Ness County Hospital

All Charges

Charge

Type

Setting

Price

ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CC/MCC

Facility

$15,114.60

Service Code	MSDRG 063
Min. Negotiated Rate	$15,114.60
Max. Negotiated Rate	$15,114.60
Rate for Payer: BCBS Commercial	$15,114.60

ISLET CELL ANTIBODY

Facility

$160.00

Service Code	HCPCS 86341
Hospital Charge Code	8634100
Hospital Revenue Code	302
Min. Negotiated Rate	$73.92
Max. Negotiated Rate	$155.20
Rate for Payer: BCBS Commercial	$79.87
Rate for Payer: Cash Price	$120.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Celtic Commercial/Exchange	$73.92
Rate for Payer: Health Partners Plans Commercial	$152.00
Rate for Payer: UnitedHealthcare Commercial	$155.20
Rate for Payer: WPPA Commercial	$134.40

ISLET CELL ANTIBODY

Facility

$160.00

Service Code	HCPCS 86341
Hospital Charge Code	8634100
Hospital Revenue Code	302
Min. Negotiated Rate	$131.20
Max. Negotiated Rate	$155.20
Rate for Payer: Cash Price	$120.00
Rate for Payer: Health Partners Plans Commercial	$152.00
Rate for Payer: UnitedHealthcare Commercial	$155.20
Rate for Payer: WPPA Commercial	$131.20

ISMO 20 MG TAB (MONOKET) (ISOSORBIDE MONONITRATE)

Facility

$3.00

Service Code	NDC 62175010701
Hospital Charge Code	2512754
Hospital Revenue Code	250
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.81
Rate for Payer: Health Partners Plans Commercial	$2.85
Rate for Payer: UnitedHealthcare Commercial	$2.91
Rate for Payer: WPPA Commercial	$2.46

ISMO 20 MG TAB (MONOKET) (ISOSORBIDE MONONITRATE)

Facility

$3.00

Service Code	NDC 62175010701
Hospital Charge Code	2512754
Hospital Revenue Code	250
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.81
Rate for Payer: Celtic Commercial/Exchange	$1.39
Rate for Payer: Health Partners Plans Commercial	$2.85
Rate for Payer: UnitedHealthcare Commercial	$2.91
Rate for Payer: WPPA Commercial	$2.52

ISORDIL 10 MG TAB (ISOSORBIDE DINITRATE)

Facility

$3.00

Service Code	NDC 68084008211
Hospital Charge Code	2503654
Hospital Revenue Code	250
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.81
Rate for Payer: Celtic Commercial/Exchange	$1.39
Rate for Payer: Health Partners Plans Commercial	$2.85
Rate for Payer: UnitedHealthcare Commercial	$2.91
Rate for Payer: WPPA Commercial	$2.52

ISORDIL 10 MG TAB (ISOSORBIDE DINITRATE)

Facility

$3.00

Service Code	NDC 68084008211
Hospital Charge Code	2503654
Hospital Revenue Code	250
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.81
Rate for Payer: Health Partners Plans Commercial	$2.85
Rate for Payer: UnitedHealthcare Commercial	$2.91
Rate for Payer: WPPA Commercial	$2.46

Isovue-370 (iopamidol) IV Solution - 100 ml bottle

Facility

$500.00

Service Code	NDC 00270131635
Hospital Charge Code	3300200
Hospital Revenue Code	250
Min. Negotiated Rate	$231.00
Max. Negotiated Rate	$485.00
Rate for Payer: Cash Price	$375.00
Rate for Payer: Celtic Commercial/Exchange	$231.00
Rate for Payer: Health Partners Plans Commercial	$475.00
Rate for Payer: UnitedHealthcare Commercial	$485.00
Rate for Payer: WPPA Commercial	$420.00

Isovue-370 (iopamidol) IV Solution - 100 ml bottle

Facility

$500.00

Service Code	NDC 00270131635
Hospital Charge Code	3300200
Hospital Revenue Code	250
Min. Negotiated Rate	$410.00
Max. Negotiated Rate	$485.00
Rate for Payer: Cash Price	$375.00
Rate for Payer: Health Partners Plans Commercial	$475.00
Rate for Payer: UnitedHealthcare Commercial	$485.00
Rate for Payer: WPPA Commercial	$410.00

IV CONNECTOR(FOR PICC/PORTACAT

Facility

$35.00

Hospital Charge Code	2517753
Hospital Revenue Code	270
Min. Negotiated Rate	$28.70
Max. Negotiated Rate	$33.95
Rate for Payer: Cash Price	$26.25
Rate for Payer: Health Partners Plans Commercial	$33.25
Rate for Payer: UnitedHealthcare Commercial	$33.95
Rate for Payer: WPPA Commercial	$28.70

IV CONNECTOR(FOR PICC/PORTACAT

Facility

$35.00

Hospital Charge Code	2517753
Hospital Revenue Code	270
Min. Negotiated Rate	$16.17
Max. Negotiated Rate	$33.95
Rate for Payer: Cash Price	$26.25
Rate for Payer: Celtic Commercial/Exchange	$16.17
Rate for Payer: Health Partners Plans Commercial	$33.25
Rate for Payer: UnitedHealthcare Commercial	$33.95
Rate for Payer: WPPA Commercial	$29.40

IV INFU,INTL,>8HRS,PORT/IMPLNT

Facility

$350.00

Service Code	HCPCS C8957
Hospital Charge Code	C895700
Hospital Revenue Code	761
Min. Negotiated Rate	$161.70
Max. Negotiated Rate	$339.50
Rate for Payer: BCBS Commercial	$267.65
Rate for Payer: Cash Price	$262.50
Rate for Payer: Cash Price	$262.50
Rate for Payer: Celtic Commercial/Exchange	$161.70
Rate for Payer: Health Partners Plans Commercial	$332.50
Rate for Payer: UnitedHealthcare Commercial	$339.50
Rate for Payer: WPPA Commercial	$294.00

IV INFU,INTL,>8HRS,PORT/IMPLNT

Facility

$350.00

Service Code	HCPCS C8957
Hospital Charge Code	C895700
Hospital Revenue Code	761
Min. Negotiated Rate	$287.00
Max. Negotiated Rate	$339.50
Rate for Payer: Cash Price	$262.50
Rate for Payer: Health Partners Plans Commercial	$332.50
Rate for Payer: UnitedHealthcare Commercial	$339.50
Rate for Payer: WPPA Commercial	$287.00

IV INFU.INTL,THER/DIAG 1ST HR

Facility

$342.00

Service Code	HCPCS 96365
Hospital Charge Code	9636500
Hospital Revenue Code	761
Min. Negotiated Rate	$280.44
Max. Negotiated Rate	$331.74
Rate for Payer: Cash Price	$256.50
Rate for Payer: Health Partners Plans Commercial	$324.90
Rate for Payer: UnitedHealthcare Commercial	$331.74
Rate for Payer: WPPA Commercial	$280.44

IV INFU.INTL,THER/DIAG 1ST HR

Facility

$342.00

Service Code	HCPCS 96365
Hospital Charge Code	9636500
Hospital Revenue Code	761
Min. Negotiated Rate	$158.00
Max. Negotiated Rate	$331.74
Rate for Payer: BCBS Commercial	$255.28
Rate for Payer: Cash Price	$256.50
Rate for Payer: Cash Price	$256.50
Rate for Payer: Celtic Commercial/Exchange	$158.00
Rate for Payer: Health Partners Plans Commercial	$324.90
Rate for Payer: UnitedHealthcare Commercial	$331.74
Rate for Payer: WPPA Commercial	$287.28

IV INFUS CASIRIVIMAB/IMDEVIMAB

Facility

$451.00

Service Code	HCPCS M0240
Hospital Charge Code	M024000
Hospital Revenue Code	761
Min. Negotiated Rate	$208.36
Max. Negotiated Rate	$437.47
Rate for Payer: Cash Price	$338.25
Rate for Payer: Celtic Commercial/Exchange	$208.36
Rate for Payer: Health Partners Plans Commercial	$428.45
Rate for Payer: UnitedHealthcare Commercial	$437.47
Rate for Payer: WPPA Commercial	$378.84

IV INFUS CASIRIVIMAB/IMDEVIMAB

Facility

$451.00

Service Code	HCPCS M0240
Hospital Charge Code	M024000
Hospital Revenue Code	761
Min. Negotiated Rate	$369.82
Max. Negotiated Rate	$437.47
Rate for Payer: Cash Price	$338.25
Rate for Payer: Health Partners Plans Commercial	$428.45
Rate for Payer: UnitedHealthcare Commercial	$437.47
Rate for Payer: WPPA Commercial	$369.82

IV INFUSION BAMLANIVIMAB &

Facility

$451.00

Service Code	HCPCS M0245
Hospital Charge Code	M024500
Hospital Revenue Code	761
Min. Negotiated Rate	$369.82
Max. Negotiated Rate	$437.47
Rate for Payer: Cash Price	$338.25
Rate for Payer: Health Partners Plans Commercial	$428.45
Rate for Payer: UnitedHealthcare Commercial	$437.47
Rate for Payer: WPPA Commercial	$369.82

IV INFUSION BAMLANIVIMAB &

Facility

$451.00

Service Code	HCPCS M0245
Hospital Charge Code	M024500
Hospital Revenue Code	761
Min. Negotiated Rate	$208.36
Max. Negotiated Rate	$437.47
Rate for Payer: Cash Price	$338.25
Rate for Payer: Celtic Commercial/Exchange	$208.36
Rate for Payer: Health Partners Plans Commercial	$428.45
Rate for Payer: UnitedHealthcare Commercial	$437.47
Rate for Payer: WPPA Commercial	$378.84

IV INFUSION,HYDRA, 2ND HR +

Facility

$142.00

Service Code	HCPCS 96361
Hospital Charge Code	9636100
Hospital Revenue Code	761
Min. Negotiated Rate	$116.44
Max. Negotiated Rate	$137.74
Rate for Payer: Cash Price	$106.50
Rate for Payer: Health Partners Plans Commercial	$134.90
Rate for Payer: UnitedHealthcare Commercial	$137.74
Rate for Payer: WPPA Commercial	$116.44

IV INFUSION,HYDRA, 2ND HR +

Facility

$142.00

Service Code	HCPCS 96361
Hospital Charge Code	9636100
Hospital Revenue Code	761
Min. Negotiated Rate	$65.60
Max. Negotiated Rate	$137.74
Rate for Payer: BCBS Commercial	$133.32
Rate for Payer: Cash Price	$106.50
Rate for Payer: Cash Price	$106.50
Rate for Payer: Celtic Commercial/Exchange	$65.60
Rate for Payer: Health Partners Plans Commercial	$134.90
Rate for Payer: UnitedHealthcare Commercial	$137.74
Rate for Payer: WPPA Commercial	$119.28

IV INFUSION,HYDRA,INITL 1ST HR

Facility

$274.00

Service Code	HCPCS 96360
Hospital Charge Code	9636000
Hospital Revenue Code	761
Min. Negotiated Rate	$126.59
Max. Negotiated Rate	$265.78
Rate for Payer: BCBS Commercial	$255.28
Rate for Payer: Cash Price	$205.50
Rate for Payer: Cash Price	$205.50
Rate for Payer: Celtic Commercial/Exchange	$126.59
Rate for Payer: Health Partners Plans Commercial	$260.30
Rate for Payer: UnitedHealthcare Commercial	$265.78
Rate for Payer: WPPA Commercial	$230.16

IV INFUSION,HYDRA,INITL 1ST HR

Facility

$274.00

Service Code	HCPCS 96360
Hospital Charge Code	9636000
Hospital Revenue Code	761
Min. Negotiated Rate	$224.68
Max. Negotiated Rate	$265.78
Rate for Payer: Cash Price	$205.50
Rate for Payer: Health Partners Plans Commercial	$260.30
Rate for Payer: UnitedHealthcare Commercial	$265.78
Rate for Payer: WPPA Commercial	$224.68

IV INFUSION OR INJ CASIRIVIMAB

Facility

$451.00

Service Code	HCPCS 96365
Hospital Charge Code	M024300
Hospital Revenue Code	761
Min. Negotiated Rate	$208.36
Max. Negotiated Rate	$437.47
Rate for Payer: BCBS Commercial	$255.28
Rate for Payer: Cash Price	$338.25
Rate for Payer: Cash Price	$338.25
Rate for Payer: Celtic Commercial/Exchange	$208.36
Rate for Payer: Health Partners Plans Commercial	$428.45
Rate for Payer: UnitedHealthcare Commercial	$437.47
Rate for Payer: WPPA Commercial	$378.84

IV INFUSION OR INJ CASIRIVIMAB

Facility

$451.00

Service Code	HCPCS 96365
Hospital Charge Code	M024300
Hospital Revenue Code	761
Min. Negotiated Rate	$369.82
Max. Negotiated Rate	$437.47
Rate for Payer: Cash Price	$338.25
Rate for Payer: Health Partners Plans Commercial	$428.45
Rate for Payer: UnitedHealthcare Commercial	$437.47
Rate for Payer: WPPA Commercial	$369.82

Know your out-of-pocket cost for care.

All Charges