Ness County Hospital

All Charges

Charge

Type

Setting

Price

PICC PEELAWAY INTRODUCER

Facility

$50.00

Hospital Charge Code	2580629
Hospital Revenue Code	270
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$48.50
Rate for Payer: Cash Price	$38.10
Rate for Payer: Celtic Commercial/Exchange	$23.10
Rate for Payer: Health Partners Plans Commercial	$47.50
Rate for Payer: UnitedHealthcare Commercial	$48.50
Rate for Payer: WPPA Commercial	$42.00

PICC STABILIZER

Facility

$30.00

Hospital Charge Code	2708378
Hospital Revenue Code	270
Min. Negotiated Rate	$24.60
Max. Negotiated Rate	$29.10
Rate for Payer: Cash Price	$22.50
Rate for Payer: Health Partners Plans Commercial	$28.50
Rate for Payer: UnitedHealthcare Commercial	$29.10
Rate for Payer: WPPA Commercial	$24.60

PICC STABILIZER

Facility

$30.00

Hospital Charge Code	2708378
Hospital Revenue Code	270
Min. Negotiated Rate	$13.86
Max. Negotiated Rate	$29.10
Rate for Payer: Cash Price	$22.50
Rate for Payer: Celtic Commercial/Exchange	$13.86
Rate for Payer: Health Partners Plans Commercial	$28.50
Rate for Payer: UnitedHealthcare Commercial	$29.10
Rate for Payer: WPPA Commercial	$25.20

PINWORM EXAM, TAPE PREP

Facility

$38.00

Service Code	HCPCS 87172
Hospital Charge Code	8717200
Hospital Revenue Code	306
Min. Negotiated Rate	$16.38
Max. Negotiated Rate	$36.86
Rate for Payer: BCBS Commercial	$16.38
Rate for Payer: Cash Price	$28.50
Rate for Payer: Cash Price	$28.50
Rate for Payer: Celtic Commercial/Exchange	$17.56
Rate for Payer: Health Partners Plans Commercial	$36.10
Rate for Payer: UnitedHealthcare Commercial	$36.86
Rate for Payer: WPPA Commercial	$31.92

PINWORM EXAM, TAPE PREP

Facility

$38.00

Service Code	HCPCS 87172
Hospital Charge Code	8717200
Hospital Revenue Code	306
Min. Negotiated Rate	$31.16
Max. Negotiated Rate	$36.86
Rate for Payer: Cash Price	$28.50
Rate for Payer: Health Partners Plans Commercial	$36.10
Rate for Payer: UnitedHealthcare Commercial	$36.86
Rate for Payer: WPPA Commercial	$31.16

PLACE GASTROSTOMY TUBE

Facility

$1,742.00

Service Code	HCPCS 43246
Hospital Charge Code	4324600
Hospital Revenue Code	761
Min. Negotiated Rate	$1,428.44
Max. Negotiated Rate	$1,689.74
Rate for Payer: Cash Price	$1,306.50
Rate for Payer: Health Partners Plans Commercial	$1,654.90
Rate for Payer: UnitedHealthcare Commercial	$1,689.74
Rate for Payer: WPPA Commercial	$1,428.44

PLACE GASTROSTOMY TUBE

Facility

$1,742.00

Service Code	HCPCS 43246
Hospital Charge Code	4324600
Hospital Revenue Code	761
Min. Negotiated Rate	$804.80
Max. Negotiated Rate	$2,371.24
Rate for Payer: BCBS Commercial	$2,371.24
Rate for Payer: Cash Price	$1,306.50
Rate for Payer: Cash Price	$1,306.50
Rate for Payer: Celtic Commercial/Exchange	$804.80
Rate for Payer: Health Partners Plans Commercial	$1,654.90
Rate for Payer: UnitedHealthcare Commercial	$1,689.74
Rate for Payer: WPPA Commercial	$1,463.28

PLACEMENT,NEEDLE,INTRAOSSEOUS

Facility

$378.00

Service Code	HCPCS 36680
Hospital Charge Code	3668000
Hospital Revenue Code	450
Min. Negotiated Rate	$174.64
Max. Negotiated Rate	$498.80
Rate for Payer: BCBS Commercial	$498.80
Rate for Payer: Cash Price	$283.50
Rate for Payer: Cash Price	$283.50
Rate for Payer: Celtic Commercial/Exchange	$174.64
Rate for Payer: Health Partners Plans Commercial	$359.10
Rate for Payer: UnitedHealthcare Commercial	$366.66
Rate for Payer: WPPA Commercial	$317.52

PLACEMENT,NEEDLE,INTRAOSSEOUS

Facility

$378.00

Service Code	HCPCS 36680
Hospital Charge Code	3668000
Hospital Revenue Code	450
Min. Negotiated Rate	$309.96
Max. Negotiated Rate	$366.66
Rate for Payer: Cash Price	$283.50
Rate for Payer: Health Partners Plans Commercial	$359.10
Rate for Payer: UnitedHealthcare Commercial	$366.66
Rate for Payer: WPPA Commercial	$309.96

PLAIN PACKING STRIP

Facility

$9.00

Hospital Charge Code	2720126
Hospital Revenue Code	272
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$6.75
Rate for Payer: Celtic Commercial/Exchange	$4.16
Rate for Payer: Health Partners Plans Commercial	$8.55
Rate for Payer: UnitedHealthcare Commercial	$8.73
Rate for Payer: WPPA Commercial	$7.56

PLAIN PACKING STRIP

Facility

$9.00

Hospital Charge Code	2720126
Hospital Revenue Code	272
Min. Negotiated Rate	$7.38
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$6.75
Rate for Payer: Health Partners Plans Commercial	$8.55
Rate for Payer: UnitedHealthcare Commercial	$8.73
Rate for Payer: WPPA Commercial	$7.38

PLAQUENIL 200 MG TAB (HYDROXYCHLOROQUINE)

Facility

$3.00

Service Code	NDC 50268041211
Hospital Charge Code	2516359
Hospital Revenue Code	250
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.78
Rate for Payer: Health Partners Plans Commercial	$2.85
Rate for Payer: UnitedHealthcare Commercial	$2.91
Rate for Payer: WPPA Commercial	$2.46

PLAQUENIL 200 MG TAB (HYDROXYCHLOROQUINE)

Facility

$3.00

Service Code	NDC 50268041211
Hospital Charge Code	2516359
Hospital Revenue Code	250
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.78
Rate for Payer: Celtic Commercial/Exchange	$1.39
Rate for Payer: Health Partners Plans Commercial	$2.85
Rate for Payer: UnitedHealthcare Commercial	$2.91
Rate for Payer: WPPA Commercial	$2.52

PLASTIC SET

Facility

$60.00

Hospital Charge Code	2722478
Hospital Revenue Code	270
Min. Negotiated Rate	$27.72
Max. Negotiated Rate	$58.20
Rate for Payer: Cash Price	$45.19
Rate for Payer: Celtic Commercial/Exchange	$27.72
Rate for Payer: Health Partners Plans Commercial	$57.00
Rate for Payer: UnitedHealthcare Commercial	$58.20
Rate for Payer: WPPA Commercial	$50.40

PLASTIC SET

Facility

$60.00

Hospital Charge Code	2722478
Hospital Revenue Code	270
Min. Negotiated Rate	$49.20
Max. Negotiated Rate	$58.20
Rate for Payer: Cash Price	$45.19
Rate for Payer: Health Partners Plans Commercial	$57.00
Rate for Payer: UnitedHealthcare Commercial	$58.20
Rate for Payer: WPPA Commercial	$49.20

PLATELET NEUTRALIZATION

Facility

$203.00

Service Code	HCPCS 85597
Hospital Charge Code	8559700
Hospital Revenue Code	305
Min. Negotiated Rate	$93.79
Max. Negotiated Rate	$196.91
Rate for Payer: BCBS Commercial	$150.26
Rate for Payer: Cash Price	$152.25
Rate for Payer: Cash Price	$152.25
Rate for Payer: Celtic Commercial/Exchange	$93.79
Rate for Payer: Health Partners Plans Commercial	$192.85
Rate for Payer: UnitedHealthcare Commercial	$196.91
Rate for Payer: WPPA Commercial	$170.52

PLATELET NEUTRALIZATION

Facility

$203.00

Service Code	HCPCS 85597
Hospital Charge Code	8559700
Hospital Revenue Code	305
Min. Negotiated Rate	$166.46
Max. Negotiated Rate	$196.91
Rate for Payer: Cash Price	$152.25
Rate for Payer: Health Partners Plans Commercial	$192.85
Rate for Payer: UnitedHealthcare Commercial	$196.91
Rate for Payer: WPPA Commercial	$166.46

PLATELET PHERES, LEUKOREDUCED

Facility

$750.00

Service Code	HCPCS 86945
Hospital Charge Code	P903500
Hospital Revenue Code	390
Min. Negotiated Rate	$346.50
Max. Negotiated Rate	$727.50
Rate for Payer: Cash Price	$562.50
Rate for Payer: Celtic Commercial/Exchange	$346.50
Rate for Payer: Health Partners Plans Commercial	$712.50
Rate for Payer: UnitedHealthcare Commercial	$727.50
Rate for Payer: WPPA Commercial	$630.00

PLATELET PHERES, LEUKOREDUCED

Facility

$750.00

Service Code	HCPCS 86945
Hospital Charge Code	P903500
Hospital Revenue Code	390
Min. Negotiated Rate	$615.00
Max. Negotiated Rate	$727.50
Rate for Payer: Cash Price	$562.50
Rate for Payer: Health Partners Plans Commercial	$712.50
Rate for Payer: UnitedHealthcare Commercial	$727.50
Rate for Payer: WPPA Commercial	$615.00

PLATLET, AGGREGATION (IN VITRO

Facility

$126.00

Service Code	HCPCS 85576
Hospital Charge Code	8557600
Hospital Revenue Code	305
Min. Negotiated Rate	$103.32
Max. Negotiated Rate	$122.22
Rate for Payer: Cash Price	$94.50
Rate for Payer: Health Partners Plans Commercial	$119.70
Rate for Payer: UnitedHealthcare Commercial	$122.22
Rate for Payer: WPPA Commercial	$103.32

PLATLET, AGGREGATION (IN VITRO

Facility

$126.00

Service Code	HCPCS 85576
Hospital Charge Code	8557600
Hospital Revenue Code	305
Min. Negotiated Rate	$54.74
Max. Negotiated Rate	$122.22
Rate for Payer: BCBS Commercial	$54.74
Rate for Payer: Cash Price	$94.50
Rate for Payer: Cash Price	$94.50
Rate for Payer: Celtic Commercial/Exchange	$58.21
Rate for Payer: Health Partners Plans Commercial	$119.70
Rate for Payer: UnitedHealthcare Commercial	$122.22
Rate for Payer: WPPA Commercial	$105.84

PLAVIX 75 MG TAB (CLOPIDOGREL)

Facility

$20.00

Service Code	NDC 68084053611
Hospital Charge Code	2514256
Hospital Revenue Code	250
Min. Negotiated Rate	$9.24
Max. Negotiated Rate	$19.40
Rate for Payer: Cash Price	$15.34
Rate for Payer: Celtic Commercial/Exchange	$9.24
Rate for Payer: Health Partners Plans Commercial	$19.00
Rate for Payer: UnitedHealthcare Commercial	$19.40
Rate for Payer: WPPA Commercial	$16.80

PLAVIX 75 MG TAB (CLOPIDOGREL)

Facility

$20.00

Service Code	NDC 68084053611
Hospital Charge Code	2514256
Hospital Revenue Code	250
Min. Negotiated Rate	$16.40
Max. Negotiated Rate	$19.40
Rate for Payer: Cash Price	$15.34
Rate for Payer: Health Partners Plans Commercial	$19.00
Rate for Payer: UnitedHealthcare Commercial	$19.40
Rate for Payer: WPPA Commercial	$16.40

PLENDIL 5 MG TAB (FELODIPINE)

Facility

$4.00

Service Code	NDC 13668013301
Hospital Charge Code	2518108
Hospital Revenue Code	250
Min. Negotiated Rate	$3.28
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$3.41
Rate for Payer: Health Partners Plans Commercial	$3.80
Rate for Payer: UnitedHealthcare Commercial	$3.88
Rate for Payer: WPPA Commercial	$3.28

PLENDIL 5 MG TAB (FELODIPINE)

Facility

$4.00

Service Code	NDC 13668013301
Hospital Charge Code	2518108
Hospital Revenue Code	250
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$3.41
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

Know your out-of-pocket cost for care.

All Charges