Ness County Hospital

All Charges

Charge

Type

Setting

Price

IV INFU.THER/DIAG 2ND-?? HR

Facility

$142.00

Service Code	HCPCS 96366
Hospital Charge Code	9636600
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 INFU.THER/DIAG 2ND-?? HR

Facility

$142.00

Service Code	HCPCS 96366
Hospital Charge Code	9636600
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 PUSH,EA ADDTL SEQUENT > 30"

Facility

$117.00

Service Code	HCPCS 96376
Hospital Charge Code	9637600
Hospital Revenue Code	761
Min. Negotiated Rate	$95.94
Max. Negotiated Rate	$113.49
Rate for Payer: Cash Price	$87.75
Rate for Payer: Health Partners Plans Commercial	$111.15
Rate for Payer: UnitedHealthcare Commercial	$113.49
Rate for Payer: WPPA Commercial	$95.94

IV PUSH,EA ADDTL SEQUENT > 30"

Facility

$117.00

Service Code	HCPCS 96376
Hospital Charge Code	9637600
Hospital Revenue Code	761
Min. Negotiated Rate	$43.43
Max. Negotiated Rate	$113.49
Rate for Payer: BCBS Commercial	$43.43
Rate for Payer: Cash Price	$87.75
Rate for Payer: Cash Price	$87.75
Rate for Payer: Celtic Commercial/Exchange	$54.05
Rate for Payer: Health Partners Plans Commercial	$111.15
Rate for Payer: UnitedHealthcare Commercial	$113.49
Rate for Payer: WPPA Commercial	$98.28

IV PUSH, EA ADDTL, THER/DIAG

Facility

$113.00

Service Code	HCPCS 96375
Hospital Charge Code	9637500
Hospital Revenue Code	761
Min. Negotiated Rate	$92.66
Max. Negotiated Rate	$109.61
Rate for Payer: Cash Price	$84.75
Rate for Payer: Health Partners Plans Commercial	$107.35
Rate for Payer: UnitedHealthcare Commercial	$109.61
Rate for Payer: WPPA Commercial	$92.66

IV PUSH, EA ADDTL, THER/DIAG

Facility

$113.00

Service Code	HCPCS 96375
Hospital Charge Code	9637500
Hospital Revenue Code	761
Min. Negotiated Rate	$52.21
Max. Negotiated Rate	$109.61
Rate for Payer: BCBS Commercial	$56.57
Rate for Payer: Cash Price	$84.75
Rate for Payer: Cash Price	$84.75
Rate for Payer: Celtic Commercial/Exchange	$52.21
Rate for Payer: Health Partners Plans Commercial	$107.35
Rate for Payer: UnitedHealthcare Commercial	$109.61
Rate for Payer: WPPA Commercial	$94.92

IV PUSH,INTL,THER/PROPHYL/DIAG

Facility

$256.00

Service Code	HCPCS 96374
Hospital Charge Code	9637400
Hospital Revenue Code	761
Min. Negotiated Rate	$118.27
Max. Negotiated Rate	$255.27
Rate for Payer: BCBS Commercial	$255.27
Rate for Payer: Cash Price	$192.00
Rate for Payer: Cash Price	$192.00
Rate for Payer: Celtic Commercial/Exchange	$118.27
Rate for Payer: Health Partners Plans Commercial	$243.20
Rate for Payer: UnitedHealthcare Commercial	$248.32
Rate for Payer: WPPA Commercial	$215.04

IV PUSH,INTL,THER/PROPHYL/DIAG

Facility

$256.00

Service Code	HCPCS 96374
Hospital Charge Code	9637400
Hospital Revenue Code	761
Min. Negotiated Rate	$209.92
Max. Negotiated Rate	$248.32
Rate for Payer: Cash Price	$192.00
Rate for Payer: Health Partners Plans Commercial	$243.20
Rate for Payer: UnitedHealthcare Commercial	$248.32
Rate for Payer: WPPA Commercial	$209.92

IV SYNTHROID 100 MCG INJ. (LEVOTHYROXINE)

Facility

$380.00

Service Code	NDC 63323064916
Hospital Charge Code	2513315
Hospital Revenue Code	250
Min. Negotiated Rate	$311.60
Max. Negotiated Rate	$368.60
Rate for Payer: Cash Price	$285.05
Rate for Payer: Health Partners Plans Commercial	$361.00
Rate for Payer: UnitedHealthcare Commercial	$368.60
Rate for Payer: WPPA Commercial	$311.60

IV SYNTHROID 100 MCG INJ. (LEVOTHYROXINE)

Facility

$380.00

Service Code	NDC 63323064916
Hospital Charge Code	2513315
Hospital Revenue Code	250
Min. Negotiated Rate	$175.56
Max. Negotiated Rate	$368.60
Rate for Payer: Cash Price	$285.05
Rate for Payer: Celtic Commercial/Exchange	$175.56
Rate for Payer: Health Partners Plans Commercial	$361.00
Rate for Payer: UnitedHealthcare Commercial	$368.60
Rate for Payer: WPPA Commercial	$319.20

JAK2 EXONS 12&13 MUTATION,QUAL

Facility

$441.00

Service Code	HCPCS 81279
Hospital Charge Code	8140300
Hospital Revenue Code	300
Min. Negotiated Rate	$361.62
Max. Negotiated Rate	$427.77
Rate for Payer: Cash Price	$330.75
Rate for Payer: Health Partners Plans Commercial	$418.95
Rate for Payer: UnitedHealthcare Commercial	$427.77
Rate for Payer: WPPA Commercial	$361.62

JAK2 EXONS 12&13 MUTATION,QUAL

Facility

$441.00

Service Code	HCPCS 81279
Hospital Charge Code	8140300
Hospital Revenue Code	300
Min. Negotiated Rate	$203.74
Max. Negotiated Rate	$427.77
Rate for Payer: BCBS Commercial	$291.80
Rate for Payer: Cash Price	$330.75
Rate for Payer: Cash Price	$330.75
Rate for Payer: Celtic Commercial/Exchange	$203.74
Rate for Payer: Health Partners Plans Commercial	$418.95
Rate for Payer: UnitedHealthcare Commercial	$427.77
Rate for Payer: WPPA Commercial	$370.44

JAK 2, GENE ALALYSIS

Facility

$157.00

Service Code	HCPCS 81270
Hospital Charge Code	8127000
Hospital Revenue Code	301
Min. Negotiated Rate	$72.53
Max. Negotiated Rate	$158.22
Rate for Payer: BCBS Commercial	$158.22
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

JAK 2, GENE ALALYSIS

Facility

$157.00

Service Code	HCPCS 81270
Hospital Charge Code	8127000
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

JANUVIA 25 MG TAB (SITAGLIPTIN)

Facility

$59.00

Service Code	NDC 00006022101
Hospital Charge Code	2518983
Hospital Revenue Code	250
Min. Negotiated Rate	$27.26
Max. Negotiated Rate	$57.23
Rate for Payer: Cash Price	$44.92
Rate for Payer: Celtic Commercial/Exchange	$27.26
Rate for Payer: Health Partners Plans Commercial	$56.05
Rate for Payer: UnitedHealthcare Commercial	$57.23
Rate for Payer: WPPA Commercial	$49.56

JANUVIA 25 MG TAB (SITAGLIPTIN)

Facility

$59.00

Service Code	NDC 00006022101
Hospital Charge Code	2518983
Hospital Revenue Code	250
Min. Negotiated Rate	$48.38
Max. Negotiated Rate	$57.23
Rate for Payer: Cash Price	$44.92
Rate for Payer: Health Partners Plans Commercial	$56.05
Rate for Payer: UnitedHealthcare Commercial	$57.23
Rate for Payer: WPPA Commercial	$48.38

JEVITY, PER CAN

Facility

$1.00

Hospital Charge Code	9995566
Hospital Revenue Code	990
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.98
Rate for Payer: Health Partners Plans Commercial	$0.95
Rate for Payer: UnitedHealthcare Commercial	$0.97
Rate for Payer: WPPA Commercial	$0.82

JEVITY, PER CAN

Facility

$1.00

Hospital Charge Code	9995566
Hospital Revenue Code	990
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.98
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

JO-1 ANTIBODY

Facility

$368.00

Service Code	HCPCS 86235
Hospital Charge Code	8623508
Hospital Revenue Code	302
Min. Negotiated Rate	$301.76
Max. Negotiated Rate	$356.96
Rate for Payer: Cash Price	$276.00
Rate for Payer: Health Partners Plans Commercial	$349.60
Rate for Payer: UnitedHealthcare Commercial	$356.96
Rate for Payer: WPPA Commercial	$301.76

JO-1 ANTIBODY

Facility

$368.00

Service Code	HCPCS 86235
Hospital Charge Code	8623508
Hospital Revenue Code	302
Min. Negotiated Rate	$52.26
Max. Negotiated Rate	$356.96
Rate for Payer: BCBS Commercial	$52.26
Rate for Payer: Cash Price	$276.00
Rate for Payer: Cash Price	$276.00
Rate for Payer: Celtic Commercial/Exchange	$170.02
Rate for Payer: Health Partners Plans Commercial	$349.60
Rate for Payer: UnitedHealthcare Commercial	$356.96
Rate for Payer: WPPA Commercial	$309.12

JUNCTIONAL TOURNIQUET SAM

Facility

$1,047.00

Hospital Charge Code	2720259
Hospital Revenue Code	270
Min. Negotiated Rate	$483.71
Max. Negotiated Rate	$1,015.59
Rate for Payer: Cash Price	$785.25
Rate for Payer: Celtic Commercial/Exchange	$483.71
Rate for Payer: Health Partners Plans Commercial	$994.65
Rate for Payer: UnitedHealthcare Commercial	$1,015.59
Rate for Payer: WPPA Commercial	$879.48

JUNCTIONAL TOURNIQUET SAM

Facility

$1,047.00

Hospital Charge Code	2720259
Hospital Revenue Code	270
Min. Negotiated Rate	$858.54
Max. Negotiated Rate	$1,015.59
Rate for Payer: Cash Price	$785.25
Rate for Payer: Health Partners Plans Commercial	$994.65
Rate for Payer: UnitedHealthcare Commercial	$1,015.59
Rate for Payer: WPPA Commercial	$858.54

Juven (with collagen) 23g oral powder in packet

Facility

$6.00

Service Code	NDC 59781066688
Hospital Charge Code	2511558
Hospital Revenue Code	250
Min. Negotiated Rate	$2.77
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$5.24
Rate for Payer: Celtic Commercial/Exchange	$2.77
Rate for Payer: Health Partners Plans Commercial	$5.70
Rate for Payer: UnitedHealthcare Commercial	$5.82
Rate for Payer: WPPA Commercial	$5.04

Juven (with collagen) 23g oral powder in packet

Facility

$6.00

Service Code	NDC 59781066688
Hospital Charge Code	2511558
Hospital Revenue Code	250
Min. Negotiated Rate	$4.92
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$5.24
Rate for Payer: Health Partners Plans Commercial	$5.70
Rate for Payer: UnitedHealthcare Commercial	$5.82
Rate for Payer: WPPA Commercial	$4.92

KALTOSTAT 7.1CM X 11.6CM

Facility

$18.00

Hospital Charge Code	2515617
Hospital Revenue Code	250
Min. Negotiated Rate	$8.32
Max. Negotiated Rate	$17.46
Rate for Payer: Cash Price	$13.95
Rate for Payer: Celtic Commercial/Exchange	$8.32
Rate for Payer: Health Partners Plans Commercial	$17.10
Rate for Payer: UnitedHealthcare Commercial	$17.46
Rate for Payer: WPPA Commercial	$15.12

Know your out-of-pocket cost for care.

All Charges