Ness County Hospital

All Charges

Charge

Type

Setting

Price

QUINIDINE 200 MG TAB

Facility

$2.00

Service Code	NDC 00185434601
Hospital Charge Code	2506129
Hospital Revenue Code	250
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.95
Rate for Payer: Celtic Commercial/Exchange	$0.92
Rate for Payer: Health Partners Plans Commercial	$1.90
Rate for Payer: UnitedHealthcare Commercial	$1.94
Rate for Payer: WPPA Commercial	$1.68

RabAvert (PF) (rabies vaccine, pcec (PF)) IM suspension for reconstitution

Facility

$1,432.00

Service Code	NDC 50632001001
Hospital Charge Code	2512762
Hospital Revenue Code	250
Min. Negotiated Rate	$661.58
Max. Negotiated Rate	$1,389.04
Rate for Payer: Cash Price	$1,074.58
Rate for Payer: Celtic Commercial/Exchange	$661.58
Rate for Payer: Health Partners Plans Commercial	$1,360.40
Rate for Payer: UnitedHealthcare Commercial	$1,389.04
Rate for Payer: WPPA Commercial	$1,202.88

RabAvert (PF) (rabies vaccine, pcec (PF)) IM suspension for reconstitution

Facility

$1,432.00

Service Code	NDC 50632001001
Hospital Charge Code	2512762
Hospital Revenue Code	250
Min. Negotiated Rate	$1,174.24
Max. Negotiated Rate	$1,389.04
Rate for Payer: Cash Price	$1,074.58
Rate for Payer: Health Partners Plans Commercial	$1,360.40
Rate for Payer: UnitedHealthcare Commercial	$1,389.04
Rate for Payer: WPPA Commercial	$1,174.24

RADIAL JAW 3

Facility

$200.00

Hospital Charge Code	2725009
Hospital Revenue Code	272
Min. Negotiated Rate	$92.40
Max. Negotiated Rate	$194.00
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

RADIAL JAW 3

Facility

$200.00

Hospital Charge Code	2725009
Hospital Revenue Code	272
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

RADIAL JAWS

Facility

$202.00

Hospital Charge Code	2706099
Hospital Revenue Code	270
Min. Negotiated Rate	$165.64
Max. Negotiated Rate	$195.94
Rate for Payer: Cash Price	$152.06
Rate for Payer: Health Partners Plans Commercial	$191.90
Rate for Payer: UnitedHealthcare Commercial	$195.94
Rate for Payer: WPPA Commercial	$165.64

RADIAL JAWS

Facility

$202.00

Hospital Charge Code	2706099
Hospital Revenue Code	270
Min. Negotiated Rate	$93.32
Max. Negotiated Rate	$195.94
Rate for Payer: Cash Price	$152.06
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

RADIOTHERAPY

Facility

$12,833.94

Service Code	MSDRG 849
Min. Negotiated Rate	$12,833.94
Max. Negotiated Rate	$12,833.94
Rate for Payer: BCBS Commercial	$12,833.94

RAPAMYCIN (SIROLIMUS)

Facility

$75.00

Service Code	HCPCS 80195
Hospital Charge Code	8019500
Hospital Revenue Code	301
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

RAPAMYCIN (SIROLIMUS)

Facility

$75.00

Service Code	HCPCS 80195
Hospital Charge Code	8019500
Hospital Revenue Code	301
Min. Negotiated Rate	$18.18
Max. Negotiated Rate	$72.75
Rate for Payer: BCBS Commercial	$18.18
Rate for Payer: Cash Price	$56.25
Rate for Payer: Cash Price	$56.25
Rate for Payer: Celtic Commercial/Exchange	$34.65
Rate for Payer: Health Partners Plans Commercial	$71.25
Rate for Payer: UnitedHealthcare Commercial	$72.75
Rate for Payer: WPPA Commercial	$63.00

RBC, LEUKOCYTES REDUCED, EA UN

Facility

$633.00

Service Code	HCPCS P9016
Hospital Charge Code	P901600
Hospital Revenue Code	390
Min. Negotiated Rate	$519.06
Max. Negotiated Rate	$614.01
Rate for Payer: Cash Price	$474.75
Rate for Payer: Health Partners Plans Commercial	$601.35
Rate for Payer: UnitedHealthcare Commercial	$614.01
Rate for Payer: WPPA Commercial	$519.06

RBC, LEUKOCYTES REDUCED, EA UN

Facility

$633.00

Service Code	HCPCS P9016
Hospital Charge Code	P901600
Hospital Revenue Code	390
Min. Negotiated Rate	$292.45
Max. Negotiated Rate	$614.01
Rate for Payer: BCBS Commercial	$534.34
Rate for Payer: Cash Price	$474.75
Rate for Payer: Cash Price	$474.75
Rate for Payer: Celtic Commercial/Exchange	$292.45
Rate for Payer: Health Partners Plans Commercial	$601.35
Rate for Payer: UnitedHealthcare Commercial	$614.01
Rate for Payer: WPPA Commercial	$531.72

RBC LEUKOREDUCED IRRADIATED

Facility

$572.00

Service Code	HCPCS P9040
Hospital Charge Code	P904000
Hospital Revenue Code	390
Min. Negotiated Rate	$264.26
Max. Negotiated Rate	$554.84
Rate for Payer: BCBS Commercial	$386.28
Rate for Payer: Cash Price	$429.00
Rate for Payer: Cash Price	$429.00
Rate for Payer: Celtic Commercial/Exchange	$264.26
Rate for Payer: Health Partners Plans Commercial	$543.40
Rate for Payer: UnitedHealthcare Commercial	$554.84
Rate for Payer: WPPA Commercial	$480.48

RBC LEUKOREDUCED IRRADIATED

Facility

$572.00

Service Code	HCPCS P9040
Hospital Charge Code	P904000
Hospital Revenue Code	390
Min. Negotiated Rate	$469.04
Max. Negotiated Rate	$554.84
Rate for Payer: Cash Price	$429.00
Rate for Payer: Health Partners Plans Commercial	$543.40
Rate for Payer: UnitedHealthcare Commercial	$554.84
Rate for Payer: WPPA Commercial	$469.04

RECEPTOR ASSAY ENDOCRINE,OTHR

Facility

$125.00

Service Code	HCPCS 84235
Hospital Charge Code	8423500
Hospital Revenue Code	301
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

RECEPTOR ASSAY ENDOCRINE,OTHR

Facility

$125.00

Service Code	HCPCS 84235
Hospital Charge Code	8423500
Hospital Revenue Code	301
Min. Negotiated Rate	$57.75
Max. Negotiated Rate	$121.25
Rate for Payer: BCBS Commercial	$120.25
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

RECLAST 5 MG/100 ML IV (ZOLEDRONIC ACID)

Facility

$3,901.00

Service Code	NDC 00078043561
Hospital Charge Code	2516789
Hospital Revenue Code	250
Min. Negotiated Rate	$3,198.82
Max. Negotiated Rate	$3,783.97
Rate for Payer: Cash Price	$2,926.42
Rate for Payer: Health Partners Plans Commercial	$3,705.95
Rate for Payer: UnitedHealthcare Commercial	$3,783.97
Rate for Payer: WPPA Commercial	$3,198.82

RECLAST 5 MG/100 ML IV (ZOLEDRONIC ACID)

Facility

$3,901.00

Service Code	NDC 00078043561
Hospital Charge Code	2516789
Hospital Revenue Code	250
Min. Negotiated Rate	$1,802.26
Max. Negotiated Rate	$3,783.97
Rate for Payer: Cash Price	$2,926.42
Rate for Payer: Celtic Commercial/Exchange	$1,802.26
Rate for Payer: Health Partners Plans Commercial	$3,705.95
Rate for Payer: UnitedHealthcare Commercial	$3,783.97
Rate for Payer: WPPA Commercial	$3,276.84

RECOVERY PHASE 2-1ST 15 MIN.

Facility

$60.00

Hospital Charge Code	7100048
Hospital Revenue Code	710
Min. Negotiated Rate	$49.20
Max. Negotiated Rate	$58.20
Rate for Payer: Cash Price	$45.00
Rate for Payer: Health Partners Plans Commercial	$57.00
Rate for Payer: UnitedHealthcare Commercial	$58.20
Rate for Payer: WPPA Commercial	$49.20

RECOVERY PHASE 2-1ST 15 MIN.

Facility

$60.00

Hospital Charge Code	7100048
Hospital Revenue Code	710
Min. Negotiated Rate	$27.72
Max. Negotiated Rate	$58.20
Rate for Payer: Cash Price	$45.00
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

RECOVERY RM EA ADDTL 15 MIN.

Facility

$71.00

Hospital Charge Code	7100019
Hospital Revenue Code	710
Min. Negotiated Rate	$32.80
Max. Negotiated Rate	$68.87
Rate for Payer: Cash Price	$53.25
Rate for Payer: Celtic Commercial/Exchange	$32.80
Rate for Payer: Health Partners Plans Commercial	$67.45
Rate for Payer: UnitedHealthcare Commercial	$68.87
Rate for Payer: WPPA Commercial	$59.64

RECOVERY RM EA ADDTL 15 MIN.

Facility

$71.00

Hospital Charge Code	7100019
Hospital Revenue Code	710
Min. Negotiated Rate	$58.22
Max. Negotiated Rate	$68.87
Rate for Payer: Cash Price	$53.25
Rate for Payer: Health Partners Plans Commercial	$67.45
Rate for Payer: UnitedHealthcare Commercial	$68.87
Rate for Payer: WPPA Commercial	$58.22

RECOVERY ROOM 1ST 15-MIN.

Facility

$168.00

Hospital Charge Code	7100001
Hospital Revenue Code	710
Min. Negotiated Rate	$137.76
Max. Negotiated Rate	$162.96
Rate for Payer: Cash Price	$126.00
Rate for Payer: Health Partners Plans Commercial	$159.60
Rate for Payer: UnitedHealthcare Commercial	$162.96
Rate for Payer: WPPA Commercial	$137.76

RECOVERY ROOM 1ST 15-MIN.

Facility

$168.00

Hospital Charge Code	7100001
Hospital Revenue Code	710
Min. Negotiated Rate	$77.62
Max. Negotiated Rate	$162.96
Rate for Payer: Cash Price	$126.00
Rate for Payer: Celtic Commercial/Exchange	$77.62
Rate for Payer: Health Partners Plans Commercial	$159.60
Rate for Payer: UnitedHealthcare Commercial	$162.96
Rate for Payer: WPPA Commercial	$141.12

RECOV PHASE 2 EA ADDTL 15 MIN

Facility

$30.00

Hospital Charge Code	7100052
Hospital Revenue Code	710
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

Know your out-of-pocket cost for care.

All Charges