Ness County Hospital

All Charges

Charge

Type

Setting

Price

OSTOMY POUCH 2 PIECE

Facility

$5.00

Hospital Charge Code	2720376
Hospital Revenue Code	272
Min. Negotiated Rate	$4.10
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$3.75
Rate for Payer: Health Partners Plans Commercial	$4.75
Rate for Payer: UnitedHealthcare Commercial	$4.85
Rate for Payer: WPPA Commercial	$4.10

OSTOMY POUCH 2 PIECE

Facility

$5.00

Hospital Charge Code	2720376
Hospital Revenue Code	272
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$3.75
Rate for Payer: Celtic Commercial/Exchange	$2.31
Rate for Payer: Health Partners Plans Commercial	$4.75
Rate for Payer: UnitedHealthcare Commercial	$4.85
Rate for Payer: WPPA Commercial	$4.20

OTC TYLENOL INFANT DROPS-30ML

Facility

$24.00

Hospital Charge Code	2508703
Hospital Revenue Code	250
Min. Negotiated Rate	$11.09
Max. Negotiated Rate	$23.28
Rate for Payer: Cash Price	$18.34
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

OTC TYLENOL INFANT DROPS-30ML

Facility

$24.00

Hospital Charge Code	2508703
Hospital Revenue Code	250
Min. Negotiated Rate	$19.68
Max. Negotiated Rate	$23.28
Rate for Payer: Cash Price	$18.34
Rate for Payer: Health Partners Plans Commercial	$22.80
Rate for Payer: UnitedHealthcare Commercial	$23.28
Rate for Payer: WPPA Commercial	$19.68

OT EVAL (AEGIS) PER 1/4 HR

Facility

$49.00

Service Code	HCPCS G0152
Hospital Charge Code	4309922
Hospital Revenue Code	431
Min. Negotiated Rate	$40.18
Max. Negotiated Rate	$47.53
Rate for Payer: Cash Price	$36.94
Rate for Payer: Health Partners Plans Commercial	$46.55
Rate for Payer: UnitedHealthcare Commercial	$47.53
Rate for Payer: WPPA Commercial	$40.18

OT EVAL (AEGIS) PER 1/4 HR

Facility

$49.00

Service Code	HCPCS G0152
Hospital Charge Code	4309922
Hospital Revenue Code	431
Min. Negotiated Rate	$22.64
Max. Negotiated Rate	$47.53
Rate for Payer: Cash Price	$36.94
Rate for Payer: Celtic Commercial/Exchange	$22.64
Rate for Payer: Health Partners Plans Commercial	$46.55
Rate for Payer: UnitedHealthcare Commercial	$47.53
Rate for Payer: WPPA Commercial	$41.16

OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC

Facility

$10,925.80

Service Code	MSDRG 818
Min. Negotiated Rate	$10,925.80
Max. Negotiated Rate	$10,925.80
Rate for Payer: BCBS Commercial	$10,925.80

OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC

Facility

$22,852.13

Service Code	MSDRG 817
Min. Negotiated Rate	$22,852.13
Max. Negotiated Rate	$22,852.13
Rate for Payer: BCBS Commercial	$22,852.13

OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC

Facility

$7,678.38

Service Code	MSDRG 819
Min. Negotiated Rate	$7,678.38
Max. Negotiated Rate	$7,678.38
Rate for Payer: BCBS Commercial	$7,678.38

OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC

Facility

$6,907.80

Service Code	MSDRG 832
Min. Negotiated Rate	$6,907.80
Max. Negotiated Rate	$6,907.80
Rate for Payer: BCBS Commercial	$6,907.80

OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC

Facility

$10,244.27

Service Code	MSDRG 831
Min. Negotiated Rate	$10,244.27
Max. Negotiated Rate	$10,244.27
Rate for Payer: BCBS Commercial	$10,244.27

OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC

Facility

$4,808.95

Service Code	MSDRG 833
Min. Negotiated Rate	$4,808.95
Max. Negotiated Rate	$4,808.95
Rate for Payer: BCBS Commercial	$4,808.95

OTHER CARDIOTHORACIC PROCEDURES WITH MCC

Facility

$55,447.55

Service Code	MSDRG 228
Min. Negotiated Rate	$55,447.55
Max. Negotiated Rate	$55,447.55
Rate for Payer: BCBS Commercial	$55,447.55

OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC

Facility

$36,604.85

Service Code	MSDRG 229
Min. Negotiated Rate	$36,604.85
Max. Negotiated Rate	$36,604.85
Rate for Payer: BCBS Commercial	$36,604.85

OTHER CEREBROVASCULAR DISORDERS WITH CC

Facility

$9,176.50

Service Code	MSDRG 071
Min. Negotiated Rate	$9,176.50
Max. Negotiated Rate	$9,176.50
Rate for Payer: BCBS Commercial	$9,176.50

OTHER CEREBROVASCULAR DISORDERS WITH MCC

Facility

$15,059.70

Service Code	MSDRG 070
Min. Negotiated Rate	$15,059.70
Max. Negotiated Rate	$15,059.70
Rate for Payer: BCBS Commercial	$15,059.70

OTHER CEREBROVASCULAR DISORDERS WITHOUT CC/MCC

Facility

$7,148.18

Service Code	MSDRG 072
Min. Negotiated Rate	$7,148.18
Max. Negotiated Rate	$7,148.18
Rate for Payer: BCBS Commercial	$7,148.18

OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC

Facility

$8,639.40

Service Code	MSDRG 315
Min. Negotiated Rate	$8,639.40
Max. Negotiated Rate	$8,639.40
Rate for Payer: BCBS Commercial	$8,639.40

OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC

Facility

$18,691.93

Service Code	MSDRG 314
Min. Negotiated Rate	$18,691.93
Max. Negotiated Rate	$18,691.93
Rate for Payer: BCBS Commercial	$18,691.93

OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC

Facility

$6,420.52

Service Code	MSDRG 316
Min. Negotiated Rate	$6,420.52
Max. Negotiated Rate	$6,420.52
Rate for Payer: BCBS Commercial	$6,420.52

OTHER CIRCULATORY SYSTEM O.R. PROCEDURES

Facility

$29,172.60

Service Code	MSDRG 264
Min. Negotiated Rate	$29,172.60
Max. Negotiated Rate	$29,172.60
Rate for Payer: BCBS Commercial	$29,172.60

OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC

Facility

$8,350.96

Service Code	MSDRG 394
Min. Negotiated Rate	$8,350.96
Max. Negotiated Rate	$8,350.96
Rate for Payer: BCBS Commercial	$8,350.96

OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC

Facility

$14,743.98

Service Code	MSDRG 393
Min. Negotiated Rate	$14,743.98
Max. Negotiated Rate	$14,743.98
Rate for Payer: BCBS Commercial	$14,743.98

OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC

Facility

$5,782.39

Service Code	MSDRG 395
Min. Negotiated Rate	$5,782.39
Max. Negotiated Rate	$5,782.39
Rate for Payer: BCBS Commercial	$5,782.39

OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC

Facility

$20,134.08

Service Code	MSDRG 357
Min. Negotiated Rate	$20,134.08
Max. Negotiated Rate	$20,134.08
Rate for Payer: BCBS Commercial	$20,134.08

Know your out-of-pocket cost for care.

All Charges