate	$35.57
Max. Negotiated Rate	$74.69
Rate for Payer: Cash Price	$57.86
Rate for Payer: Celtic Commercial/Exchange	$35.57
Rate for Payer: Health Partners Plans Commercial	$73.15
Rate for Payer: UnitedHealthcare Commercial	$74.69
Rate for Payer: WPPA Commercial	$64.68

IMITREX 6 MG INJ. (SUMATRIPTAN SUCCINATE)

Facility

$255.00

Service Code	NDC 64679072801
Hospital Charge Code	2516151
Hospital Revenue Code	250
Min. Negotiated Rate	$209.10
Max. Negotiated Rate	$247.35
Rate for Payer: Cash Price	$191.25
Rate for Payer: Health Partners Plans Commercial	$242.25
Rate for Payer: UnitedHealthcare Commercial	$247.35
Rate for Payer: WPPA Commercial	$209.10

IMITREX 6 MG INJ. (SUMATRIPTAN SUCCINATE)

Facility

$255.00

Service Code	NDC 64679072801
Hospital Charge Code	2516151
Hospital Revenue Code	250
Min. Negotiated Rate	$117.81
Max. Negotiated Rate	$247.35
Rate for Payer: Cash Price	$191.25
Rate for Payer: Celtic Commercial/Exchange	$117.81
Rate for Payer: Health Partners Plans Commercial	$242.25
Rate for Payer: UnitedHealthcare Commercial	$247.35
Rate for Payer: WPPA Commercial	$214.20

Know your out-of-pocket cost for care.

All Charges