Ness County Hospital

All Charges

Charge

Type

Setting

Price

PNEUMOTHORAX WITHOUT CC/MCC

Facility

$6,298.04

Service Code	MSDRG 201
Min. Negotiated Rate	$6,298.04
Max. Negotiated Rate	$6,298.04
Rate for Payer: BCBS Commercial	$6,298.04

PNEUMOVAX 23 INJ. 25 MCG/0.5 ML

Facility

$397.00

Service Code	NDC 00006494300
Hospital Charge Code	2505691
Hospital Revenue Code	250
Min. Negotiated Rate	$183.41
Max. Negotiated Rate	$385.09
Rate for Payer: Cash Price	$298.24
Rate for Payer: Celtic Commercial/Exchange	$183.41
Rate for Payer: Health Partners Plans Commercial	$377.15
Rate for Payer: UnitedHealthcare Commercial	$385.09
Rate for Payer: WPPA Commercial	$333.48

PNEUMOVAX 23 INJ. 25 MCG/0.5 ML

Facility

$397.00

Service Code	NDC 00006494300
Hospital Charge Code	2505691
Hospital Revenue Code	250
Min. Negotiated Rate	$325.54
Max. Negotiated Rate	$385.09
Rate for Payer: Cash Price	$298.24
Rate for Payer: Health Partners Plans Commercial	$377.15
Rate for Payer: UnitedHealthcare Commercial	$385.09
Rate for Payer: WPPA Commercial	$325.54

POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC

Facility

$13,256.59

Service Code	MSDRG 917
Min. Negotiated Rate	$13,256.59
Max. Negotiated Rate	$13,256.59
Rate for Payer: BCBS Commercial	$13,256.59

POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC

Facility

$7,449.92

Service Code	MSDRG 918
Min. Negotiated Rate	$7,449.92
Max. Negotiated Rate	$7,449.92
Rate for Payer: BCBS Commercial	$7,449.92

POLYMEM 3X3" DRESSING

Facility

$10.00

Hospital Charge Code	2725056
Hospital Revenue Code	270
Min. Negotiated Rate	$8.20
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$7.50
Rate for Payer: Health Partners Plans Commercial	$9.50
Rate for Payer: UnitedHealthcare Commercial	$9.70
Rate for Payer: WPPA Commercial	$8.20

POLYMEM 3X3" DRESSING

Facility

$10.00

Hospital Charge Code	2725056
Hospital Revenue Code	270
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$7.50
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

POLYMEM NON ADH AG

Facility

$12.00

Hospital Charge Code	2720731
Hospital Revenue Code	272
Min. Negotiated Rate	$9.84
Max. Negotiated Rate	$11.64
Rate for Payer: Cash Price	$9.00
Rate for Payer: Health Partners Plans Commercial	$11.40
Rate for Payer: UnitedHealthcare Commercial	$11.64
Rate for Payer: WPPA Commercial	$9.84

POLYMEM NON ADH AG

Facility

$12.00

Hospital Charge Code	2720731
Hospital Revenue Code	272
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$11.64
Rate for Payer: Cash Price	$9.00
Rate for Payer: Celtic Commercial/Exchange	$5.54
Rate for Payer: Health Partners Plans Commercial	$11.40
Rate for Payer: UnitedHealthcare Commercial	$11.64
Rate for Payer: WPPA Commercial	$10.08

POLYMEM NON-ADHESIVE PAD

Facility

$10.00

Hospital Charge Code	2720736
Hospital Revenue Code	272
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$7.50
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

POLYMEM NON-ADHESIVE PAD

Facility

$10.00

Hospital Charge Code	2720736
Hospital Revenue Code	272
Min. Negotiated Rate	$8.20
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$7.50
Rate for Payer: Health Partners Plans Commercial	$9.50
Rate for Payer: UnitedHealthcare Commercial	$9.70
Rate for Payer: WPPA Commercial	$8.20

POLYP SNARE SINGE USE MD 20MM

Facility

$50.00

Hospital Charge Code	2700686
Hospital Revenue Code	270
Min. Negotiated Rate	$41.00
Max. Negotiated Rate	$48.50
Rate for Payer: Cash Price	$37.50
Rate for Payer: Health Partners Plans Commercial	$47.50
Rate for Payer: UnitedHealthcare Commercial	$48.50
Rate for Payer: WPPA Commercial	$41.00

POLYP SNARE SINGE USE MD 20MM

Facility

$50.00

Hospital Charge Code	2700686
Hospital Revenue Code	270
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$48.50
Rate for Payer: Cash Price	$37.50
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

POLYP TRAP QUAD CHAMBER

Facility

$35.00

Hospital Charge Code	2709468
Hospital Revenue Code	270
Min. Negotiated Rate	$16.17
Max. Negotiated Rate	$33.95
Rate for Payer: Cash Price	$26.25
Rate for Payer: Celtic Commercial/Exchange	$16.17
Rate for Payer: Health Partners Plans Commercial	$33.25
Rate for Payer: UnitedHealthcare Commercial	$33.95
Rate for Payer: WPPA Commercial	$29.40

POLYP TRAP QUAD CHAMBER

Facility

$35.00

Hospital Charge Code	2709468
Hospital Revenue Code	270
Min. Negotiated Rate	$28.70
Max. Negotiated Rate	$33.95
Rate for Payer: Cash Price	$26.25
Rate for Payer: Health Partners Plans Commercial	$33.25
Rate for Payer: UnitedHealthcare Commercial	$33.95
Rate for Payer: WPPA Commercial	$28.70

POLYTRIM ophth solut-(polymyxin B/trimeth)

Facility

$61.00

Service Code	NDC 61314062810
Hospital Charge Code	2513778
Hospital Revenue Code	250
Min. Negotiated Rate	$28.18
Max. Negotiated Rate	$59.17
Rate for Payer: Cash Price	$46.12
Rate for Payer: Celtic Commercial/Exchange	$28.18
Rate for Payer: Health Partners Plans Commercial	$57.95
Rate for Payer: UnitedHealthcare Commercial	$59.17
Rate for Payer: WPPA Commercial	$51.24

POLYTRIM ophth solut-(polymyxin B/trimeth)

Facility

$61.00

Service Code	NDC 61314062810
Hospital Charge Code	2513778
Hospital Revenue Code	250
Min. Negotiated Rate	$50.02
Max. Negotiated Rate	$59.17
Rate for Payer: Cash Price	$46.12
Rate for Payer: Health Partners Plans Commercial	$57.95
Rate for Payer: UnitedHealthcare Commercial	$59.17
Rate for Payer: WPPA Commercial	$50.02

PONTOCAINE 0.5 % 4 ML OPTHALMIC DROPS (TETRACAINE)

Facility

$57.00

Service Code	NDC 00065074114
Hospital Charge Code	2505741
Hospital Revenue Code	250
Min. Negotiated Rate	$46.74
Max. Negotiated Rate	$55.29
Rate for Payer: Cash Price	$43.35
Rate for Payer: Health Partners Plans Commercial	$54.15
Rate for Payer: UnitedHealthcare Commercial	$55.29
Rate for Payer: WPPA Commercial	$46.74

PONTOCAINE 0.5 % 4 ML OPTHALMIC DROPS (TETRACAINE)

Facility

$57.00

Service Code	NDC 00065074114
Hospital Charge Code	2505741
Hospital Revenue Code	250
Min. Negotiated Rate	$26.33
Max. Negotiated Rate	$55.29
Rate for Payer: Cash Price	$43.35
Rate for Payer: Celtic Commercial/Exchange	$26.33
Rate for Payer: Health Partners Plans Commercial	$54.15
Rate for Payer: UnitedHealthcare Commercial	$55.29
Rate for Payer: WPPA Commercial	$47.88

POOL PLATELETS/OTHER BLD PROD.

Facility

$158.00

Service Code	HCPCS 86965
Hospital Charge Code	8696500
Hospital Revenue Code	309
Min. Negotiated Rate	$129.56
Max. Negotiated Rate	$153.26
Rate for Payer: Cash Price	$118.50
Rate for Payer: Health Partners Plans Commercial	$150.10
Rate for Payer: UnitedHealthcare Commercial	$153.26
Rate for Payer: WPPA Commercial	$129.56

POOL PLATELETS/OTHER BLD PROD.

Facility

$158.00

Service Code	HCPCS 86965
Hospital Charge Code	8696500
Hospital Revenue Code	309
Min. Negotiated Rate	$73.00
Max. Negotiated Rate	$153.26
Rate for Payer: Cash Price	$118.50
Rate for Payer: Celtic Commercial/Exchange	$73.00
Rate for Payer: Health Partners Plans Commercial	$150.10
Rate for Payer: UnitedHealthcare Commercial	$153.26
Rate for Payer: WPPA Commercial	$132.72

PORPHOBILINOGEN, QUANT 24HR UA

Facility

$74.00

Service Code	HCPCS 84110
Hospital Charge Code	8411000
Hospital Revenue Code	301
Min. Negotiated Rate	$34.19
Max. Negotiated Rate	$71.78
Rate for Payer: BCBS Commercial	$39.32
Rate for Payer: Cash Price	$55.50
Rate for Payer: Cash Price	$55.50
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

PORPHOBILINOGEN, QUANT 24HR UA

Facility

$74.00

Service Code	HCPCS 84110
Hospital Charge Code	8411000
Hospital Revenue Code	301
Min. Negotiated Rate	$60.68
Max. Negotiated Rate	$71.78
Rate for Payer: Cash Price	$55.50
Rate for Payer: Health Partners Plans Commercial	$70.30
Rate for Payer: UnitedHealthcare Commercial	$71.78
Rate for Payer: WPPA Commercial	$60.68

PORPHYRINS,UA QUANT & FRACTION

Facility

$113.00

Service Code	HCPCS 84120
Hospital Charge Code	8412000
Hospital Revenue Code	301
Min. Negotiated Rate	$92.66
Max. Negotiated Rate	$109.61
Rate for Payer: Cash Price	$84.75
Rate for Payer: Health Partners Plans Commercial	$107.35
Rate for Payer: UnitedHealthcare Commercial	$109.61
Rate for Payer: WPPA Commercial	$92.66

PORPHYRINS,UA QUANT & FRACTION

Facility

$113.00

Service Code	HCPCS 84120
Hospital Charge Code	8412000
Hospital Revenue Code	301
Min. Negotiated Rate	$52.21
Max. Negotiated Rate	$109.61
Rate for Payer: BCBS Commercial	$60.56
Rate for Payer: Cash Price	$84.75
Rate for Payer: Cash Price	$84.75
Rate for Payer: Celtic Commercial/Exchange	$52.21
Rate for Payer: Health Partners Plans Commercial	$107.35
Rate for Payer: UnitedHealthcare Commercial	$109.61
Rate for Payer: WPPA Commercial	$94.92

Know your out-of-pocket cost for care.

All Charges