Ness County Hospital

All Charges

Charge

Type

Setting

Price

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	$109.06
Max. Negotiated Rate	$129.01
Rate for Payer: Cash Price	$99.75
Rate for Payer: Health Partners Plans Commercial	$126.35
Rate for Payer: UnitedHealthcare Commercial	$129.01
Rate for Payer: WPPA Commercial	$109.06

MOTRIN 200 MG TAB (IBUPROFEN)

Facility

$1.00

Service Code	NDC 00904791461
Hospital Charge Code	2504553
Hospital Revenue Code	250
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.75
Rate for Payer: Health Partners Plans Commercial	$0.95
Rate for Payer: UnitedHealthcare Commercial	$0.97
Rate for Payer: WPPA Commercial	$0.82

MOTRIN 200 MG TAB (IBUPROFEN)

Facility

$1.00

Service Code	NDC 00904791461
Hospital Charge Code	2504553
Hospital Revenue Code	250
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.75
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

MOTRIN SUSPENSION 100 MG/5 ML (IBUPROFEN)

Facility

$1.00

Service Code	NDC 24385090534
Hospital Charge Code	2514503
Hospital Revenue Code	250
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.75
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

MOTRIN SUSPENSION 100 MG/5 ML (IBUPROFEN)

Facility

$1.00

Service Code	NDC 24385090534
Hospital Charge Code	2514503
Hospital Revenue Code	250
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.75
Rate for Payer: Health Partners Plans Commercial	$0.95
Rate for Payer: UnitedHealthcare Commercial	$0.97
Rate for Payer: WPPA Commercial	$0.82

MOUTH PROCEDURES WITH CC/MCC

Facility

$13,399.34

Service Code	MSDRG 137
Min. Negotiated Rate	$13,399.34
Max. Negotiated Rate	$13,399.34
Rate for Payer: BCBS Commercial	$13,399.34

MOUTH PROCEDURES WITHOUT CC/MCC

Facility

$7,528.80

Service Code	MSDRG 138
Min. Negotiated Rate	$7,528.80
Max. Negotiated Rate	$7,528.80
Rate for Payer: BCBS Commercial	$7,528.80

Mouthwash (listerine 4 oz.)

Facility

$4.00

Service Code	NDC 12547042755
Hospital Charge Code	2501302
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

Mouthwash (listerine 4 oz.)

Facility

$4.00

Service Code	NDC 12547042755
Hospital Charge Code	2501302
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

M-PHMTRC ALYS ISH QUANT-SEMIQ

Facility

$415.00

Service Code	HCPCS 88377
Hospital Charge Code	8837700
Hospital Revenue Code	310
Min. Negotiated Rate	$340.30
Max. Negotiated Rate	$402.55
Rate for Payer: Cash Price	$311.25
Rate for Payer: Health Partners Plans Commercial	$394.25
Rate for Payer: UnitedHealthcare Commercial	$402.55
Rate for Payer: WPPA Commercial	$340.30

M-PHMTRC ALYS ISH QUANT-SEMIQ

Facility

$415.00

Service Code	HCPCS 88377
Hospital Charge Code	8837700
Hospital Revenue Code	310
Min. Negotiated Rate	$191.73
Max. Negotiated Rate	$418.90
Rate for Payer: BCBS Commercial	$418.90
Rate for Payer: Cash Price	$311.25
Rate for Payer: Cash Price	$311.25
Rate for Payer: Celtic Commercial/Exchange	$191.73
Rate for Payer: Health Partners Plans Commercial	$394.25
Rate for Payer: UnitedHealthcare Commercial	$402.55
Rate for Payer: WPPA Commercial	$348.60

MPL MUTATION ANALYSIS,QUAL/LEU

Facility

$488.00

Service Code	HCPCS 81402
Hospital Charge Code	8140200
Hospital Revenue Code	300
Min. Negotiated Rate	$225.46
Max. Negotiated Rate	$473.36
Rate for Payer: BCBS Commercial	$345.29
Rate for Payer: Cash Price	$366.00
Rate for Payer: Cash Price	$366.00
Rate for Payer: Celtic Commercial/Exchange	$225.46
Rate for Payer: Health Partners Plans Commercial	$463.60
Rate for Payer: UnitedHealthcare Commercial	$473.36
Rate for Payer: WPPA Commercial	$409.92

MPL MUTATION ANALYSIS,QUAL/LEU

Facility

$488.00

Service Code	HCPCS 81402
Hospital Charge Code	8140200
Hospital Revenue Code	300
Min. Negotiated Rate	$400.16
Max. Negotiated Rate	$473.36
Rate for Payer: Cash Price	$366.00
Rate for Payer: Health Partners Plans Commercial	$463.60
Rate for Payer: UnitedHealthcare Commercial	$473.36
Rate for Payer: WPPA Commercial	$400.16

MPL proto-oncogene, thrombopoietin receptor gene analysis; sequence exon 10

Facility

$275.00

Service Code	HCPCS 81339
Hospital Charge Code	8133900
Hospital Revenue Code	300
Min. Negotiated Rate	$225.50
Max. Negotiated Rate	$266.75
Rate for Payer: Cash Price	$206.25
Rate for Payer: Health Partners Plans Commercial	$261.25
Rate for Payer: UnitedHealthcare Commercial	$266.75
Rate for Payer: WPPA Commercial	$225.50

MPL proto-oncogene, thrombopoietin receptor gene analysis; sequence exon 10

Facility

$275.00

Service Code	HCPCS 81339
Hospital Charge Code	8133900
Hospital Revenue Code	300
Min. Negotiated Rate	$127.05
Max. Negotiated Rate	$347.25
Rate for Payer: BCBS Commercial	$347.25
Rate for Payer: Cash Price	$206.25
Rate for Payer: Cash Price	$206.25
Rate for Payer: Celtic Commercial/Exchange	$127.05
Rate for Payer: Health Partners Plans Commercial	$261.25
Rate for Payer: UnitedHealthcare Commercial	$266.75
Rate for Payer: WPPA Commercial	$231.00

MRA HEAD WITH CONTRAST

Facility

$2,070.00

Service Code	HCPCS 70545
Hospital Charge Code	7054500
Hospital Revenue Code	610
Min. Negotiated Rate	$1,697.40
Max. Negotiated Rate	$2,007.90
Rate for Payer: Cash Price	$1,552.50
Rate for Payer: Health Partners Plans Commercial	$1,966.50
Rate for Payer: UnitedHealthcare Commercial	$2,007.90
Rate for Payer: WPPA Commercial	$1,697.40

MRA HEAD WITH CONTRAST

Facility

$2,070.00

Service Code	HCPCS 70545
Hospital Charge Code	7054500
Hospital Revenue Code	610
Min. Negotiated Rate	$664.93
Max. Negotiated Rate	$2,007.90
Rate for Payer: BCBS Commercial	$664.93
Rate for Payer: Cash Price	$1,552.50
Rate for Payer: Cash Price	$1,552.50
Rate for Payer: Celtic Commercial/Exchange	$956.34
Rate for Payer: Health Partners Plans Commercial	$1,966.50
Rate for Payer: UnitedHealthcare Commercial	$2,007.90
Rate for Payer: WPPA Commercial	$1,738.80

MRA HEAD W/O CONTRAST

Facility

$2,092.00

Service Code	HCPCS 70544
Hospital Charge Code	7054400
Hospital Revenue Code	610
Min. Negotiated Rate	$664.93
Max. Negotiated Rate	$2,029.24
Rate for Payer: BCBS Commercial	$664.93
Rate for Payer: Cash Price	$1,569.00
Rate for Payer: Cash Price	$1,569.00
Rate for Payer: Celtic Commercial/Exchange	$966.50
Rate for Payer: Health Partners Plans Commercial	$1,987.40
Rate for Payer: UnitedHealthcare Commercial	$2,029.24
Rate for Payer: WPPA Commercial	$1,757.28

MRA HEAD W/O CONTRAST

Facility

$2,092.00

Service Code	HCPCS 70544
Hospital Charge Code	7054400
Hospital Revenue Code	610
Min. Negotiated Rate	$1,715.44
Max. Negotiated Rate	$2,029.24
Rate for Payer: Cash Price	$1,569.00
Rate for Payer: Health Partners Plans Commercial	$1,987.40
Rate for Payer: UnitedHealthcare Commercial	$2,029.24
Rate for Payer: WPPA Commercial	$1,715.44

MRA HEAD WO/W CONTRAST

Facility

$2,200.00

Service Code	HCPCS 70546
Hospital Charge Code	7054600
Hospital Revenue Code	610
Min. Negotiated Rate	$1,804.00
Max. Negotiated Rate	$2,134.00
Rate for Payer: Cash Price	$1,650.00
Rate for Payer: Health Partners Plans Commercial	$2,090.00
Rate for Payer: UnitedHealthcare Commercial	$2,134.00
Rate for Payer: WPPA Commercial	$1,804.00

MRA HEAD WO/W CONTRAST

Facility

$2,200.00

Service Code	HCPCS 70546
Hospital Charge Code	7054600
Hospital Revenue Code	610
Min. Negotiated Rate	$664.93
Max. Negotiated Rate	$2,134.00
Rate for Payer: BCBS Commercial	$664.93
Rate for Payer: Cash Price	$1,650.00
Rate for Payer: Cash Price	$1,650.00
Rate for Payer: Celtic Commercial/Exchange	$1,016.40
Rate for Payer: Health Partners Plans Commercial	$2,090.00
Rate for Payer: UnitedHealthcare Commercial	$2,134.00
Rate for Payer: WPPA Commercial	$1,848.00

MRA NECK WITH CONTRAST

Facility

$2,070.00

Service Code	HCPCS 70548
Hospital Charge Code	7054800
Hospital Revenue Code	610
Min. Negotiated Rate	$1,697.40
Max. Negotiated Rate	$2,007.90
Rate for Payer: Cash Price	$1,552.50
Rate for Payer: Health Partners Plans Commercial	$1,966.50
Rate for Payer: UnitedHealthcare Commercial	$2,007.90
Rate for Payer: WPPA Commercial	$1,697.40

MRA NECK WITH CONTRAST

Facility

$2,070.00

Service Code	HCPCS 70548
Hospital Charge Code	7054800
Hospital Revenue Code	610
Min. Negotiated Rate	$664.93
Max. Negotiated Rate	$2,007.90
Rate for Payer: BCBS Commercial	$664.93
Rate for Payer: Cash Price	$1,552.50
Rate for Payer: Cash Price	$1,552.50
Rate for Payer: Celtic Commercial/Exchange	$956.34
Rate for Payer: Health Partners Plans Commercial	$1,966.50
Rate for Payer: UnitedHealthcare Commercial	$2,007.90
Rate for Payer: WPPA Commercial	$1,738.80

MRA NECK W/O CONTRAST

Facility

$2,443.00

Service Code	HCPCS 70547
Hospital Charge Code	7054700
Hospital Revenue Code	610
Min. Negotiated Rate	$664.93
Max. Negotiated Rate	$2,369.71
Rate for Payer: BCBS Commercial	$664.93
Rate for Payer: Cash Price	$1,832.25
Rate for Payer: Cash Price	$1,832.25
Rate for Payer: Celtic Commercial/Exchange	$1,128.67
Rate for Payer: Health Partners Plans Commercial	$2,320.85
Rate for Payer: UnitedHealthcare Commercial	$2,369.71
Rate for Payer: WPPA Commercial	$2,052.12

MRA NECK W/O CONTRAST

Facility

$2,443.00

Service Code	HCPCS 70547
Hospital Charge Code	7054700
Hospital Revenue Code	610
Min. Negotiated Rate	$2,003.26
Max. Negotiated Rate	$2,369.71
Rate for Payer: Cash Price	$1,832.25
Rate for Payer: Health Partners Plans Commercial	$2,320.85
Rate for Payer: UnitedHealthcare Commercial	$2,369.71
Rate for Payer: WPPA Commercial	$2,003.26

Know your out-of-pocket cost for care.

All Charges