Ness County Hospital

All Charges

Charge

Type

Setting

Price

NEUROSES EXCEPT DEPRESSIVE

Facility

$8,871.20

Service Code	MSDRG 882
Min. Negotiated Rate	$8,871.20
Max. Negotiated Rate	$8,871.20
Rate for Payer: BCBS Commercial	$8,871.20

NEW PATIENT 45-59MIN LVL 4

Facility

$239.00

Service Code	HCPCS 99204 GF
Hospital Charge Code	99204WC
Hospital Revenue Code	983
Min. Negotiated Rate	$195.98
Max. Negotiated Rate	$231.83
Rate for Payer: Cash Price	$179.25
Rate for Payer: Health Partners Plans Commercial	$227.05
Rate for Payer: UnitedHealthcare Commercial	$231.83
Rate for Payer: WPPA Commercial	$195.98

NEW PATIENT 45-59MIN LVL 4

Facility

$239.00

Service Code	HCPCS 99204 GF
Hospital Charge Code	99204WC
Hospital Revenue Code	983
Min. Negotiated Rate	$101.00
Max. Negotiated Rate	$231.83
Rate for Payer: BCBS Commercial	$101.00
Rate for Payer: Cash Price	$179.25
Rate for Payer: Cash Price	$179.25
Rate for Payer: Celtic Commercial/Exchange	$110.42
Rate for Payer: Health Partners Plans Commercial	$227.05
Rate for Payer: UnitedHealthcare Commercial	$231.83
Rate for Payer: WPPA Commercial	$200.76

NEW PATIENT,WND MGMNT,<=10CM

Facility

$74.00

Service Code	HCPCS 99201 GP
Hospital Charge Code	9920109
Hospital Revenue Code	421
Min. Negotiated Rate	$34.19
Max. Negotiated Rate	$71.78
Rate for Payer: Cash Price	$55.88
Rate for Payer: Celtic Commercial/Exchange	$34.19
Rate for Payer: Health Partners Plans Commercial	$70.30
Rate for Payer: UnitedHealthcare Commercial	$71.78
Rate for Payer: WPPA Commercial	$62.16

NEW PATIENT,WND MGMNT,<=10CM

Facility

$74.00

Service Code	HCPCS 99201 GP
Hospital Charge Code	9920109
Hospital Revenue Code	421
Min. Negotiated Rate	$60.68
Max. Negotiated Rate	$71.78
Rate for Payer: Cash Price	$55.88
Rate for Payer: Health Partners Plans Commercial	$70.30
Rate for Payer: UnitedHealthcare Commercial	$71.78
Rate for Payer: WPPA Commercial	$60.68

NEW PATIENT,WND MGMT,11-25 CM

Facility

$104.00

Service Code	HCPCS 99202 GP
Hospital Charge Code	9920209
Hospital Revenue Code	421
Min. Negotiated Rate	$85.28
Max. Negotiated Rate	$100.88
Rate for Payer: Cash Price	$78.00
Rate for Payer: Health Partners Plans Commercial	$98.80
Rate for Payer: UnitedHealthcare Commercial	$100.88
Rate for Payer: WPPA Commercial	$85.28

NEW PATIENT,WND MGMT,11-25 CM

Facility

$104.00

Service Code	HCPCS 99202 GP
Hospital Charge Code	9920209
Hospital Revenue Code	421
Min. Negotiated Rate	$48.05
Max. Negotiated Rate	$100.88
Rate for Payer: BCBS Commercial	$67.67
Rate for Payer: Cash Price	$78.00
Rate for Payer: Cash Price	$78.00
Rate for Payer: Celtic Commercial/Exchange	$48.05
Rate for Payer: Health Partners Plans Commercial	$98.80
Rate for Payer: UnitedHealthcare Commercial	$100.88
Rate for Payer: WPPA Commercial	$87.36

NEW PATIENT,WND MGMT, 26-50 CM

Facility

$130.00

Service Code	HCPCS 99203 GP
Hospital Charge Code	9920309
Hospital Revenue Code	421
Min. Negotiated Rate	$60.06
Max. Negotiated Rate	$126.10
Rate for Payer: BCBS Commercial	$101.00
Rate for Payer: Cash Price	$97.50
Rate for Payer: Cash Price	$97.50
Rate for Payer: Celtic Commercial/Exchange	$60.06
Rate for Payer: Health Partners Plans Commercial	$123.50
Rate for Payer: UnitedHealthcare Commercial	$126.10
Rate for Payer: WPPA Commercial	$109.20

NEW PATIENT,WND MGMT, 26-50 CM

Facility

$130.00

Service Code	HCPCS 99203 GP
Hospital Charge Code	9920309
Hospital Revenue Code	421
Min. Negotiated Rate	$106.60
Max. Negotiated Rate	$126.10
Rate for Payer: Cash Price	$97.50
Rate for Payer: Health Partners Plans Commercial	$123.50
Rate for Payer: UnitedHealthcare Commercial	$126.10
Rate for Payer: WPPA Commercial	$106.60

NEW PATIENT,WND MGMT, 51-75 CM

Facility

$208.00

Service Code	HCPCS 99204 GP
Hospital Charge Code	9920409
Hospital Revenue Code	421
Min. Negotiated Rate	$96.10
Max. Negotiated Rate	$201.76
Rate for Payer: BCBS Commercial	$101.00
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

NEW PATIENT,WND MGMT, 51-75 CM

Facility

$208.00

Service Code	HCPCS 99204 GP
Hospital Charge Code	9920409
Hospital Revenue Code	421
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

NEW PATIENT,WND MGMT, >=76 CM

Facility

$260.00

Service Code	HCPCS 99205 GP
Hospital Charge Code	9920509
Hospital Revenue Code	421
Min. Negotiated Rate	$120.12
Max. Negotiated Rate	$252.20
Rate for Payer: BCBS Commercial	$168.67
Rate for Payer: Cash Price	$195.00
Rate for Payer: Cash Price	$195.00
Rate for Payer: Celtic Commercial/Exchange	$120.12
Rate for Payer: Health Partners Plans Commercial	$247.00
Rate for Payer: UnitedHealthcare Commercial	$252.20
Rate for Payer: WPPA Commercial	$218.40

NEW PATIENT,WND MGMT, >=76 CM

Facility

$260.00

Service Code	HCPCS 99205 GP
Hospital Charge Code	9920509
Hospital Revenue Code	421
Min. Negotiated Rate	$213.20
Max. Negotiated Rate	$252.20
Rate for Payer: Cash Price	$195.00
Rate for Payer: Health Partners Plans Commercial	$247.00
Rate for Payer: UnitedHealthcare Commercial	$252.20
Rate for Payer: WPPA Commercial	$213.20

NEXIUM 20 MG CAP (ESOMEPRAZOLE MAGNESIUM)

Facility

$27.00

Service Code	NDC 43598050990
Hospital Charge Code	2514925
Hospital Revenue Code	250
Min. Negotiated Rate	$22.14
Max. Negotiated Rate	$26.19
Rate for Payer: Cash Price	$20.33
Rate for Payer: Health Partners Plans Commercial	$25.65
Rate for Payer: UnitedHealthcare Commercial	$26.19
Rate for Payer: WPPA Commercial	$22.14

NEXIUM 20 MG CAP (ESOMEPRAZOLE MAGNESIUM)

Facility

$27.00

Service Code	NDC 43598050990
Hospital Charge Code	2514925
Hospital Revenue Code	250
Min. Negotiated Rate	$12.47
Max. Negotiated Rate	$26.19
Rate for Payer: Cash Price	$20.33
Rate for Payer: Celtic Commercial/Exchange	$12.47
Rate for Payer: Health Partners Plans Commercial	$25.65
Rate for Payer: UnitedHealthcare Commercial	$26.19
Rate for Payer: WPPA Commercial	$22.68

NEXIUM 40 MG/VIAL IV (ESOMEPRAZOLE SODIUM)

Facility

$180.00

Service Code	NDC 67457039299
Hospital Charge Code	2515849
Hospital Revenue Code	250
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

NEXIUM 40 MG/VIAL IV (ESOMEPRAZOLE SODIUM)

Facility

$180.00

Service Code	NDC 67457039299
Hospital Charge Code	2515849
Hospital Revenue Code	250
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

Nicoderm 14mg/24hr patch(nicotine transdermal system)

Facility

$7.00

Service Code	NDC 60505706200
Hospital Charge Code	2517076
Hospital Revenue Code	250
Min. Negotiated Rate	$3.23
Max. Negotiated Rate	$6.79
Rate for Payer: Cash Price	$5.70
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

Nicoderm 14mg/24hr patch(nicotine transdermal system)

Facility

$7.00

Service Code	NDC 60505706200
Hospital Charge Code	2517076
Hospital Revenue Code	250
Min. Negotiated Rate	$5.74
Max. Negotiated Rate	$6.79
Rate for Payer: Cash Price	$5.70
Rate for Payer: Health Partners Plans Commercial	$6.65
Rate for Payer: UnitedHealthcare Commercial	$6.79
Rate for Payer: WPPA Commercial	$5.74

NICODERM 7 MG PATCH (NICOTINE TRANSDERMAL SYSTEM)

Facility

$10.00

Service Code	NDC 60505706100
Hospital Charge Code	2513893
Hospital Revenue Code	250
Min. Negotiated Rate	$8.20
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$7.95
Rate for Payer: Health Partners Plans Commercial	$9.50
Rate for Payer: UnitedHealthcare Commercial	$9.70
Rate for Payer: WPPA Commercial	$8.20

NICODERM 7 MG PATCH (NICOTINE TRANSDERMAL SYSTEM)

Facility

$10.00

Service Code	NDC 60505706100
Hospital Charge Code	2513893
Hospital Revenue Code	250
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$7.95
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

NIFEREX 150 MG CAP (POLYSACCHARIDE IRON COMPLEX)

Facility

$1.00

Service Code	NDC 00904539561
Hospital Charge Code	2512226
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

NIFEREX 150 MG CAP (POLYSACCHARIDE IRON COMPLEX)

Facility

$1.00

Service Code	NDC 00904539561
Hospital Charge Code	2512226
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

NIGHT BRIEFS

Facility

$28.00

Hospital Charge Code	2706646
Hospital Revenue Code	270
Min. Negotiated Rate	$12.94
Max. Negotiated Rate	$27.16
Rate for Payer: Cash Price	$21.00
Rate for Payer: Celtic Commercial/Exchange	$12.94
Rate for Payer: Health Partners Plans Commercial	$26.60
Rate for Payer: UnitedHealthcare Commercial	$27.16
Rate for Payer: WPPA Commercial	$23.52

NIGHT BRIEFS

Facility

$28.00

Hospital Charge Code	2706646
Hospital Revenue Code	270
Min. Negotiated Rate	$22.96
Max. Negotiated Rate	$27.16
Rate for Payer: Cash Price	$21.00
Rate for Payer: Health Partners Plans Commercial	$26.60
Rate for Payer: UnitedHealthcare Commercial	$27.16
Rate for Payer: WPPA Commercial	$22.96

Know your out-of-pocket cost for care.

All Charges