Ness County Hospital

All Charges

Charge

Type

Setting

Price

PURACOL PLUS COLLAGEN WOUND DRESSING

Facility

$20.00

Hospital Charge Code	2725067
Hospital Revenue Code	272
Min. Negotiated Rate	$16.40
Max. Negotiated Rate	$19.40
Rate for Payer: Cash Price	$15.00
Rate for Payer: Health Partners Plans Commercial	$19.00
Rate for Payer: UnitedHealthcare Commercial	$19.40
Rate for Payer: WPPA Commercial	$16.40

PURACOL ULTRA COLLAGEN POWDER

Facility

$56.00

Hospital Charge Code	2725066
Hospital Revenue Code	272
Min. Negotiated Rate	$25.87
Max. Negotiated Rate	$54.32
Rate for Payer: Cash Price	$42.05
Rate for Payer: Celtic Commercial/Exchange	$25.87
Rate for Payer: Health Partners Plans Commercial	$53.20
Rate for Payer: UnitedHealthcare Commercial	$54.32
Rate for Payer: WPPA Commercial	$47.04

PURACOL ULTRA COLLAGEN POWDER

Facility

$56.00

Hospital Charge Code	2725066
Hospital Revenue Code	272
Min. Negotiated Rate	$45.92
Max. Negotiated Rate	$54.32
Rate for Payer: Cash Price	$42.05
Rate for Payer: Health Partners Plans Commercial	$53.20
Rate for Payer: UnitedHealthcare Commercial	$54.32
Rate for Payer: WPPA Commercial	$45.92

PURAPLY AM 1.6CM PER SQ CM

Facility

$495.00

Service Code	HCPCS Q4196
Hospital Charge Code	Q4196231
Hospital Revenue Code	636
Min. Negotiated Rate	$405.90
Max. Negotiated Rate	$480.15
Rate for Payer: Cash Price	$371.25
Rate for Payer: Health Partners Plans Commercial	$470.25
Rate for Payer: UnitedHealthcare Commercial	$480.15
Rate for Payer: WPPA Commercial	$405.90

PURAPLY AM 1.6CM PER SQ CM

Facility

$495.00

Service Code	HCPCS Q4196
Hospital Charge Code	Q4196231
Hospital Revenue Code	636
Min. Negotiated Rate	$228.69
Max. Negotiated Rate	$480.15
Rate for Payer: Cash Price	$371.25
Rate for Payer: Celtic Commercial/Exchange	$228.69
Rate for Payer: Health Partners Plans Commercial	$470.25
Rate for Payer: UnitedHealthcare Commercial	$480.15
Rate for Payer: WPPA Commercial	$415.80

PURAPLY AM 2X2CM PER SQ CM

Facility

$825.00

Service Code	HCPCS Q4196
Hospital Charge Code	Q4196232
Hospital Revenue Code	636
Min. Negotiated Rate	$381.15
Max. Negotiated Rate	$800.25
Rate for Payer: Cash Price	$618.75
Rate for Payer: Celtic Commercial/Exchange	$381.15
Rate for Payer: Health Partners Plans Commercial	$783.75
Rate for Payer: UnitedHealthcare Commercial	$800.25
Rate for Payer: WPPA Commercial	$693.00

PURAPLY AM 2X2CM PER SQ CM

Facility

$825.00

Service Code	HCPCS Q4196
Hospital Charge Code	Q4196232
Hospital Revenue Code	636
Min. Negotiated Rate	$676.50
Max. Negotiated Rate	$800.25
Rate for Payer: Cash Price	$618.75
Rate for Payer: Health Partners Plans Commercial	$783.75
Rate for Payer: UnitedHealthcare Commercial	$800.25
Rate for Payer: WPPA Commercial	$676.50

PURAPLY AM 2X4CM PER SQ CM

Facility

$9,903.00

Service Code	HCPCS Q4196
Hospital Charge Code	Q4196235
Hospital Revenue Code	636
Min. Negotiated Rate	$4,575.19
Max. Negotiated Rate	$9,605.91
Rate for Payer: Cash Price	$7,427.25
Rate for Payer: Celtic Commercial/Exchange	$4,575.19
Rate for Payer: Health Partners Plans Commercial	$9,407.85
Rate for Payer: UnitedHealthcare Commercial	$9,605.91
Rate for Payer: WPPA Commercial	$8,318.52

PURAPLY AM 2X4CM PER SQ CM

Facility

$9,903.00

Service Code	HCPCS Q4196
Hospital Charge Code	Q4196235
Hospital Revenue Code	636
Min. Negotiated Rate	$8,120.46
Max. Negotiated Rate	$9,605.91
Rate for Payer: Cash Price	$7,427.25
Rate for Payer: Health Partners Plans Commercial	$9,407.85
Rate for Payer: UnitedHealthcare Commercial	$9,605.91
Rate for Payer: WPPA Commercial	$8,120.46

PURAPLY AM 5X5CM PER SQ CM

Facility

$2,860.00

Service Code	HCPCS Q4196
Hospital Charge Code	Q4196234
Hospital Revenue Code	636
Min. Negotiated Rate	$1,321.32
Max. Negotiated Rate	$2,774.20
Rate for Payer: Cash Price	$2,145.00
Rate for Payer: Celtic Commercial/Exchange	$1,321.32
Rate for Payer: Health Partners Plans Commercial	$2,717.00
Rate for Payer: UnitedHealthcare Commercial	$2,774.20
Rate for Payer: WPPA Commercial	$2,402.40

PURAPLY AM 5X5CM PER SQ CM

Facility

$2,860.00

Service Code	HCPCS Q4196
Hospital Charge Code	Q4196234
Hospital Revenue Code	636
Min. Negotiated Rate	$2,345.20
Max. Negotiated Rate	$2,774.20
Rate for Payer: Cash Price	$2,145.00
Rate for Payer: Health Partners Plans Commercial	$2,717.00
Rate for Payer: UnitedHealthcare Commercial	$2,774.20
Rate for Payer: WPPA Commercial	$2,345.20

PURAPLY AM 6X9CM PER SQ CM

Facility

$5,643.00

Service Code	HCPCS Q4196
Hospital Charge Code	Q4196233
Hospital Revenue Code	636
Min. Negotiated Rate	$2,607.07
Max. Negotiated Rate	$5,473.71
Rate for Payer: Cash Price	$4,232.25
Rate for Payer: Celtic Commercial/Exchange	$2,607.07
Rate for Payer: Health Partners Plans Commercial	$5,360.85
Rate for Payer: UnitedHealthcare Commercial	$5,473.71
Rate for Payer: WPPA Commercial	$4,740.12

PURAPLY AM 6X9CM PER SQ CM

Facility

$5,643.00

Service Code	HCPCS Q4196
Hospital Charge Code	Q4196233
Hospital Revenue Code	636
Min. Negotiated Rate	$4,627.26
Max. Negotiated Rate	$5,473.71
Rate for Payer: Cash Price	$4,232.25
Rate for Payer: Health Partners Plans Commercial	$5,360.85
Rate for Payer: UnitedHealthcare Commercial	$5,473.71
Rate for Payer: WPPA Commercial	$4,627.26

PURAPLY XT 4.91X4.91 PER SQ CM

Facility

$4,675.00

Service Code	HCPCS Q4197
Hospital Charge Code	Q419723
Hospital Revenue Code	636
Min. Negotiated Rate	$3,833.50
Max. Negotiated Rate	$4,534.75
Rate for Payer: Cash Price	$3,506.25
Rate for Payer: Health Partners Plans Commercial	$4,441.25
Rate for Payer: UnitedHealthcare Commercial	$4,534.75
Rate for Payer: WPPA Commercial	$3,833.50

PURAPLY XT 4.91X4.91 PER SQ CM

Facility

$4,675.00

Service Code	HCPCS Q4197
Hospital Charge Code	Q419723
Hospital Revenue Code	636
Min. Negotiated Rate	$2,159.85
Max. Negotiated Rate	$4,534.75
Rate for Payer: Cash Price	$3,506.25
Rate for Payer: Celtic Commercial/Exchange	$2,159.85
Rate for Payer: Health Partners Plans Commercial	$4,441.25
Rate for Payer: UnitedHealthcare Commercial	$4,534.75
Rate for Payer: WPPA Commercial	$3,927.00

PUREWICK

Facility

$48.00

Hospital Charge Code	2702232
Hospital Revenue Code	272
Min. Negotiated Rate	$39.36
Max. Negotiated Rate	$46.56
Rate for Payer: Cash Price	$36.00
Rate for Payer: Health Partners Plans Commercial	$45.60
Rate for Payer: UnitedHealthcare Commercial	$46.56
Rate for Payer: WPPA Commercial	$39.36

PUREWICK

Facility

$48.00

Hospital Charge Code	2702232
Hospital Revenue Code	272
Min. Negotiated Rate	$22.18
Max. Negotiated Rate	$46.56
Rate for Payer: Cash Price	$36.00
Rate for Payer: Celtic Commercial/Exchange	$22.18
Rate for Payer: Health Partners Plans Commercial	$45.60
Rate for Payer: UnitedHealthcare Commercial	$46.56
Rate for Payer: WPPA Commercial	$40.32

PYRIDIUM 100 MG TAB (PHENAZOPYRIDINE HCL)

Facility

$8.00

Service Code	NDC 65162068110
Hospital Charge Code	2502508
Hospital Revenue Code	250
Min. Negotiated Rate	$3.70
Max. Negotiated Rate	$7.76
Rate for Payer: Cash Price	$6.07
Rate for Payer: Celtic Commercial/Exchange	$3.70
Rate for Payer: Health Partners Plans Commercial	$7.60
Rate for Payer: UnitedHealthcare Commercial	$7.76
Rate for Payer: WPPA Commercial	$6.72

PYRIDIUM 100 MG TAB (PHENAZOPYRIDINE HCL)

Facility

$8.00

Service Code	NDC 65162068110
Hospital Charge Code	2502508
Hospital Revenue Code	250
Min. Negotiated Rate	$6.56
Max. Negotiated Rate	$7.76
Rate for Payer: Cash Price	$6.07
Rate for Payer: Health Partners Plans Commercial	$7.60
Rate for Payer: UnitedHealthcare Commercial	$7.76
Rate for Payer: WPPA Commercial	$6.56

QUAD CANE

Facility

$109.00

Hospital Charge Code	5710223
Hospital Revenue Code	271
Min. Negotiated Rate	$50.36
Max. Negotiated Rate	$105.73
Rate for Payer: Cash Price	$81.94
Rate for Payer: Celtic Commercial/Exchange	$50.36
Rate for Payer: Health Partners Plans Commercial	$103.55
Rate for Payer: UnitedHealthcare Commercial	$105.73
Rate for Payer: WPPA Commercial	$91.56

QUAD CANE

Facility

$109.00

Hospital Charge Code	5710223
Hospital Revenue Code	271
Min. Negotiated Rate	$89.38
Max. Negotiated Rate	$105.73
Rate for Payer: Cash Price	$81.94
Rate for Payer: Health Partners Plans Commercial	$103.55
Rate for Payer: UnitedHealthcare Commercial	$105.73
Rate for Payer: WPPA Commercial	$89.38

QUAL OR SEMIQUANT IMMUNOSSAYS

Facility

$125.00

Service Code	HCPCS 86008
Hospital Charge Code	8600800
Hospital Revenue Code	302
Min. Negotiated Rate	$102.50
Max. Negotiated Rate	$121.25
Rate for Payer: Cash Price	$93.75
Rate for Payer: Health Partners Plans Commercial	$118.75
Rate for Payer: UnitedHealthcare Commercial	$121.25
Rate for Payer: WPPA Commercial	$102.50

QUAL OR SEMIQUANT IMMUNOSSAYS

Facility

$125.00

Service Code	HCPCS 86008
Hospital Charge Code	8600800
Hospital Revenue Code	302
Min. Negotiated Rate	$40.26
Max. Negotiated Rate	$121.25
Rate for Payer: BCBS Commercial	$40.26
Rate for Payer: Cash Price	$93.75
Rate for Payer: Cash Price	$93.75
Rate for Payer: Celtic Commercial/Exchange	$57.75
Rate for Payer: Health Partners Plans Commercial	$118.75
Rate for Payer: UnitedHealthcare Commercial	$121.25
Rate for Payer: WPPA Commercial	$105.00

QUANTIFERON - TB GOLD

Facility

$231.00

Service Code	HCPCS 86480
Hospital Charge Code	8648000
Hospital Revenue Code	302
Min. Negotiated Rate	$106.72
Max. Negotiated Rate	$224.07
Rate for Payer: BCBS Commercial	$133.00
Rate for Payer: Cash Price	$173.25
Rate for Payer: Cash Price	$173.25
Rate for Payer: Celtic Commercial/Exchange	$106.72
Rate for Payer: Health Partners Plans Commercial	$219.45
Rate for Payer: UnitedHealthcare Commercial	$224.07
Rate for Payer: WPPA Commercial	$194.04

QUANTIFERON - TB GOLD

Facility

$231.00

Service Code	HCPCS 86480
Hospital Charge Code	8648000
Hospital Revenue Code	302
Min. Negotiated Rate	$189.42
Max. Negotiated Rate	$224.07
Rate for Payer: Cash Price	$173.25
Rate for Payer: Health Partners Plans Commercial	$219.45
Rate for Payer: UnitedHealthcare Commercial	$224.07
Rate for Payer: WPPA Commercial	$189.42

Know your out-of-pocket cost for care.

All Charges