Ness County Hospital

All Charges

Charge

Type

Setting

Price

MULTIVITAMIN ¨C 12 IV (INFUVITE-ADULT)(MVI-12)

Facility

$793.00

Service Code	NDC 54643900701
Hospital Charge Code	2508208
Hospital Revenue Code	250
Min. Negotiated Rate	$650.26
Max. Negotiated Rate	$769.21
Rate for Payer: Cash Price	$595.35
Rate for Payer: Health Partners Plans Commercial	$753.35
Rate for Payer: UnitedHealthcare Commercial	$769.21
Rate for Payer: WPPA Commercial	$650.26

MULTIVITAMIN W/ MINERALS

Facility

$1.00

Service Code	NDC 00904549261
Hospital Charge Code	2507101
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

MULTIVITAMIN W/ MINERALS

Facility

$1.00

Service Code	NDC 00904549261
Hospital Charge Code	2507101
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

MUMPS VIRUS ANTIBODY (IGM)

Facility

$80.00

Service Code	HCPCS 86735
Hospital Charge Code	8673500
Hospital Revenue Code	302
Min. Negotiated Rate	$36.96
Max. Negotiated Rate	$77.60
Rate for Payer: BCBS Commercial	$64.95
Rate for Payer: Cash Price	$60.00
Rate for Payer: Cash Price	$60.00
Rate for Payer: Celtic Commercial/Exchange	$36.96
Rate for Payer: Health Partners Plans Commercial	$76.00
Rate for Payer: UnitedHealthcare Commercial	$77.60
Rate for Payer: WPPA Commercial	$67.20

MUMPS VIRUS ANTIBODY (IGM)

Facility

$80.00

Service Code	HCPCS 86735
Hospital Charge Code	8673500
Hospital Revenue Code	302
Min. Negotiated Rate	$65.60
Max. Negotiated Rate	$77.60
Rate for Payer: Cash Price	$60.00
Rate for Payer: Health Partners Plans Commercial	$76.00
Rate for Payer: UnitedHealthcare Commercial	$77.60
Rate for Payer: WPPA Commercial	$65.60

MUMPS VIRUS RNA,QUAL RLTM PCR

Facility

$211.00

Service Code	HCPCS 87798
Hospital Charge Code	8779801
Hospital Revenue Code	306
Min. Negotiated Rate	$173.02
Max. Negotiated Rate	$204.67
Rate for Payer: Cash Price	$158.25
Rate for Payer: Health Partners Plans Commercial	$200.45
Rate for Payer: UnitedHealthcare Commercial	$204.67
Rate for Payer: WPPA Commercial	$173.02

MUMPS VIRUS RNA,QUAL RLTM PCR

Facility

$211.00

Service Code	HCPCS 87798
Hospital Charge Code	8779801
Hospital Revenue Code	306
Min. Negotiated Rate	$97.48
Max. Negotiated Rate	$204.67
Rate for Payer: BCBS Commercial	$185.64
Rate for Payer: Cash Price	$158.25
Rate for Payer: Cash Price	$158.25
Rate for Payer: Celtic Commercial/Exchange	$97.48
Rate for Payer: Health Partners Plans Commercial	$200.45
Rate for Payer: UnitedHealthcare Commercial	$204.67
Rate for Payer: WPPA Commercial	$177.24

MUSCLE TESTING, MANUAL,HAND

Facility

$56.00

Service Code	HCPCS 95832 GP
Hospital Charge Code	4201473
Hospital Revenue Code	420
Min. Negotiated Rate	$25.87
Max. Negotiated Rate	$54.32
Rate for Payer: Cash Price	$42.19
Rate for Payer: Celtic Commercial/Exchange	$25.87
Rate for Payer: Health Partners Plans Commercial	$53.20
Rate for Payer: UnitedHealthcare Commercial	$54.32
Rate for Payer: WPPA Commercial	$47.04

MUSCLE TESTING, MANUAL,HAND

Facility

$56.00

Service Code	HCPCS 95832 GP
Hospital Charge Code	4201473
Hospital Revenue Code	420
Min. Negotiated Rate	$45.92
Max. Negotiated Rate	$54.32
Rate for Payer: Cash Price	$42.19
Rate for Payer: Health Partners Plans Commercial	$53.20
Rate for Payer: UnitedHealthcare Commercial	$54.32
Rate for Payer: WPPA Commercial	$45.92

MUSCLE TEST,MAN, EXT/TRUNK

Facility

$56.00

Service Code	HCPCS 95831 GP
Hospital Charge Code	4201562
Hospital Revenue Code	420
Min. Negotiated Rate	$45.92
Max. Negotiated Rate	$54.32
Rate for Payer: Cash Price	$42.19
Rate for Payer: Health Partners Plans Commercial	$53.20
Rate for Payer: UnitedHealthcare Commercial	$54.32
Rate for Payer: WPPA Commercial	$45.92

MUSCLE TEST,MAN, EXT/TRUNK

Facility

$56.00

Service Code	HCPCS 95831 GP
Hospital Charge Code	4201562
Hospital Revenue Code	420
Min. Negotiated Rate	$25.87
Max. Negotiated Rate	$54.32
Rate for Payer: Cash Price	$42.19
Rate for Payer: Celtic Commercial/Exchange	$25.87
Rate for Payer: Health Partners Plans Commercial	$53.20
Rate for Payer: UnitedHealthcare Commercial	$54.32
Rate for Payer: WPPA Commercial	$47.04

MVISTA HISTOPLASMA QUANT ANTIG

Facility

$227.00

Service Code	HCPCS 87385
Hospital Charge Code	8738502
Hospital Revenue Code	306
Min. Negotiated Rate	$186.14
Max. Negotiated Rate	$220.19
Rate for Payer: Cash Price	$170.25
Rate for Payer: Health Partners Plans Commercial	$215.65
Rate for Payer: UnitedHealthcare Commercial	$220.19
Rate for Payer: WPPA Commercial	$186.14

MVISTA HISTOPLASMA QUANT ANTIG

Facility

$227.00

Service Code	HCPCS 87385
Hospital Charge Code	8738502
Hospital Revenue Code	306
Min. Negotiated Rate	$54.84
Max. Negotiated Rate	$220.19
Rate for Payer: BCBS Commercial	$54.84
Rate for Payer: Cash Price	$170.25
Rate for Payer: Cash Price	$170.25
Rate for Payer: Celtic Commercial/Exchange	$104.87
Rate for Payer: Health Partners Plans Commercial	$215.65
Rate for Payer: UnitedHealthcare Commercial	$220.19
Rate for Payer: WPPA Commercial	$190.68

MYASTHENIA GRAVIS PANEL 2 W/

Facility

$243.00

Hospital Charge Code	8888928
Hospital Revenue Code	301
Min. Negotiated Rate	$199.26
Max. Negotiated Rate	$235.71
Rate for Payer: Cash Price	$182.25
Rate for Payer: Health Partners Plans Commercial	$230.85
Rate for Payer: UnitedHealthcare Commercial	$235.71
Rate for Payer: WPPA Commercial	$199.26

MYASTHENIA GRAVIS PANEL 2 W/

Facility

$243.00

Hospital Charge Code	8888928
Hospital Revenue Code	301
Min. Negotiated Rate	$112.27
Max. Negotiated Rate	$235.71
Rate for Payer: Cash Price	$182.25
Rate for Payer: Celtic Commercial/Exchange	$112.27
Rate for Payer: Health Partners Plans Commercial	$230.85
Rate for Payer: UnitedHealthcare Commercial	$235.71
Rate for Payer: WPPA Commercial	$204.12

Mycamine 100 mg vial(micafungin)

Facility

$1,011.00

Service Code	NDC 00469321199
Hospital Charge Code	2518878
Hospital Revenue Code	250
Min. Negotiated Rate	$467.08
Max. Negotiated Rate	$980.67
Rate for Payer: Cash Price	$758.25
Rate for Payer: Celtic Commercial/Exchange	$467.08
Rate for Payer: Health Partners Plans Commercial	$960.45
Rate for Payer: UnitedHealthcare Commercial	$980.67
Rate for Payer: WPPA Commercial	$849.24

Mycamine 100 mg vial(micafungin)

Facility

$1,011.00

Service Code	NDC 00469321199
Hospital Charge Code	2518878
Hospital Revenue Code	250
Min. Negotiated Rate	$829.02
Max. Negotiated Rate	$980.67
Rate for Payer: Cash Price	$758.25
Rate for Payer: Health Partners Plans Commercial	$960.45
Rate for Payer: UnitedHealthcare Commercial	$980.67
Rate for Payer: WPPA Commercial	$829.02

MYCELEX TROCHE 10 MG (CLOTRIMEZOLE)

Facility

$10.00

Service Code	NDC 00054814622
Hospital Charge Code	2509362
Hospital Revenue Code	250
Min. Negotiated Rate	$8.20
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$7.72
Rate for Payer: Health Partners Plans Commercial	$9.50
Rate for Payer: UnitedHealthcare Commercial	$9.70
Rate for Payer: WPPA Commercial	$8.20

MYCELEX TROCHE 10 MG (CLOTRIMEZOLE)

Facility

$10.00

Service Code	NDC 00054814622
Hospital Charge Code	2509362
Hospital Revenue Code	250
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$7.72
Rate for Payer: Celtic Commercial/Exchange	$4.62
Rate for Payer: Health Partners Plans Commercial	$9.50
Rate for Payer: UnitedHealthcare Commercial	$9.70
Rate for Payer: WPPA Commercial	$8.40

MYCOBACTERIA TUBERCULOSIS

Facility

$75.00

Service Code	HCPCS 87556
Hospital Charge Code	8755600
Hospital Revenue Code	306
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

MYCOBACTERIA TUBERCULOSIS

Facility

$75.00

Service Code	HCPCS 87556
Hospital Charge Code	8755600
Hospital Revenue Code	306
Min. Negotiated Rate	$34.65
Max. Negotiated Rate	$75.30
Rate for Payer: BCBS Commercial	$75.30
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

MYCOLOG/MYCOGEN II CREAM 15 GM tube (NYSTATIN & TRIAMCINOLONE ACETONIDE)

Facility

$920.00

Service Code	NDC 51672126301
Hospital Charge Code	2504595
Hospital Revenue Code	250
Min. Negotiated Rate	$425.04
Max. Negotiated Rate	$892.40
Rate for Payer: Cash Price	$690.60
Rate for Payer: Celtic Commercial/Exchange	$425.04
Rate for Payer: Health Partners Plans Commercial	$874.00
Rate for Payer: UnitedHealthcare Commercial	$892.40
Rate for Payer: WPPA Commercial	$772.80

MYCOLOG/MYCOGEN II CREAM 15 GM tube (NYSTATIN & TRIAMCINOLONE ACETONIDE)

Facility

$920.00

Service Code	NDC 51672126301
Hospital Charge Code	2504595
Hospital Revenue Code	250
Min. Negotiated Rate	$754.40
Max. Negotiated Rate	$892.40
Rate for Payer: Cash Price	$690.60
Rate for Payer: Health Partners Plans Commercial	$874.00
Rate for Payer: UnitedHealthcare Commercial	$892.40
Rate for Payer: WPPA Commercial	$754.40

MYCOPLASMA PNEUMONIAE (IGM)

Facility

$132.00

Service Code	HCPCS 86738
Hospital Charge Code	8673801
Hospital Revenue Code	302
Min. Negotiated Rate	$60.98
Max. Negotiated Rate	$128.04
Rate for Payer: BCBS Commercial	$71.08
Rate for Payer: Cash Price	$99.00
Rate for Payer: Cash Price	$99.00
Rate for Payer: Celtic Commercial/Exchange	$60.98
Rate for Payer: Health Partners Plans Commercial	$125.40
Rate for Payer: UnitedHealthcare Commercial	$128.04
Rate for Payer: WPPA Commercial	$110.88

MYCOPLASMA PNEUMONIAE (IGM)

Facility

$132.00

Service Code	HCPCS 86738
Hospital Charge Code	8673801
Hospital Revenue Code	302
Min. Negotiated Rate	$108.24
Max. Negotiated Rate	$128.04
Rate for Payer: Cash Price	$99.00
Rate for Payer: Health Partners Plans Commercial	$125.40
Rate for Payer: UnitedHealthcare Commercial	$128.04
Rate for Payer: WPPA Commercial	$108.24

Know your out-of-pocket cost for care.

All Charges