Ness County Hospital

All Charges

Charge

Type

Setting

Price

PED SHORT ARM FX CAST BRACE

Facility

$175.00

Hospital Charge Code	L398400
Hospital Revenue Code	270
Min. Negotiated Rate	$143.50
Max. Negotiated Rate	$169.75
Rate for Payer: Cash Price	$131.25
Rate for Payer: Health Partners Plans Commercial	$166.25
Rate for Payer: UnitedHealthcare Commercial	$169.75
Rate for Payer: WPPA Commercial	$143.50

PED SHORT ARM FX CAST BRACE

Facility

$175.00

Hospital Charge Code	L398400
Hospital Revenue Code	270
Min. Negotiated Rate	$80.85
Max. Negotiated Rate	$169.75
Rate for Payer: Cash Price	$131.25
Rate for Payer: Celtic Commercial/Exchange	$80.85
Rate for Payer: Health Partners Plans Commercial	$166.25
Rate for Payer: UnitedHealthcare Commercial	$169.75
Rate for Payer: WPPA Commercial	$147.00

PEDS U BAG

Facility

$5.00

Hospital Charge Code	2726012
Hospital Revenue Code	270
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

PEDS U BAG

Facility

$5.00

Hospital Charge Code	2726012
Hospital Revenue Code	270
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

PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITH CC/MCC

Facility

$19,741.79

Service Code	MSDRG 734
Min. Negotiated Rate	$19,741.79
Max. Negotiated Rate	$19,741.79
Rate for Payer: BCBS Commercial	$19,741.79

PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITHOUT CC/MCC

Facility

$12,546.40

Service Code	MSDRG 735
Min. Negotiated Rate	$12,546.40
Max. Negotiated Rate	$12,546.40
Rate for Payer: BCBS Commercial	$12,546.40

PELVIS 1 OR 2 VIEWS

Facility

$246.00

Service Code	HCPCS 72170
Hospital Charge Code	3290028
Hospital Revenue Code	320
Min. Negotiated Rate	$113.65
Max. Negotiated Rate	$238.62
Rate for Payer: BCBS Commercial	$132.93
Rate for Payer: Cash Price	$184.50
Rate for Payer: Cash Price	$184.50
Rate for Payer: Celtic Commercial/Exchange	$113.65
Rate for Payer: Health Partners Plans Commercial	$233.70
Rate for Payer: UnitedHealthcare Commercial	$238.62
Rate for Payer: WPPA Commercial	$206.64

PELVIS 1 OR 2 VIEWS

Facility

$246.00

Service Code	HCPCS 72170
Hospital Charge Code	3290028
Hospital Revenue Code	320
Min. Negotiated Rate	$201.72
Max. Negotiated Rate	$238.62
Rate for Payer: Cash Price	$184.50
Rate for Payer: Health Partners Plans Commercial	$233.70
Rate for Payer: UnitedHealthcare Commercial	$238.62
Rate for Payer: WPPA Commercial	$201.72

PELVIS 3V MINIMUM

Facility

$309.00

Service Code	HCPCS 72190
Hospital Charge Code	3290034
Hospital Revenue Code	320
Min. Negotiated Rate	$135.66
Max. Negotiated Rate	$299.73
Rate for Payer: BCBS Commercial	$135.66
Rate for Payer: Cash Price	$231.82
Rate for Payer: Cash Price	$231.82
Rate for Payer: Celtic Commercial/Exchange	$142.76
Rate for Payer: Health Partners Plans Commercial	$293.55
Rate for Payer: UnitedHealthcare Commercial	$299.73
Rate for Payer: WPPA Commercial	$259.56

PELVIS 3V MINIMUM

Facility

$309.00

Service Code	HCPCS 72190
Hospital Charge Code	3290034
Hospital Revenue Code	320
Min. Negotiated Rate	$253.38
Max. Negotiated Rate	$299.73
Rate for Payer: Cash Price	$231.82
Rate for Payer: Health Partners Plans Commercial	$293.55
Rate for Payer: UnitedHealthcare Commercial	$299.73
Rate for Payer: WPPA Commercial	$253.38

PENIS PROCEDURES WITH CC/MCC

Facility

$20,554.78

Service Code	MSDRG 709
Min. Negotiated Rate	$20,554.78
Max. Negotiated Rate	$20,554.78
Rate for Payer: BCBS Commercial	$20,554.78

PENIS PROCEDURES WITHOUT CC/MCC

Facility

$13,800.98

Service Code	MSDRG 710
Min. Negotiated Rate	$13,800.98
Max. Negotiated Rate	$13,800.98
Rate for Payer: BCBS Commercial	$13,800.98

PENROSE DRAIN

Facility

$10.00

Hospital Charge Code	2722031
Hospital Revenue Code	272
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$7.88
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

PENROSE DRAIN

Facility

$10.00

Hospital Charge Code	2722031
Hospital Revenue Code	272
Min. Negotiated Rate	$8.20
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$7.88
Rate for Payer: Health Partners Plans Commercial	$9.50
Rate for Payer: UnitedHealthcare Commercial	$9.70
Rate for Payer: WPPA Commercial	$8.20

PEN-VEE K 250 MG TAB (PENICILLIN V POTASSIUM )

Facility

$2.00

Service Code	NDC 00143983701
Hospital Charge Code	2505261
Hospital Revenue Code	250
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.91
Rate for Payer: Health Partners Plans Commercial	$1.90
Rate for Payer: UnitedHealthcare Commercial	$1.94
Rate for Payer: WPPA Commercial	$1.64

PEN-VEE K 250 MG TAB (PENICILLIN V POTASSIUM )

Facility

$2.00

Service Code	NDC 00143983701
Hospital Charge Code	2505261
Hospital Revenue Code	250
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.91
Rate for Payer: Celtic Commercial/Exchange	$0.92
Rate for Payer: Health Partners Plans Commercial	$1.90
Rate for Payer: UnitedHealthcare Commercial	$1.94
Rate for Payer: WPPA Commercial	$1.68

PEPCID 20 MG TAB (FAMOTIDINE)

Facility

$7.00

Service Code	NDC 50268029911
Hospital Charge Code	2510121
Hospital Revenue Code	250
Min. Negotiated Rate	$5.74
Max. Negotiated Rate	$6.79
Rate for Payer: Cash Price	$5.44
Rate for Payer: Health Partners Plans Commercial	$6.65
Rate for Payer: UnitedHealthcare Commercial	$6.79
Rate for Payer: WPPA Commercial	$5.74

PEPCID 20 MG TAB (FAMOTIDINE)

Facility

$7.00

Service Code	NDC 50268029911
Hospital Charge Code	2510121
Hospital Revenue Code	250
Min. Negotiated Rate	$3.23
Max. Negotiated Rate	$6.79
Rate for Payer: Cash Price	$5.44
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

PEP DEVICE

Facility

$121.00

Hospital Charge Code	2704194
Hospital Revenue Code	270
Min. Negotiated Rate	$99.22
Max. Negotiated Rate	$117.37
Rate for Payer: Cash Price	$91.12
Rate for Payer: Health Partners Plans Commercial	$114.95
Rate for Payer: UnitedHealthcare Commercial	$117.37
Rate for Payer: WPPA Commercial	$99.22

PEP DEVICE

Facility

$121.00

Hospital Charge Code	2704194
Hospital Revenue Code	270
Min. Negotiated Rate	$55.90
Max. Negotiated Rate	$117.37
Rate for Payer: Cash Price	$91.12
Rate for Payer: Celtic Commercial/Exchange	$55.90
Rate for Payer: Health Partners Plans Commercial	$114.95
Rate for Payer: UnitedHealthcare Commercial	$117.37
Rate for Payer: WPPA Commercial	$101.64

PERCOCET 10/325 MG TAB (OXYCODONE/ACE)

Facility

$14.00

Service Code	NDC 68084071001
Hospital Charge Code	2517789
Hospital Revenue Code	250
Min. Negotiated Rate	$6.47
Max. Negotiated Rate	$13.58
Rate for Payer: Cash Price	$11.18
Rate for Payer: Celtic Commercial/Exchange	$6.47
Rate for Payer: Health Partners Plans Commercial	$13.30
Rate for Payer: UnitedHealthcare Commercial	$13.58
Rate for Payer: WPPA Commercial	$11.76

PERCOCET 10/325 MG TAB (OXYCODONE/ACE)

Facility

$14.00

Service Code	NDC 68084071001
Hospital Charge Code	2517789
Hospital Revenue Code	250
Min. Negotiated Rate	$11.48
Max. Negotiated Rate	$13.58
Rate for Payer: Cash Price	$11.18
Rate for Payer: Health Partners Plans Commercial	$13.30
Rate for Payer: UnitedHealthcare Commercial	$13.58
Rate for Payer: WPPA Commercial	$11.48

PERCOCET 5/325 MG TAB (OXYCODONE+ACE)

Facility

$4.00

Service Code	NDC 68084035501
Hospital Charge Code	2505378
Hospital Revenue Code	250
Min. Negotiated Rate	$3.28
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$3.15
Rate for Payer: Health Partners Plans Commercial	$3.80
Rate for Payer: UnitedHealthcare Commercial	$3.88
Rate for Payer: WPPA Commercial	$3.28

PERCOCET 5/325 MG TAB (OXYCODONE+ACE)

Facility

$4.00

Service Code	NDC 68084035501
Hospital Charge Code	2505378
Hospital Revenue Code	250
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$3.15
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

PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC

Facility

$26,880.43

Service Code	MSDRG 273
Min. Negotiated Rate	$26,880.43
Max. Negotiated Rate	$26,880.43
Rate for Payer: BCBS Commercial	$26,880.43

Know your out-of-pocket cost for care.

All Charges