Ness County Hospital

All Charges

Charge

Type

Setting

Price

PROCARDIA XL 30 MG TAB (NIFEDIPINE ER)

Facility

$5.00

Service Code	NDC 68084059711
Hospital Charge Code	2510881
Hospital Revenue Code	250
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$3.94
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

PROCARDIA XL 30 MG TAB (NIFEDIPINE ER)

Facility

$5.00

Service Code	NDC 68084059711
Hospital Charge Code	2510881
Hospital Revenue Code	250
Min. Negotiated Rate	$4.10
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$3.94
Rate for Payer: Health Partners Plans Commercial	$4.75
Rate for Payer: UnitedHealthcare Commercial	$4.85
Rate for Payer: WPPA Commercial	$4.10

Procrit 10,000 units inj. (epoetin alfa)

Facility

$927.00

Service Code	NDC 59676031001
Hospital Charge Code	2519734
Hospital Revenue Code	250
Min. Negotiated Rate	$428.27
Max. Negotiated Rate	$899.19
Rate for Payer: Cash Price	$695.32
Rate for Payer: Celtic Commercial/Exchange	$428.27
Rate for Payer: Health Partners Plans Commercial	$880.65
Rate for Payer: UnitedHealthcare Commercial	$899.19
Rate for Payer: WPPA Commercial	$778.68

Procrit 10,000 units inj. (epoetin alfa)

Facility

$927.00

Service Code	NDC 59676031001
Hospital Charge Code	2519734
Hospital Revenue Code	250
Min. Negotiated Rate	$760.14
Max. Negotiated Rate	$899.19
Rate for Payer: Cash Price	$695.32
Rate for Payer: Health Partners Plans Commercial	$880.65
Rate for Payer: UnitedHealthcare Commercial	$899.19
Rate for Payer: WPPA Commercial	$760.14

Procrit 20,000 units vial(epoetin alfa)

Facility

$1,854.00

Service Code	NDC 59676032004
Hospital Charge Code	2519726
Hospital Revenue Code	250
Min. Negotiated Rate	$856.55
Max. Negotiated Rate	$1,798.38
Rate for Payer: Cash Price	$1,390.61
Rate for Payer: Celtic Commercial/Exchange	$856.55
Rate for Payer: Health Partners Plans Commercial	$1,761.30
Rate for Payer: UnitedHealthcare Commercial	$1,798.38
Rate for Payer: WPPA Commercial	$1,557.36

Procrit 20,000 units vial(epoetin alfa)

Facility

$1,854.00

Service Code	NDC 59676032004
Hospital Charge Code	2519726
Hospital Revenue Code	250
Min. Negotiated Rate	$1,520.28
Max. Negotiated Rate	$1,798.38
Rate for Payer: Cash Price	$1,390.61
Rate for Payer: Health Partners Plans Commercial	$1,761.30
Rate for Payer: UnitedHealthcare Commercial	$1,798.38
Rate for Payer: WPPA Commercial	$1,520.28

Procrit 40,000 U/ML (epoetin alfa) Inj Solution

Facility

$3,853.00

Service Code	NDC 59676034001
Hospital Charge Code	2511905
Hospital Revenue Code	250
Min. Negotiated Rate	$3,159.46
Max. Negotiated Rate	$3,737.41
Rate for Payer: Cash Price	$2,889.75
Rate for Payer: Health Partners Plans Commercial	$3,660.35
Rate for Payer: UnitedHealthcare Commercial	$3,737.41
Rate for Payer: WPPA Commercial	$3,159.46

Procrit 40,000 U/ML (epoetin alfa) Inj Solution

Facility

$3,853.00

Service Code	NDC 59676034001
Hospital Charge Code	2511905
Hospital Revenue Code	250
Min. Negotiated Rate	$1,780.09
Max. Negotiated Rate	$3,737.41
Rate for Payer: Cash Price	$2,889.75
Rate for Payer: Celtic Commercial/Exchange	$1,780.09
Rate for Payer: Health Partners Plans Commercial	$3,660.35
Rate for Payer: UnitedHealthcare Commercial	$3,737.41
Rate for Payer: WPPA Commercial	$3,236.52

PROCRIT 40,000 UNITS/DIALYSIS

Facility

$3,853.00

Hospital Charge Code	2518074
Hospital Revenue Code	250
Min. Negotiated Rate	$1,780.09
Max. Negotiated Rate	$3,737.41
Rate for Payer: Cash Price	$2,889.75
Rate for Payer: Celtic Commercial/Exchange	$1,780.09
Rate for Payer: Health Partners Plans Commercial	$3,660.35
Rate for Payer: UnitedHealthcare Commercial	$3,737.41
Rate for Payer: WPPA Commercial	$3,236.52

PROCRIT 40,000 UNITS/DIALYSIS

Facility

$3,853.00

Hospital Charge Code	2518074
Hospital Revenue Code	250
Min. Negotiated Rate	$3,159.46
Max. Negotiated Rate	$3,737.41
Rate for Payer: Cash Price	$2,889.75
Rate for Payer: Health Partners Plans Commercial	$3,660.35
Rate for Payer: UnitedHealthcare Commercial	$3,737.41
Rate for Payer: WPPA Commercial	$3,159.46

PROCTOSIGMOINOSCOPY,RIGID

Facility

$1,700.00

Service Code	HCPCS 45303
Hospital Charge Code	4530300
Hospital Revenue Code	761
Min. Negotiated Rate	$785.40
Max. Negotiated Rate	$1,649.00
Rate for Payer: BCBS Commercial	$808.00
Rate for Payer: Cash Price	$1,275.00
Rate for Payer: Cash Price	$1,275.00
Rate for Payer: Celtic Commercial/Exchange	$785.40
Rate for Payer: Health Partners Plans Commercial	$1,615.00
Rate for Payer: UnitedHealthcare Commercial	$1,649.00
Rate for Payer: WPPA Commercial	$1,428.00

PROCTOSIGMOINOSCOPY,RIGID

Facility

$1,700.00

Service Code	HCPCS 45303
Hospital Charge Code	4530300
Hospital Revenue Code	761
Min. Negotiated Rate	$1,394.00
Max. Negotiated Rate	$1,649.00
Rate for Payer: Cash Price	$1,275.00
Rate for Payer: Health Partners Plans Commercial	$1,615.00
Rate for Payer: UnitedHealthcare Commercial	$1,649.00
Rate for Payer: WPPA Commercial	$1,394.00

PROF BIOPSY SKIN,SUBCUT TISSUE

Facility

$105.00

Service Code	HCPCS 11000
Hospital Charge Code	1100001
Hospital Revenue Code	982
Min. Negotiated Rate	$48.51
Max. Negotiated Rate	$278.76
Rate for Payer: BCBS Commercial	$278.76
Rate for Payer: Cash Price	$78.75
Rate for Payer: Cash Price	$78.75
Rate for Payer: Celtic Commercial/Exchange	$48.51
Rate for Payer: Health Partners Plans Commercial	$99.75
Rate for Payer: UnitedHealthcare Commercial	$101.85
Rate for Payer: WPPA Commercial	$88.20

PROF BIOPSY SKIN,SUBCUT TISSUE

Facility

$105.00

Service Code	HCPCS 11000
Hospital Charge Code	1100001
Hospital Revenue Code	982
Min. Negotiated Rate	$86.10
Max. Negotiated Rate	$101.85
Rate for Payer: Cash Price	$78.75
Rate for Payer: Health Partners Plans Commercial	$99.75
Rate for Payer: UnitedHealthcare Commercial	$101.85
Rate for Payer: WPPA Commercial	$86.10

PROF DEBRD SUBQ TIS-ADDTL 20SQ

Facility

$120.00

Service Code	HCPCS 11045 GF
Hospital Charge Code	11045WC
Hospital Revenue Code	983
Min. Negotiated Rate	$98.40
Max. Negotiated Rate	$116.40
Rate for Payer: Cash Price	$90.00
Rate for Payer: Health Partners Plans Commercial	$114.00
Rate for Payer: UnitedHealthcare Commercial	$116.40
Rate for Payer: WPPA Commercial	$98.40

PROF DEBRD SUBQ TIS-ADDTL 20SQ

Facility

$120.00

Service Code	HCPCS 11045 GF
Hospital Charge Code	11045WC
Hospital Revenue Code	983
Min. Negotiated Rate	$55.44
Max. Negotiated Rate	$278.76
Rate for Payer: BCBS Commercial	$278.76
Rate for Payer: Cash Price	$90.00
Rate for Payer: Cash Price	$90.00
Rate for Payer: Celtic Commercial/Exchange	$55.44
Rate for Payer: Health Partners Plans Commercial	$114.00
Rate for Payer: UnitedHealthcare Commercial	$116.40
Rate for Payer: WPPA Commercial	$100.80

PROF DEBRIDE SUBQ TIS <=20SQCM

Facility

$120.00

Service Code	HCPCS 11042 GF
Hospital Charge Code	11042WC
Hospital Revenue Code	983
Min. Negotiated Rate	$55.44
Max. Negotiated Rate	$451.17
Rate for Payer: BCBS Commercial	$451.17
Rate for Payer: Cash Price	$90.00
Rate for Payer: Cash Price	$90.00
Rate for Payer: Celtic Commercial/Exchange	$55.44
Rate for Payer: Health Partners Plans Commercial	$114.00
Rate for Payer: UnitedHealthcare Commercial	$116.40
Rate for Payer: WPPA Commercial	$100.80

PROF DEBRIDE SUBQ TIS <=20SQCM

Facility

$120.00

Service Code	HCPCS 11042 GF
Hospital Charge Code	11042WC
Hospital Revenue Code	983
Min. Negotiated Rate	$98.40
Max. Negotiated Rate	$116.40
Rate for Payer: Cash Price	$90.00
Rate for Payer: Health Partners Plans Commercial	$114.00
Rate for Payer: UnitedHealthcare Commercial	$116.40
Rate for Payer: WPPA Commercial	$98.40

PROFESSIONAL FEES-CRNA Medicare

Facility

$100.00

Hospital Charge Code	9640004
Hospital Revenue Code	964
Min. Negotiated Rate	$82.00
Max. Negotiated Rate	$97.00
Rate for Payer: Cash Price	$75.00
Rate for Payer: Health Partners Plans Commercial	$95.00
Rate for Payer: UnitedHealthcare Commercial	$97.00
Rate for Payer: WPPA Commercial	$82.00

PROFESSIONAL FEES-CRNA Medicare

Facility

$100.00

Hospital Charge Code	9640004
Hospital Revenue Code	964
Min. Negotiated Rate	$46.20
Max. Negotiated Rate	$97.00
Rate for Payer: Cash Price	$75.00
Rate for Payer: Celtic Commercial/Exchange	$46.20
Rate for Payer: Health Partners Plans Commercial	$95.00
Rate for Payer: UnitedHealthcare Commercial	$97.00
Rate for Payer: WPPA Commercial	$84.00

PROF FEE-ADMIT/DISCHG SAME DAY-LOW

Facility

$200.00

Service Code	HCPCS 99234
Hospital Charge Code	9923400
Hospital Revenue Code	982
Min. Negotiated Rate	$92.40
Max. Negotiated Rate	$194.00
Rate for Payer: BCBS Commercial	$184.00
Rate for Payer: Cash Price	$150.00
Rate for Payer: Cash Price	$150.00
Rate for Payer: Celtic Commercial/Exchange	$92.40
Rate for Payer: Health Partners Plans Commercial	$190.00
Rate for Payer: UnitedHealthcare Commercial	$194.00
Rate for Payer: WPPA Commercial	$168.00

PROF FEE-ADMIT/DISCHG SAME DAY-LOW

Facility

$200.00

Service Code	HCPCS 99234
Hospital Charge Code	9923400
Hospital Revenue Code	982
Min. Negotiated Rate	$164.00
Max. Negotiated Rate	$194.00
Rate for Payer: Cash Price	$150.00
Rate for Payer: Health Partners Plans Commercial	$190.00
Rate for Payer: UnitedHealthcare Commercial	$194.00
Rate for Payer: WPPA Commercial	$164.00

PROF FEE WND CLIN-DEBRIDE SOFT TISSUE/MUSCLE

Facility

$180.00

Service Code	HCPCS 11043 GF
Hospital Charge Code	11043WC
Hospital Revenue Code	983
Min. Negotiated Rate	$83.16
Max. Negotiated Rate	$700.21
Rate for Payer: BCBS Commercial	$700.21
Rate for Payer: Cash Price	$135.00
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

PROF FEE WND CLIN-DEBRIDE SOFT TISSUE/MUSCLE

Facility

$180.00

Service Code	HCPCS 11043 GF
Hospital Charge Code	11043WC
Hospital Revenue Code	983
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

Prof Fee Wnd Clinic-Chemical cauterization of granulation tissue

Facility

$75.00

Service Code	HCPCS 17250
Hospital Charge Code	17250WC
Hospital Revenue Code	983
Min. Negotiated Rate	$61.50
Max. Negotiated Rate	$72.75
Rate for Payer: Cash Price	$56.25
Rate for Payer: Health Partners Plans Commercial	$71.25
Rate for Payer: UnitedHealthcare Commercial	$72.75
Rate for Payer: WPPA Commercial	$61.50

Know your out-of-pocket cost for care.

All Charges