Ness County Hospital

All Charges

Charge

Type

Setting

Price

IODOFORM GAUZE 1/4 INCH X 5 YD

Facility

$12.00

Hospital Charge Code	2509601
Hospital Revenue Code	272
Min. Negotiated Rate	$9.84
Max. Negotiated Rate	$11.64
Rate for Payer: Cash Price	$9.19
Rate for Payer: Health Partners Plans Commercial	$11.40
Rate for Payer: UnitedHealthcare Commercial	$11.64
Rate for Payer: WPPA Commercial	$9.84

IONTOPHORESIS SYSTEM 6PK

Facility

$89.00

Hospital Charge Code	2709889
Hospital Revenue Code	270
Min. Negotiated Rate	$72.98
Max. Negotiated Rate	$86.33
Rate for Payer: Cash Price	$66.75
Rate for Payer: Health Partners Plans Commercial	$84.55
Rate for Payer: UnitedHealthcare Commercial	$86.33
Rate for Payer: WPPA Commercial	$72.98

IONTOPHORESIS SYSTEM 6PK

Facility

$89.00

Hospital Charge Code	2709889
Hospital Revenue Code	270
Min. Negotiated Rate	$41.12
Max. Negotiated Rate	$86.33
Rate for Payer: Cash Price	$66.75
Rate for Payer: Celtic Commercial/Exchange	$41.12
Rate for Payer: Health Partners Plans Commercial	$84.55
Rate for Payer: UnitedHealthcare Commercial	$86.33
Rate for Payer: WPPA Commercial	$74.76

IPPB CIRCUIT

Facility

$21.00

Hospital Charge Code	4100260
Hospital Revenue Code	270
Min. Negotiated Rate	$17.22
Max. Negotiated Rate	$20.37
Rate for Payer: Cash Price	$16.31
Rate for Payer: Health Partners Plans Commercial	$19.95
Rate for Payer: UnitedHealthcare Commercial	$20.37
Rate for Payer: WPPA Commercial	$17.22

IPPB CIRCUIT

Facility

$21.00

Hospital Charge Code	4100260
Hospital Revenue Code	270
Min. Negotiated Rate	$9.70
Max. Negotiated Rate	$20.37
Rate for Payer: Cash Price	$16.31
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

IPPB MANIFOLDS

Facility

$17.00

Hospital Charge Code	4100273
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

IPPB MANIFOLDS

Facility

$17.00

Hospital Charge Code	4100273
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

IRON

Facility

$74.00

Service Code	HCPCS 83540
Hospital Charge Code	8354000
Hospital Revenue Code	301
Min. Negotiated Rate	$25.62
Max. Negotiated Rate	$71.78
Rate for Payer: BCBS Commercial	$25.62
Rate for Payer: Cash Price	$55.50
Rate for Payer: Cash Price	$55.50
Rate for Payer: Celtic Commercial/Exchange	$34.19
Rate for Payer: Health Partners Plans Commercial	$70.30
Rate for Payer: UnitedHealthcare Commercial	$71.78
Rate for Payer: WPPA Commercial	$62.16

IRON

Facility

$74.00

Service Code	HCPCS 83540
Hospital Charge Code	8354000
Hospital Revenue Code	301
Min. Negotiated Rate	$60.68
Max. Negotiated Rate	$71.78
Rate for Payer: Cash Price	$55.50
Rate for Payer: Health Partners Plans Commercial	$70.30
Rate for Payer: UnitedHealthcare Commercial	$71.78
Rate for Payer: WPPA Commercial	$60.68

IRON BINDING CAPACITY

Facility

$96.00

Service Code	HCPCS 83550
Hospital Charge Code	8355000
Hospital Revenue Code	301
Min. Negotiated Rate	$78.72
Max. Negotiated Rate	$93.12
Rate for Payer: Cash Price	$72.00
Rate for Payer: Health Partners Plans Commercial	$91.20
Rate for Payer: UnitedHealthcare Commercial	$93.12
Rate for Payer: WPPA Commercial	$78.72

IRON BINDING CAPACITY

Facility

$96.00

Service Code	HCPCS 83550
Hospital Charge Code	8355000
Hospital Revenue Code	301
Min. Negotiated Rate	$41.23
Max. Negotiated Rate	$93.12
Rate for Payer: BCBS Commercial	$41.23
Rate for Payer: Cash Price	$72.00
Rate for Payer: Cash Price	$72.00
Rate for Payer: Celtic Commercial/Exchange	$44.35
Rate for Payer: Health Partners Plans Commercial	$91.20
Rate for Payer: UnitedHealthcare Commercial	$93.12
Rate for Payer: WPPA Commercial	$80.64

IRON DEXTRAN 100MG/2ML

Facility

$135.00

Hospital Charge Code	2515153
Hospital Revenue Code	250
Min. Negotiated Rate	$62.37
Max. Negotiated Rate	$130.95
Rate for Payer: Cash Price	$101.25
Rate for Payer: Celtic Commercial/Exchange	$62.37
Rate for Payer: Health Partners Plans Commercial	$128.25
Rate for Payer: UnitedHealthcare Commercial	$130.95
Rate for Payer: WPPA Commercial	$113.40

IRON DEXTRAN 100MG/2ML

Facility

$135.00

Hospital Charge Code	2515153
Hospital Revenue Code	250
Min. Negotiated Rate	$110.70
Max. Negotiated Rate	$130.95
Rate for Payer: Cash Price	$101.25
Rate for Payer: Health Partners Plans Commercial	$128.25
Rate for Payer: UnitedHealthcare Commercial	$130.95
Rate for Payer: WPPA Commercial	$110.70

IRRIGATION TRAY (DISPOSABLE

Facility

$22.00

Hospital Charge Code	2720258
Hospital Revenue Code	272
Min. Negotiated Rate	$10.16
Max. Negotiated Rate	$21.34
Rate for Payer: Cash Price	$16.50
Rate for Payer: Celtic Commercial/Exchange	$10.16
Rate for Payer: Health Partners Plans Commercial	$20.90
Rate for Payer: UnitedHealthcare Commercial	$21.34
Rate for Payer: WPPA Commercial	$18.48

IRRIGATION TRAY (DISPOSABLE

Facility

$22.00

Hospital Charge Code	2720258
Hospital Revenue Code	272
Min. Negotiated Rate	$18.04
Max. Negotiated Rate	$21.34
Rate for Payer: Cash Price	$16.50
Rate for Payer: Health Partners Plans Commercial	$20.90
Rate for Payer: UnitedHealthcare Commercial	$21.34
Rate for Payer: WPPA Commercial	$18.04

IRRIG,IMPLANTED VENOUS DEVICE

Facility

$129.00

Service Code	HCPCS 96523
Hospital Charge Code	9652300
Hospital Revenue Code	761
Min. Negotiated Rate	$105.78
Max. Negotiated Rate	$125.13
Rate for Payer: Cash Price	$96.75
Rate for Payer: Health Partners Plans Commercial	$122.55
Rate for Payer: UnitedHealthcare Commercial	$125.13
Rate for Payer: WPPA Commercial	$105.78

IRRIG,IMPLANTED VENOUS DEVICE

Facility

$129.00

Service Code	HCPCS 96523
Hospital Charge Code	9652300
Hospital Revenue Code	761
Min. Negotiated Rate	$54.54
Max. Negotiated Rate	$125.13
Rate for Payer: BCBS Commercial	$54.54
Rate for Payer: Cash Price	$96.75
Rate for Payer: Cash Price	$96.75
Rate for Payer: Celtic Commercial/Exchange	$59.60
Rate for Payer: Health Partners Plans Commercial	$122.55
Rate for Payer: UnitedHealthcare Commercial	$125.13
Rate for Payer: WPPA Commercial	$108.36

ISB HAIR CARE-OUTSIDE SOURCE

Facility

$25.00

Hospital Charge Code	9997733
Hospital Revenue Code	990
Min. Negotiated Rate	$11.55
Max. Negotiated Rate	$24.25
Rate for Payer: Cash Price	$18.75
Rate for Payer: Celtic Commercial/Exchange	$11.55
Rate for Payer: Health Partners Plans Commercial	$23.75
Rate for Payer: UnitedHealthcare Commercial	$24.25
Rate for Payer: WPPA Commercial	$21.00

ISB HAIR CARE-OUTSIDE SOURCE

Facility

$25.00

Hospital Charge Code	9997733
Hospital Revenue Code	990
Min. Negotiated Rate	$20.50
Max. Negotiated Rate	$24.25
Rate for Payer: Cash Price	$18.75
Rate for Payer: Health Partners Plans Commercial	$23.75
Rate for Payer: UnitedHealthcare Commercial	$24.25
Rate for Payer: WPPA Commercial	$20.50

ISB HAIRCUT FROM OUTSIDE SOURC

Facility

$25.00

Hospital Charge Code	9997711
Hospital Revenue Code	990
Min. Negotiated Rate	$20.50
Max. Negotiated Rate	$24.25
Rate for Payer: Cash Price	$18.75
Rate for Payer: Health Partners Plans Commercial	$23.75
Rate for Payer: UnitedHealthcare Commercial	$24.25
Rate for Payer: WPPA Commercial	$20.50

ISB HAIRCUT FROM OUTSIDE SOURC

Facility

$25.00

Hospital Charge Code	9997711
Hospital Revenue Code	990
Min. Negotiated Rate	$11.55
Max. Negotiated Rate	$24.25
Rate for Payer: Cash Price	$18.75
Rate for Payer: Celtic Commercial/Exchange	$11.55
Rate for Payer: Health Partners Plans Commercial	$23.75
Rate for Payer: UnitedHealthcare Commercial	$24.25
Rate for Payer: WPPA Commercial	$21.00

ISB LEVEL 1 Room & Board

Facility

$245.00

Hospital Charge Code	7777777
Hospital Revenue Code	110
Min. Negotiated Rate	$200.90
Max. Negotiated Rate	$4,738.80
Rate for Payer: Cash Price	$183.75
Rate for Payer: Cash Price	$183.75
Rate for Payer: Celtic Commercial/Exchange	$4,738.80
Rate for Payer: Health Partners Plans Commercial	$232.75
Rate for Payer: UnitedHealthcare Commercial	$237.65
Rate for Payer: WPPA Commercial	$200.90

ISB LEVEL 2 Room & Board

Facility

$255.00

Hospital Charge Code	7777778
Hospital Revenue Code	110
Min. Negotiated Rate	$209.10
Max. Negotiated Rate	$4,738.80
Rate for Payer: Cash Price	$191.25
Rate for Payer: Cash Price	$191.25
Rate for Payer: Celtic Commercial/Exchange	$4,738.80
Rate for Payer: Health Partners Plans Commercial	$242.25
Rate for Payer: UnitedHealthcare Commercial	$247.35
Rate for Payer: WPPA Commercial	$209.10

ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC

Facility

$18,391.50

Service Code	MSDRG 062
Min. Negotiated Rate	$18,391.50
Max. Negotiated Rate	$18,391.50
Rate for Payer: BCBS Commercial	$18,391.50

ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC

Facility

$26,678.70

Service Code	MSDRG 061
Min. Negotiated Rate	$26,678.70
Max. Negotiated Rate	$26,678.70
Rate for Payer: BCBS Commercial	$26,678.70

Know your out-of-pocket cost for care.

All Charges