Ness County Hospital

All Charges

Charge

Type

Setting

Price

MASSAGE/VIBRA/PERCUS INITIAL

Facility

$183.00

Service Code	HCPCS 94667 59
Hospital Charge Code	9466700
Hospital Revenue Code	410
Min. Negotiated Rate	$84.55
Max. Negotiated Rate	$177.51
Rate for Payer: BCBS Commercial	$161.13
Rate for Payer: Cash Price	$137.25
Rate for Payer: Cash Price	$137.25
Rate for Payer: Celtic Commercial/Exchange	$84.55
Rate for Payer: Health Partners Plans Commercial	$173.85
Rate for Payer: UnitedHealthcare Commercial	$177.51
Rate for Payer: WPPA Commercial	$153.72

MASS/TANDEM MASS SPECTROM-QUAN

Facility

$208.00

Service Code	HCPCS 83789
Hospital Charge Code	8378900
Hospital Revenue Code	301
Min. Negotiated Rate	$96.10
Max. Negotiated Rate	$201.76
Rate for Payer: BCBS Commercial	$185.82
Rate for Payer: Cash Price	$156.00
Rate for Payer: Cash Price	$156.00
Rate for Payer: Celtic Commercial/Exchange	$96.10
Rate for Payer: Health Partners Plans Commercial	$197.60
Rate for Payer: UnitedHealthcare Commercial	$201.76
Rate for Payer: WPPA Commercial	$174.72

MASS/TANDEM MASS SPECTROM-QUAN

Facility

$208.00

Service Code	HCPCS 83789
Hospital Charge Code	8378900
Hospital Revenue Code	301
Min. Negotiated Rate	$170.56
Max. Negotiated Rate	$201.76
Rate for Payer: Cash Price	$156.00
Rate for Payer: Health Partners Plans Commercial	$197.60
Rate for Payer: UnitedHealthcare Commercial	$201.76
Rate for Payer: WPPA Commercial	$170.56

MASTECTOMY FOR MALIGNANCY WITH CC/MCC

Facility

$14,572.81

Service Code	MSDRG 582
Min. Negotiated Rate	$14,572.81
Max. Negotiated Rate	$14,572.81
Rate for Payer: BCBS Commercial	$14,572.81

MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC

Facility

$11,176.34

Service Code	MSDRG 583
Min. Negotiated Rate	$11,176.34
Max. Negotiated Rate	$11,176.34
Rate for Payer: BCBS Commercial	$11,176.34

MASTISOL LIQUID ADHESIVE

Facility

$7.00

Hospital Charge Code	2720732
Hospital Revenue Code	272
Min. Negotiated Rate	$3.23
Max. Negotiated Rate	$6.79
Rate for Payer: Cash Price	$5.25
Rate for Payer: Celtic Commercial/Exchange	$3.23
Rate for Payer: Health Partners Plans Commercial	$6.65
Rate for Payer: UnitedHealthcare Commercial	$6.79
Rate for Payer: WPPA Commercial	$5.88

MASTISOL LIQUID ADHESIVE

Facility

$7.00

Hospital Charge Code	2720732
Hospital Revenue Code	272
Min. Negotiated Rate	$5.74
Max. Negotiated Rate	$6.79
Rate for Payer: Cash Price	$5.25
Rate for Payer: Health Partners Plans Commercial	$6.65
Rate for Payer: UnitedHealthcare Commercial	$6.79
Rate for Payer: WPPA Commercial	$5.74

MASTISOL LIQUID LTC

Facility

$7.00

Hospital Charge Code	2720732LTC
Hospital Revenue Code	272
Min. Negotiated Rate	$3.23
Max. Negotiated Rate	$6.79
Rate for Payer: Cash Price	$5.25
Rate for Payer: Celtic Commercial/Exchange	$3.23
Rate for Payer: Health Partners Plans Commercial	$6.65
Rate for Payer: UnitedHealthcare Commercial	$6.79
Rate for Payer: WPPA Commercial	$5.88

MASTISOL LIQUID LTC

Facility

$7.00

Hospital Charge Code	2720732LTC
Hospital Revenue Code	272
Min. Negotiated Rate	$5.74
Max. Negotiated Rate	$6.79
Rate for Payer: Cash Price	$5.25
Rate for Payer: Health Partners Plans Commercial	$6.65
Rate for Payer: UnitedHealthcare Commercial	$6.79
Rate for Payer: WPPA Commercial	$5.74

MAVIK 1 MG TAB (TRANDOLAPRIL)

Facility

$4.00

Service Code	NDC 68180056601
Hospital Charge Code	2503068
Hospital Revenue Code	250
Min. Negotiated Rate	$3.28
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$3.15
Rate for Payer: Health Partners Plans Commercial	$3.80
Rate for Payer: UnitedHealthcare Commercial	$3.88
Rate for Payer: WPPA Commercial	$3.28

MAVIK 1 MG TAB (TRANDOLAPRIL)

Facility

$4.00

Service Code	NDC 68180056601
Hospital Charge Code	2503068
Hospital Revenue Code	250
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$3.15
Rate for Payer: Celtic Commercial/Exchange	$1.85
Rate for Payer: Health Partners Plans Commercial	$3.80
Rate for Payer: UnitedHealthcare Commercial	$3.88
Rate for Payer: WPPA Commercial	$3.36

Maxipime 1 GM premix IV (cefepime)

Facility

$61.00

Service Code	NDC 00264319311
Hospital Charge Code	2518041
Hospital Revenue Code	250
Min. Negotiated Rate	$28.18
Max. Negotiated Rate	$59.17
Rate for Payer: Cash Price	$45.97
Rate for Payer: Celtic Commercial/Exchange	$28.18
Rate for Payer: Health Partners Plans Commercial	$57.95
Rate for Payer: UnitedHealthcare Commercial	$59.17
Rate for Payer: WPPA Commercial	$51.24

Maxipime 1 GM premix IV (cefepime)

Facility

$61.00

Service Code	NDC 00264319311
Hospital Charge Code	2518041
Hospital Revenue Code	250
Min. Negotiated Rate	$50.02
Max. Negotiated Rate	$59.17
Rate for Payer: Cash Price	$45.97
Rate for Payer: Health Partners Plans Commercial	$57.95
Rate for Payer: UnitedHealthcare Commercial	$59.17
Rate for Payer: WPPA Commercial	$50.02

Maxipime 1 GM vial (cefepime)

Facility

$70.00

Service Code	NDC 60505603004
Hospital Charge Code	2504280
Hospital Revenue Code	250
Min. Negotiated Rate	$57.40
Max. Negotiated Rate	$67.90
Rate for Payer: Cash Price	$52.88
Rate for Payer: Health Partners Plans Commercial	$66.50
Rate for Payer: UnitedHealthcare Commercial	$67.90
Rate for Payer: WPPA Commercial	$57.40

Maxipime 1 GM vial (cefepime)

Facility

$70.00

Service Code	NDC 60505603004
Hospital Charge Code	2504280
Hospital Revenue Code	250
Min. Negotiated Rate	$32.34
Max. Negotiated Rate	$67.90
Rate for Payer: Cash Price	$52.88
Rate for Payer: Celtic Commercial/Exchange	$32.34
Rate for Payer: Health Partners Plans Commercial	$66.50
Rate for Payer: UnitedHealthcare Commercial	$67.90
Rate for Payer: WPPA Commercial	$58.80

Maxipime 2 GM Premix(cefepime)

Facility

$87.00

Service Code	NDC 00264319511
Hospital Charge Code	2518694
Hospital Revenue Code	250
Min. Negotiated Rate	$40.19
Max. Negotiated Rate	$84.39
Rate for Payer: Cash Price	$65.59
Rate for Payer: Celtic Commercial/Exchange	$40.19
Rate for Payer: Health Partners Plans Commercial	$82.65
Rate for Payer: UnitedHealthcare Commercial	$84.39
Rate for Payer: WPPA Commercial	$73.08

Maxipime 2 GM Premix(cefepime)

Facility

$87.00

Service Code	NDC 00264319511
Hospital Charge Code	2518694
Hospital Revenue Code	250
Min. Negotiated Rate	$71.34
Max. Negotiated Rate	$84.39
Rate for Payer: Cash Price	$65.59
Rate for Payer: Health Partners Plans Commercial	$82.65
Rate for Payer: UnitedHealthcare Commercial	$84.39
Rate for Payer: WPPA Commercial	$71.34

MAXZIDE 37.5/25 MG TAB (DYAZIDE) (TRIAMTERENE & HCTZ)

Facility

$2.00

Service Code	NDC 68084075095
Hospital Charge Code	2504207
Hospital Revenue Code	250
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$2.03
Rate for Payer: Health Partners Plans Commercial	$1.90
Rate for Payer: UnitedHealthcare Commercial	$1.94
Rate for Payer: WPPA Commercial	$1.64

MAXZIDE 37.5/25 MG TAB (DYAZIDE) (TRIAMTERENE & HCTZ)

Facility

$2.00

Service Code	NDC 68084075095
Hospital Charge Code	2504207
Hospital Revenue Code	250
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$2.03
Rate for Payer: Celtic Commercial/Exchange	$0.92
Rate for Payer: Health Partners Plans Commercial	$1.90
Rate for Payer: UnitedHealthcare Commercial	$1.94
Rate for Payer: WPPA Commercial	$1.68

MC GADOLINIUM 20 ML, PER ML

Facility

$12.00

Service Code	HCPCS A9579
Hospital Charge Code	A957900
Hospital Revenue Code	254
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$11.64
Rate for Payer: BCBS Commercial	$9.50
Rate for Payer: Cash Price	$9.49
Rate for Payer: Cash Price	$9.49
Rate for Payer: Celtic Commercial/Exchange	$5.54
Rate for Payer: Health Partners Plans Commercial	$11.40
Rate for Payer: UnitedHealthcare Commercial	$11.64
Rate for Payer: WPPA Commercial	$10.08

MC GADOLINIUM 20 ML, PER ML

Facility

$12.00

Service Code	HCPCS A9579
Hospital Charge Code	A957900
Hospital Revenue Code	254
Min. Negotiated Rate	$9.84
Max. Negotiated Rate	$11.64
Rate for Payer: Cash Price	$9.49
Rate for Payer: Health Partners Plans Commercial	$11.40
Rate for Payer: UnitedHealthcare Commercial	$11.64
Rate for Payer: WPPA Commercial	$9.84

MC GADOLINIUM, DISCARDED, ML

Facility

$12.00

Service Code	HCPCS A9579 JW
Hospital Charge Code	A9579JW
Hospital Revenue Code	254
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$11.64
Rate for Payer: BCBS Commercial	$9.50
Rate for Payer: Cash Price	$9.49
Rate for Payer: Cash Price	$9.49
Rate for Payer: Celtic Commercial/Exchange	$5.54
Rate for Payer: Health Partners Plans Commercial	$11.40
Rate for Payer: UnitedHealthcare Commercial	$11.64
Rate for Payer: WPPA Commercial	$10.08

MC GADOLINIUM, DISCARDED, ML

Facility

$12.00

Service Code	HCPCS A9579 JW
Hospital Charge Code	A9579JW
Hospital Revenue Code	254
Min. Negotiated Rate	$9.84
Max. Negotiated Rate	$11.64
Rate for Payer: Cash Price	$9.49
Rate for Payer: Health Partners Plans Commercial	$11.40
Rate for Payer: UnitedHealthcare Commercial	$11.64
Rate for Payer: WPPA Commercial	$9.84

MEASLES ANTIBODY IGG

Facility

$124.00

Service Code	HCPCS 86765
Hospital Charge Code	8676501
Hospital Revenue Code	302
Min. Negotiated Rate	$101.68
Max. Negotiated Rate	$120.28
Rate for Payer: Cash Price	$93.00
Rate for Payer: Health Partners Plans Commercial	$117.80
Rate for Payer: UnitedHealthcare Commercial	$120.28
Rate for Payer: WPPA Commercial	$101.68

MEASLES ANTIBODY IGG

Facility

$124.00

Service Code	HCPCS 86765
Hospital Charge Code	8676501
Hospital Revenue Code	302
Min. Negotiated Rate	$57.29
Max. Negotiated Rate	$120.28
Rate for Payer: BCBS Commercial	$68.27
Rate for Payer: Cash Price	$93.00
Rate for Payer: Cash Price	$93.00
Rate for Payer: Celtic Commercial/Exchange	$57.29
Rate for Payer: Health Partners Plans Commercial	$117.80
Rate for Payer: UnitedHealthcare Commercial	$120.28
Rate for Payer: WPPA Commercial	$104.16

Know your out-of-pocket cost for care.

All Charges