Ness County Hospital

All Charges

Charge

Type

Setting

Price

LANTUS SOLOSTAR U-100 INSULIN (INSULIN GLARGINE) SQ PEN

Facility

$75.00

Service Code	NDC 00088221905
Hospital Charge Code	2515450
Hospital Revenue Code	250
Min. Negotiated Rate	$61.50
Max. Negotiated Rate	$72.75
Rate for Payer: Cash Price	$56.25
Rate for Payer: Health Partners Plans Commercial	$71.25
Rate for Payer: UnitedHealthcare Commercial	$72.75
Rate for Payer: WPPA Commercial	$61.50

LANTUS SOLOSTAR U-100 INSULIN (INSULIN GLARGINE) SQ PEN

Facility

$75.00

Service Code	NDC 00088221905
Hospital Charge Code	2515450
Hospital Revenue Code	250
Min. Negotiated Rate	$34.65
Max. Negotiated Rate	$72.75
Rate for Payer: Cash Price	$56.25
Rate for Payer: Celtic Commercial/Exchange	$34.65
Rate for Payer: Health Partners Plans Commercial	$71.25
Rate for Payer: UnitedHealthcare Commercial	$72.75
Rate for Payer: WPPA Commercial	$63.00

LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC

Facility

$14,990.72

Service Code	MSDRG 418
Min. Negotiated Rate	$14,990.72
Max. Negotiated Rate	$14,990.72
Rate for Payer: BCBS Commercial	$14,990.72

LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC

Facility

$21,516.88

Service Code	MSDRG 417
Min. Negotiated Rate	$21,516.88
Max. Negotiated Rate	$21,516.88
Rate for Payer: BCBS Commercial	$21,516.88

LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC

Facility

$11,809.04

Service Code	MSDRG 419
Min. Negotiated Rate	$11,809.04
Max. Negotiated Rate	$11,809.04
Rate for Payer: BCBS Commercial	$11,809.04

LARYNGOCOPY DIRECT W/ OR W/O

Facility

$1,643.00

Service Code	HCPCS 31525
Hospital Charge Code	3152500
Hospital Revenue Code	450
Min. Negotiated Rate	$1,347.26
Max. Negotiated Rate	$1,593.71
Rate for Payer: Cash Price	$1,232.25
Rate for Payer: Health Partners Plans Commercial	$1,560.85
Rate for Payer: UnitedHealthcare Commercial	$1,593.71
Rate for Payer: WPPA Commercial	$1,347.26

LARYNGOCOPY DIRECT W/ OR W/O

Facility

$1,643.00

Service Code	HCPCS 31525
Hospital Charge Code	3152500
Hospital Revenue Code	450
Min. Negotiated Rate	$759.07
Max. Negotiated Rate	$4,467.23
Rate for Payer: BCBS Commercial	$4,467.23
Rate for Payer: Cash Price	$1,232.25
Rate for Payer: Cash Price	$1,232.25
Rate for Payer: Celtic Commercial/Exchange	$759.07
Rate for Payer: Health Partners Plans Commercial	$1,560.85
Rate for Payer: UnitedHealthcare Commercial	$1,593.71
Rate for Payer: WPPA Commercial	$1,380.12

LASIX 40 MG/4 ML INJ. (FUROSEMIDE)

Facility

$71.00

Service Code	NDC 00409610236
Hospital Charge Code	2503944
Hospital Revenue Code	250
Min. Negotiated Rate	$32.80
Max. Negotiated Rate	$68.87
Rate for Payer: Cash Price	$53.55
Rate for Payer: Celtic Commercial/Exchange	$32.80
Rate for Payer: Health Partners Plans Commercial	$67.45
Rate for Payer: UnitedHealthcare Commercial	$68.87
Rate for Payer: WPPA Commercial	$59.64

LASIX 40 MG/4 ML INJ. (FUROSEMIDE)

Facility

$71.00

Service Code	NDC 00409610236
Hospital Charge Code	2503944
Hospital Revenue Code	250
Min. Negotiated Rate	$58.22
Max. Negotiated Rate	$68.87
Rate for Payer: Cash Price	$53.55
Rate for Payer: Health Partners Plans Commercial	$67.45
Rate for Payer: UnitedHealthcare Commercial	$68.87
Rate for Payer: WPPA Commercial	$58.22

LASIX 40 MG TAB (FUROSEMIDE)

Facility

$1.00

Service Code	NDC 69315011701
Hospital Charge Code	2506442
Hospital Revenue Code	250
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.82
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

LASIX 40 MG TAB (FUROSEMIDE)

Facility

$1.00

Service Code	NDC 69315011701
Hospital Charge Code	2506442
Hospital Revenue Code	250
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.82
Rate for Payer: Health Partners Plans Commercial	$0.95
Rate for Payer: UnitedHealthcare Commercial	$0.97
Rate for Payer: WPPA Commercial	$0.82

LATEX-FREE EXTENSION TUBING

Facility

$5.00

Hospital Charge Code	2707947
Hospital Revenue Code	270
Min. Negotiated Rate	$4.10
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$3.75
Rate for Payer: Health Partners Plans Commercial	$4.75
Rate for Payer: UnitedHealthcare Commercial	$4.85
Rate for Payer: WPPA Commercial	$4.10

LATEX-FREE EXTENSION TUBING

Facility

$5.00

Hospital Charge Code	2707947
Hospital Revenue Code	270
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$3.75
Rate for Payer: Celtic Commercial/Exchange	$2.31
Rate for Payer: Health Partners Plans Commercial	$4.75
Rate for Payer: UnitedHealthcare Commercial	$4.85
Rate for Payer: WPPA Commercial	$4.20

LAW ENFORCEMENT DRAW FEE

Facility

$50.00

Hospital Charge Code	8000000
Hospital Revenue Code	309
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$48.50
Rate for Payer: Cash Price	$37.50
Rate for Payer: Celtic Commercial/Exchange	$23.10
Rate for Payer: Health Partners Plans Commercial	$47.50
Rate for Payer: UnitedHealthcare Commercial	$48.50
Rate for Payer: WPPA Commercial	$42.00

LAW ENFORCEMENT DRAW FEE

Facility

$50.00

Hospital Charge Code	8000000
Hospital Revenue Code	309
Min. Negotiated Rate	$41.00
Max. Negotiated Rate	$48.50
Rate for Payer: Cash Price	$37.50
Rate for Payer: Health Partners Plans Commercial	$47.50
Rate for Payer: UnitedHealthcare Commercial	$48.50
Rate for Payer: WPPA Commercial	$41.00

LAYER CLOS.FACE 2.5CM OR LESS

Facility

$409.00

Service Code	HCPCS 12051
Hospital Charge Code	1205101
Hospital Revenue Code	981
Min. Negotiated Rate	$188.96
Max. Negotiated Rate	$715.08
Rate for Payer: BCBS Commercial	$715.08
Rate for Payer: Cash Price	$306.75
Rate for Payer: Cash Price	$306.75
Rate for Payer: Celtic Commercial/Exchange	$188.96
Rate for Payer: Health Partners Plans Commercial	$388.55
Rate for Payer: UnitedHealthcare Commercial	$396.73
Rate for Payer: WPPA Commercial	$343.56

LAYER CLOS.FACE 2.5CM OR LESS

Facility

$409.00

Service Code	HCPCS 12051
Hospital Charge Code	1205101
Hospital Revenue Code	981
Min. Negotiated Rate	$335.38
Max. Negotiated Rate	$396.73
Rate for Payer: Cash Price	$306.75
Rate for Payer: Health Partners Plans Commercial	$388.55
Rate for Payer: UnitedHealthcare Commercial	$396.73
Rate for Payer: WPPA Commercial	$335.38

LAYER CLOS SCLP/TRUNK <2.5 CM

Facility

$353.00

Service Code	HCPCS 12031
Hospital Charge Code	1203100
Hospital Revenue Code	762
Min. Negotiated Rate	$289.46
Max. Negotiated Rate	$342.41
Rate for Payer: Cash Price	$264.75
Rate for Payer: Health Partners Plans Commercial	$335.35
Rate for Payer: UnitedHealthcare Commercial	$342.41
Rate for Payer: WPPA Commercial	$289.46

LAYER CLOS SCLP/TRUNK <2.5 CM

Facility

$353.00

Service Code	HCPCS 12031
Hospital Charge Code	1203100
Hospital Revenue Code	762
Min. Negotiated Rate	$163.09
Max. Negotiated Rate	$451.17
Rate for Payer: BCBS Commercial	$451.17
Rate for Payer: Cash Price	$264.75
Rate for Payer: Cash Price	$264.75
Rate for Payer: Celtic Commercial/Exchange	$163.09
Rate for Payer: Health Partners Plans Commercial	$335.35
Rate for Payer: UnitedHealthcare Commercial	$342.41
Rate for Payer: WPPA Commercial	$296.52

LAYER CLOSURE 2.5 CM OR LESS

Facility

$444.00

Service Code	HCPCS 12042
Hospital Charge Code	1204201
Hospital Revenue Code	981
Min. Negotiated Rate	$364.08
Max. Negotiated Rate	$430.68
Rate for Payer: Cash Price	$333.00
Rate for Payer: Health Partners Plans Commercial	$421.80
Rate for Payer: UnitedHealthcare Commercial	$430.68
Rate for Payer: WPPA Commercial	$364.08

LAYER CLOSURE 2.5 CM OR LESS

Facility

$444.00

Service Code	HCPCS 12042
Hospital Charge Code	1204201
Hospital Revenue Code	981
Min. Negotiated Rate	$205.13
Max. Negotiated Rate	$707.00
Rate for Payer: BCBS Commercial	$707.00
Rate for Payer: Cash Price	$333.00
Rate for Payer: Cash Price	$333.00
Rate for Payer: Celtic Commercial/Exchange	$205.13
Rate for Payer: Health Partners Plans Commercial	$421.80
Rate for Payer: UnitedHealthcare Commercial	$430.68
Rate for Payer: WPPA Commercial	$372.96

LAYER CLOSURE 7.6-12.5 CM

Facility

$581.00

Service Code	HCPCS 12044
Hospital Charge Code	1204400
Hospital Revenue Code	450
Min. Negotiated Rate	$476.42
Max. Negotiated Rate	$563.57
Rate for Payer: Cash Price	$435.75
Rate for Payer: Health Partners Plans Commercial	$551.95
Rate for Payer: UnitedHealthcare Commercial	$563.57
Rate for Payer: WPPA Commercial	$476.42

LAYER CLOSURE 7.6-12.5 CM

Facility

$581.00

Service Code	HCPCS 12044
Hospital Charge Code	1204400
Hospital Revenue Code	450
Min. Negotiated Rate	$268.42
Max. Negotiated Rate	$809.01
Rate for Payer: BCBS Commercial	$809.01
Rate for Payer: Cash Price	$435.75
Rate for Payer: Cash Price	$435.75
Rate for Payer: Celtic Commercial/Exchange	$268.42
Rate for Payer: Health Partners Plans Commercial	$551.95
Rate for Payer: UnitedHealthcare Commercial	$563.57
Rate for Payer: WPPA Commercial	$488.04

LAYER CLOSURE/FACE 2.6 TO 5.0

Facility

$452.00

Service Code	HCPCS 12052
Hospital Charge Code	1205200
Hospital Revenue Code	450
Min. Negotiated Rate	$370.64
Max. Negotiated Rate	$438.44
Rate for Payer: Cash Price	$339.00
Rate for Payer: Health Partners Plans Commercial	$429.40
Rate for Payer: UnitedHealthcare Commercial	$438.44
Rate for Payer: WPPA Commercial	$370.64

LAYER CLOSURE/FACE 2.6 TO 5.0

Facility

$452.00

Service Code	HCPCS 12052
Hospital Charge Code	1205200
Hospital Revenue Code	450
Min. Negotiated Rate	$208.82
Max. Negotiated Rate	$451.17
Rate for Payer: BCBS Commercial	$451.17
Rate for Payer: Cash Price	$339.00
Rate for Payer: Cash Price	$339.00
Rate for Payer: Celtic Commercial/Exchange	$208.82
Rate for Payer: Health Partners Plans Commercial	$429.40
Rate for Payer: UnitedHealthcare Commercial	$438.44
Rate for Payer: WPPA Commercial	$379.68

Know your out-of-pocket cost for care.

All Charges