Ness County Hospital

All Charges

Charge

Type

Setting

Price

Molecular Path Proc., specifically classifed as Tier 2, Level 6

Facility

$790.00

Service Code	HCPCS 81405
Hospital Charge Code	8140500
Hospital Revenue Code	300
Min. Negotiated Rate	$647.80
Max. Negotiated Rate	$766.30
Rate for Payer: Cash Price	$592.50
Rate for Payer: Health Partners Plans Commercial	$750.50
Rate for Payer: UnitedHealthcare Commercial	$766.30
Rate for Payer: WPPA Commercial	$647.80

Molecular Path Proc., specifically classifed as Tier 2, Level 6

Facility

$790.00

Service Code	HCPCS 81405
Hospital Charge Code	8140500
Hospital Revenue Code	300
Min. Negotiated Rate	$364.98
Max. Negotiated Rate	$766.30
Rate for Payer: BCBS Commercial	$739.83
Rate for Payer: Cash Price	$592.50
Rate for Payer: Cash Price	$592.50
Rate for Payer: Celtic Commercial/Exchange	$364.98
Rate for Payer: Health Partners Plans Commercial	$750.50
Rate for Payer: UnitedHealthcare Commercial	$766.30
Rate for Payer: WPPA Commercial	$663.60

MONITORED ANES CARE-1ST 15 MIN

Facility

$323.00

Hospital Charge Code	3700001
Hospital Revenue Code	370
Min. Negotiated Rate	$149.23
Max. Negotiated Rate	$313.31
Rate for Payer: Cash Price	$242.25
Rate for Payer: Celtic Commercial/Exchange	$149.23
Rate for Payer: Health Partners Plans Commercial	$306.85
Rate for Payer: UnitedHealthcare Commercial	$313.31
Rate for Payer: WPPA Commercial	$271.32

MONITORED ANES CARE-1ST 15 MIN

Facility

$323.00

Hospital Charge Code	3700001
Hospital Revenue Code	370
Min. Negotiated Rate	$264.86
Max. Negotiated Rate	$313.31
Rate for Payer: Cash Price	$242.25
Rate for Payer: Health Partners Plans Commercial	$306.85
Rate for Payer: UnitedHealthcare Commercial	$313.31
Rate for Payer: WPPA Commercial	$264.86

MONITORED ANES EA ADDTL 15 MIN

Facility

$108.00

Hospital Charge Code	3700003
Hospital Revenue Code	370
Min. Negotiated Rate	$88.56
Max. Negotiated Rate	$104.76
Rate for Payer: Cash Price	$81.00
Rate for Payer: Health Partners Plans Commercial	$102.60
Rate for Payer: UnitedHealthcare Commercial	$104.76
Rate for Payer: WPPA Commercial	$88.56

MONITORED ANES EA ADDTL 15 MIN

Facility

$108.00

Hospital Charge Code	3700003
Hospital Revenue Code	370
Min. Negotiated Rate	$49.90
Max. Negotiated Rate	$104.76
Rate for Payer: Cash Price	$81.00
Rate for Payer: Celtic Commercial/Exchange	$49.90
Rate for Payer: Health Partners Plans Commercial	$102.60
Rate for Payer: UnitedHealthcare Commercial	$104.76
Rate for Payer: WPPA Commercial	$90.72

MONOCRYL SUTURE

Facility

$20.00

Hospital Charge Code	2727333
Hospital Revenue Code	270
Min. Negotiated Rate	$9.24
Max. Negotiated Rate	$19.40
Rate for Payer: Cash Price	$15.00
Rate for Payer: Celtic Commercial/Exchange	$9.24
Rate for Payer: Health Partners Plans Commercial	$19.00
Rate for Payer: UnitedHealthcare Commercial	$19.40
Rate for Payer: WPPA Commercial	$16.80

MONOCRYL SUTURE

Facility

$20.00

Hospital Charge Code	2727333
Hospital Revenue Code	270
Min. Negotiated Rate	$16.40
Max. Negotiated Rate	$19.40
Rate for Payer: Cash Price	$15.00
Rate for Payer: Health Partners Plans Commercial	$19.00
Rate for Payer: UnitedHealthcare Commercial	$19.40
Rate for Payer: WPPA Commercial	$16.40

MONONUCLEAR CELL ANTIGEN,QUAN

Facility

$75.00

Service Code	HCPCS 86356
Hospital Charge Code	8635600
Hospital Revenue Code	302
Min. Negotiated Rate	$34.65
Max. Negotiated Rate	$72.75
Rate for Payer: BCBS Commercial	$50.96
Rate for Payer: Cash Price	$56.25
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

MONONUCLEAR CELL ANTIGEN,QUAN

Facility

$75.00

Service Code	HCPCS 86356
Hospital Charge Code	8635600
Hospital Revenue Code	302
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

MONTHLY O2 PER CONCENTRATOR

Facility

$180.00

Hospital Charge Code	4120100
Hospital Revenue Code	270
Min. Negotiated Rate	$147.60
Max. Negotiated Rate	$174.60
Rate for Payer: Cash Price	$135.00
Rate for Payer: Health Partners Plans Commercial	$171.00
Rate for Payer: UnitedHealthcare Commercial	$174.60
Rate for Payer: WPPA Commercial	$147.60

MONTHLY O2 PER CONCENTRATOR

Facility

$180.00

Hospital Charge Code	4120100
Hospital Revenue Code	270
Min. Negotiated Rate	$83.16
Max. Negotiated Rate	$174.60
Rate for Payer: Cash Price	$135.00
Rate for Payer: Celtic Commercial/Exchange	$83.16
Rate for Payer: Health Partners Plans Commercial	$171.00
Rate for Payer: UnitedHealthcare Commercial	$174.60
Rate for Payer: WPPA Commercial	$151.20

MORGAN EYE WASH LENS

Facility

$174.00

Hospital Charge Code	2700011
Hospital Revenue Code	270
Min. Negotiated Rate	$142.68
Max. Negotiated Rate	$168.78
Rate for Payer: Cash Price	$130.50
Rate for Payer: Health Partners Plans Commercial	$165.30
Rate for Payer: UnitedHealthcare Commercial	$168.78
Rate for Payer: WPPA Commercial	$142.68

MORGAN EYE WASH LENS

Facility

$174.00

Hospital Charge Code	2700011
Hospital Revenue Code	270
Min. Negotiated Rate	$80.39
Max. Negotiated Rate	$168.78
Rate for Payer: Cash Price	$130.50
Rate for Payer: Celtic Commercial/Exchange	$80.39
Rate for Payer: Health Partners Plans Commercial	$165.30
Rate for Payer: UnitedHealthcare Commercial	$168.78
Rate for Payer: WPPA Commercial	$146.16

MORPHINE 15 MG I.R. tab

Facility

$4.00

Service Code	NDC 00054023524
Hospital Charge Code	2507366
Hospital Revenue Code	250
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$3.00
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

MORPHINE 15 MG I.R. tab

Facility

$4.00

Service Code	NDC 00054023524
Hospital Charge Code	2507366
Hospital Revenue Code	250
Min. Negotiated Rate	$3.28
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$3.00
Rate for Payer: Health Partners Plans Commercial	$3.80
Rate for Payer: UnitedHealthcare Commercial	$3.88
Rate for Payer: WPPA Commercial	$3.28

MORPHINE PCA 5 MG/ML - 150 MG SYRINGE/vial

Facility

$133.00

Service Code	NDC 00409602804
Hospital Charge Code	2504512
Hospital Revenue Code	250
Min. Negotiated Rate	$109.06
Max. Negotiated Rate	$129.01
Rate for Payer: Cash Price	$100.46
Rate for Payer: Health Partners Plans Commercial	$126.35
Rate for Payer: UnitedHealthcare Commercial	$129.01
Rate for Payer: WPPA Commercial	$109.06

MORPHINE PCA 5 MG/ML - 150 MG SYRINGE/vial

Facility

$133.00

Service Code	NDC 00409602804
Hospital Charge Code	2504512
Hospital Revenue Code	250
Min. Negotiated Rate	$61.45
Max. Negotiated Rate	$129.01
Rate for Payer: Cash Price	$100.46
Rate for Payer: Celtic Commercial/Exchange	$61.45
Rate for Payer: Health Partners Plans Commercial	$126.35
Rate for Payer: UnitedHealthcare Commercial	$129.01
Rate for Payer: WPPA Commercial	$111.72

Morphine Sulfate 10 mg/ml inj.

Facility

$16.00

Service Code	NDC 63323045101
Hospital Charge Code	2513877
Hospital Revenue Code	250
Min. Negotiated Rate	$13.12
Max. Negotiated Rate	$15.52
Rate for Payer: Cash Price	$12.00
Rate for Payer: Health Partners Plans Commercial	$15.20
Rate for Payer: UnitedHealthcare Commercial	$15.52
Rate for Payer: WPPA Commercial	$13.12

Morphine Sulfate 10 mg/ml inj.

Facility

$16.00

Service Code	NDC 63323045101
Hospital Charge Code	2513877
Hospital Revenue Code	250
Min. Negotiated Rate	$7.39
Max. Negotiated Rate	$15.52
Rate for Payer: Cash Price	$12.00
Rate for Payer: Celtic Commercial/Exchange	$7.39
Rate for Payer: Health Partners Plans Commercial	$15.20
Rate for Payer: UnitedHealthcare Commercial	$15.52
Rate for Payer: WPPA Commercial	$13.44

Morphine Sulfate 2 mg/ml inj.

Facility

$24.00

Service Code	NDC 00409189003
Hospital Charge Code	2504538
Hospital Revenue Code	250
Min. Negotiated Rate	$19.68
Max. Negotiated Rate	$23.28
Rate for Payer: Cash Price	$18.00
Rate for Payer: Health Partners Plans Commercial	$22.80
Rate for Payer: UnitedHealthcare Commercial	$23.28
Rate for Payer: WPPA Commercial	$19.68

Morphine Sulfate 2 mg/ml inj.

Facility

$24.00

Service Code	NDC 00409189003
Hospital Charge Code	2504538
Hospital Revenue Code	250
Min. Negotiated Rate	$11.09
Max. Negotiated Rate	$23.28
Rate for Payer: Cash Price	$18.00
Rate for Payer: Celtic Commercial/Exchange	$11.09
Rate for Payer: Health Partners Plans Commercial	$22.80
Rate for Payer: UnitedHealthcare Commercial	$23.28
Rate for Payer: WPPA Commercial	$20.16

Morphine Sulfate 4 mg/ml inj.

Facility

$16.00

Service Code	NDC 00409189103
Hospital Charge Code	2512085
Hospital Revenue Code	250
Min. Negotiated Rate	$13.12
Max. Negotiated Rate	$15.52
Rate for Payer: Cash Price	$12.00
Rate for Payer: Health Partners Plans Commercial	$15.20
Rate for Payer: UnitedHealthcare Commercial	$15.52
Rate for Payer: WPPA Commercial	$13.12

Morphine Sulfate 4 mg/ml inj.

Facility

$16.00

Service Code	NDC 00409189103
Hospital Charge Code	2512085
Hospital Revenue Code	250
Min. Negotiated Rate	$7.39
Max. Negotiated Rate	$15.52
Rate for Payer: Cash Price	$12.00
Rate for Payer: Celtic Commercial/Exchange	$7.39
Rate for Payer: Health Partners Plans Commercial	$15.20
Rate for Payer: UnitedHealthcare Commercial	$15.52
Rate for Payer: WPPA Commercial	$13.44

Morphometric Analysis, Tumor Immunohistochemistry, quant. or semiquant, ea antibody; manual

Facility

$133.00

Service Code	HCPCS 88360
Hospital Charge Code	8836000
Hospital Revenue Code	300
Min. Negotiated Rate	$61.45
Max. Negotiated Rate	$131.65
Rate for Payer: BCBS Commercial	$131.65
Rate for Payer: Cash Price	$99.75
Rate for Payer: Cash Price	$99.75
Rate for Payer: Celtic Commercial/Exchange	$61.45
Rate for Payer: Health Partners Plans Commercial	$126.35
Rate for Payer: UnitedHealthcare Commercial	$129.01
Rate for Payer: WPPA Commercial	$111.72

Know your out-of-pocket cost for care.

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