Ness County Hospital

All Charges

Charge

Type

Setting

Price

QUANT OF DRUG AMIDRON

Facility

$108.00

Service Code	HCPCS 80299
Hospital Charge Code	8029901
Hospital Revenue Code	301
Min. Negotiated Rate	$88.56
Max. Negotiated Rate	$104.76
Rate for Payer: Cash Price	$81.00
Rate for Payer: Health Partners Plans Commercial	$102.60
Rate for Payer: UnitedHealthcare Commercial	$104.76
Rate for Payer: WPPA Commercial	$88.56

QUANT OF DRUG AMIDRON

Facility

$108.00

Service Code	HCPCS 80299
Hospital Charge Code	8029901
Hospital Revenue Code	301
Min. Negotiated Rate	$49.90
Max. Negotiated Rate	$104.76
Rate for Payer: BCBS Commercial	$65.71
Rate for Payer: Cash Price	$81.00
Rate for Payer: Cash Price	$81.00
Rate for Payer: Celtic Commercial/Exchange	$49.90
Rate for Payer: Health Partners Plans Commercial	$102.60
Rate for Payer: UnitedHealthcare Commercial	$104.76
Rate for Payer: WPPA Commercial	$90.72

QUANT OF DRUG, BACLOFEN

Facility

$108.00

Service Code	HCPCS 80299
Hospital Charge Code	8029904
Hospital Revenue Code	301
Min. Negotiated Rate	$88.56
Max. Negotiated Rate	$104.76
Rate for Payer: Cash Price	$81.00
Rate for Payer: Health Partners Plans Commercial	$102.60
Rate for Payer: UnitedHealthcare Commercial	$104.76
Rate for Payer: WPPA Commercial	$88.56

QUANT OF DRUG, BACLOFEN

Facility

$108.00

Service Code	HCPCS 80299
Hospital Charge Code	8029904
Hospital Revenue Code	301
Min. Negotiated Rate	$49.90
Max. Negotiated Rate	$104.76
Rate for Payer: BCBS Commercial	$65.71
Rate for Payer: Cash Price	$81.00
Rate for Payer: Cash Price	$81.00
Rate for Payer: Celtic Commercial/Exchange	$49.90
Rate for Payer: Health Partners Plans Commercial	$102.60
Rate for Payer: UnitedHealthcare Commercial	$104.76
Rate for Payer: WPPA Commercial	$90.72

QUANT OF DRUG LACOSAMIDE

Facility

$108.00

Service Code	HCPCS 80299
Hospital Charge Code	8029902
Hospital Revenue Code	301
Min. Negotiated Rate	$49.90
Max. Negotiated Rate	$104.76
Rate for Payer: BCBS Commercial	$65.71
Rate for Payer: Cash Price	$81.00
Rate for Payer: Cash Price	$81.00
Rate for Payer: Celtic Commercial/Exchange	$49.90
Rate for Payer: Health Partners Plans Commercial	$102.60
Rate for Payer: UnitedHealthcare Commercial	$104.76
Rate for Payer: WPPA Commercial	$90.72

QUANT OF DRUG LACOSAMIDE

Facility

$108.00

Service Code	HCPCS 80299
Hospital Charge Code	8029902
Hospital Revenue Code	301
Min. Negotiated Rate	$88.56
Max. Negotiated Rate	$104.76
Rate for Payer: Cash Price	$81.00
Rate for Payer: Health Partners Plans Commercial	$102.60
Rate for Payer: UnitedHealthcare Commercial	$104.76
Rate for Payer: WPPA Commercial	$88.56

QUANT OF DRUG,NES CAFFEINE

Facility

$108.00

Service Code	HCPCS 80299
Hospital Charge Code	8029910
Hospital Revenue Code	301
Min. Negotiated Rate	$49.90
Max. Negotiated Rate	$104.76
Rate for Payer: BCBS Commercial	$65.71
Rate for Payer: Cash Price	$81.00
Rate for Payer: Cash Price	$81.00
Rate for Payer: Celtic Commercial/Exchange	$49.90
Rate for Payer: Health Partners Plans Commercial	$102.60
Rate for Payer: UnitedHealthcare Commercial	$104.76
Rate for Payer: WPPA Commercial	$90.72

QUANT OF DRUG,NES CAFFEINE

Facility

$108.00

Service Code	HCPCS 80299
Hospital Charge Code	8029910
Hospital Revenue Code	301
Min. Negotiated Rate	$88.56
Max. Negotiated Rate	$104.76
Rate for Payer: Cash Price	$81.00
Rate for Payer: Health Partners Plans Commercial	$102.60
Rate for Payer: UnitedHealthcare Commercial	$104.76
Rate for Payer: WPPA Commercial	$88.56

QUANT. OF DRUG-NOS

Facility

$202.00

Service Code	HCPCS 80299
Hospital Charge Code	8029900
Hospital Revenue Code	301
Min. Negotiated Rate	$165.64
Max. Negotiated Rate	$195.94
Rate for Payer: Cash Price	$151.50
Rate for Payer: Health Partners Plans Commercial	$191.90
Rate for Payer: UnitedHealthcare Commercial	$195.94
Rate for Payer: WPPA Commercial	$165.64

QUANT. OF DRUG-NOS

Facility

$202.00

Service Code	HCPCS 80299
Hospital Charge Code	8029900
Hospital Revenue Code	301
Min. Negotiated Rate	$65.71
Max. Negotiated Rate	$195.94
Rate for Payer: BCBS Commercial	$65.71
Rate for Payer: Cash Price	$151.50
Rate for Payer: Cash Price	$151.50
Rate for Payer: Celtic Commercial/Exchange	$93.32
Rate for Payer: Health Partners Plans Commercial	$191.90
Rate for Payer: UnitedHealthcare Commercial	$195.94
Rate for Payer: WPPA Commercial	$169.68

QUANT OF DRUG QUETIAPINE

Facility

$108.00

Service Code	HCPCS 80299
Hospital Charge Code	8029903
Hospital Revenue Code	301
Min. Negotiated Rate	$88.56
Max. Negotiated Rate	$104.76
Rate for Payer: Cash Price	$81.00
Rate for Payer: Health Partners Plans Commercial	$102.60
Rate for Payer: UnitedHealthcare Commercial	$104.76
Rate for Payer: WPPA Commercial	$88.56

QUANT OF DRUG QUETIAPINE

Facility

$108.00

Service Code	HCPCS 80299
Hospital Charge Code	8029903
Hospital Revenue Code	301
Min. Negotiated Rate	$49.90
Max. Negotiated Rate	$104.76
Rate for Payer: BCBS Commercial	$65.71
Rate for Payer: Cash Price	$81.00
Rate for Payer: Cash Price	$81.00
Rate for Payer: Celtic Commercial/Exchange	$49.90
Rate for Payer: Health Partners Plans Commercial	$102.60
Rate for Payer: UnitedHealthcare Commercial	$104.76
Rate for Payer: WPPA Commercial	$90.72

QUESTASSURED 25-HYDROXYVITAMIN

Facility

$357.00

Service Code	HCPCS 82306
Hospital Charge Code	8230601
Hospital Revenue Code	301
Min. Negotiated Rate	$292.74
Max. Negotiated Rate	$346.29
Rate for Payer: Cash Price	$267.75
Rate for Payer: Health Partners Plans Commercial	$339.15
Rate for Payer: UnitedHealthcare Commercial	$346.29
Rate for Payer: WPPA Commercial	$292.74

QUESTASSURED 25-HYDROXYVITAMIN

Facility

$357.00

Service Code	HCPCS 82306
Hospital Charge Code	8230601
Hospital Revenue Code	301
Min. Negotiated Rate	$164.93
Max. Negotiated Rate	$346.29
Rate for Payer: BCBS Commercial	$218.43
Rate for Payer: Cash Price	$267.75
Rate for Payer: Cash Price	$267.75
Rate for Payer: Celtic Commercial/Exchange	$164.93
Rate for Payer: Health Partners Plans Commercial	$339.15
Rate for Payer: UnitedHealthcare Commercial	$346.29
Rate for Payer: WPPA Commercial	$299.88

QUESTRAN 4 GM PACKET (PREVALITE / CHOLESTYRAMINE)

Facility

$15.00

Service Code	NDC 00245003689
Hospital Charge Code	2506087
Hospital Revenue Code	250
Min. Negotiated Rate	$12.30
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$11.51
Rate for Payer: Health Partners Plans Commercial	$14.25
Rate for Payer: UnitedHealthcare Commercial	$14.55
Rate for Payer: WPPA Commercial	$12.30

QUESTRAN 4 GM PACKET (PREVALITE / CHOLESTYRAMINE)

Facility

$15.00

Service Code	NDC 00245003689
Hospital Charge Code	2506087
Hospital Revenue Code	250
Min. Negotiated Rate	$6.93
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$11.51
Rate for Payer: Celtic Commercial/Exchange	$6.93
Rate for Payer: Health Partners Plans Commercial	$14.25
Rate for Payer: UnitedHealthcare Commercial	$14.55
Rate for Payer: WPPA Commercial	$12.60

QUICK CRICOTHYROTOMY

Facility

$127.00

Hospital Charge Code	2702233
Hospital Revenue Code	272
Min. Negotiated Rate	$104.14
Max. Negotiated Rate	$123.19
Rate for Payer: Cash Price	$95.25
Rate for Payer: Health Partners Plans Commercial	$120.65
Rate for Payer: UnitedHealthcare Commercial	$123.19
Rate for Payer: WPPA Commercial	$104.14

QUICK CRICOTHYROTOMY

Facility

$127.00

Hospital Charge Code	2702233
Hospital Revenue Code	272
Min. Negotiated Rate	$58.67
Max. Negotiated Rate	$123.19
Rate for Payer: Cash Price	$95.25
Rate for Payer: Celtic Commercial/Exchange	$58.67
Rate for Payer: Health Partners Plans Commercial	$120.65
Rate for Payer: UnitedHealthcare Commercial	$123.19
Rate for Payer: WPPA Commercial	$106.68

QUIK CLOT

Facility

$23.00

Hospital Charge Code	2704578
Hospital Revenue Code	270
Min. Negotiated Rate	$18.86
Max. Negotiated Rate	$22.31
Rate for Payer: Cash Price	$17.44
Rate for Payer: Health Partners Plans Commercial	$21.85
Rate for Payer: UnitedHealthcare Commercial	$22.31
Rate for Payer: WPPA Commercial	$18.86

QUIK CLOT

Facility

$23.00

Hospital Charge Code	2704578
Hospital Revenue Code	270
Min. Negotiated Rate	$10.63
Max. Negotiated Rate	$22.31
Rate for Payer: Cash Price	$17.44
Rate for Payer: Celtic Commercial/Exchange	$10.63
Rate for Payer: Health Partners Plans Commercial	$21.85
Rate for Payer: UnitedHealthcare Commercial	$22.31
Rate for Payer: WPPA Commercial	$19.32

QUIK CLOT 2X2 X-RAY

Facility

$50.00

Hospital Charge Code	2730005
Hospital Revenue Code	272
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

QUIK CLOT 2X2 X-RAY

Facility

$50.00

Hospital Charge Code	2730005
Hospital Revenue Code	272
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

QUINIDINE

Facility

$103.00

Service Code	HCPCS 80194
Hospital Charge Code	8019400
Hospital Revenue Code	301
Min. Negotiated Rate	$84.46
Max. Negotiated Rate	$99.91
Rate for Payer: Cash Price	$77.25
Rate for Payer: Health Partners Plans Commercial	$97.85
Rate for Payer: UnitedHealthcare Commercial	$99.91
Rate for Payer: WPPA Commercial	$84.46

QUINIDINE

Facility

$103.00

Service Code	HCPCS 80194
Hospital Charge Code	8019400
Hospital Revenue Code	301
Min. Negotiated Rate	$47.59
Max. Negotiated Rate	$99.91
Rate for Payer: BCBS Commercial	$60.92
Rate for Payer: Cash Price	$77.25
Rate for Payer: Cash Price	$77.25
Rate for Payer: Celtic Commercial/Exchange	$47.59
Rate for Payer: Health Partners Plans Commercial	$97.85
Rate for Payer: UnitedHealthcare Commercial	$99.91
Rate for Payer: WPPA Commercial	$86.52

QUINIDINE 200 MG TAB

Facility

$2.00

Service Code	NDC 00185434601
Hospital Charge Code	2506129
Hospital Revenue Code	250
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.95
Rate for Payer: Health Partners Plans Commercial	$1.90
Rate for Payer: UnitedHealthcare Commercial	$1.94
Rate for Payer: WPPA Commercial	$1.64

Know your out-of-pocket cost for care.

All Charges