Ness County Hospital

All Charges

Charge

Type

Setting

Price

RECOV PHASE 2 EA ADDTL 15 MIN

Facility

$30.00

Hospital Charge Code	7100052
Hospital Revenue Code	710
Min. Negotiated Rate	$24.60
Max. Negotiated Rate	$29.10
Rate for Payer: Cash Price	$22.50
Rate for Payer: Health Partners Plans Commercial	$28.50
Rate for Payer: UnitedHealthcare Commercial	$29.10
Rate for Payer: WPPA Commercial	$24.60

RECTAL RESECTION WITH CC

Facility

$18,474.63

Service Code	MSDRG 333
Min. Negotiated Rate	$18,474.63
Max. Negotiated Rate	$18,474.63
Rate for Payer: BCBS Commercial	$18,474.63

RECTAL RESECTION WITH MCC

Facility

$36,348.88

Service Code	MSDRG 332
Min. Negotiated Rate	$36,348.88
Max. Negotiated Rate	$36,348.88
Rate for Payer: BCBS Commercial	$36,348.88

RECTAL RESECTION WITHOUT CC/MCC

Facility

$13,939.75

Service Code	MSDRG 334
Min. Negotiated Rate	$13,939.75
Max. Negotiated Rate	$13,939.75
Rate for Payer: BCBS Commercial	$13,939.75

RED BLOOD CELL DISORDERS WITH MCC

Facility

$12,241.97

Service Code	MSDRG 811
Min. Negotiated Rate	$12,241.97
Max. Negotiated Rate	$12,241.97
Rate for Payer: BCBS Commercial	$12,241.97

RED BLOOD CELL DISORDERS WITHOUT MCC

Facility

$7,892.98

Service Code	MSDRG 812
Min. Negotiated Rate	$7,892.98
Max. Negotiated Rate	$7,892.98
Rate for Payer: BCBS Commercial	$7,892.98

RED BLOOD CELLS, IRRADIATED

Facility

$450.00

Service Code	HCPCS 86945
Hospital Charge Code	P903800
Hospital Revenue Code	390
Min. Negotiated Rate	$207.90
Max. Negotiated Rate	$436.50
Rate for Payer: Cash Price	$337.50
Rate for Payer: Celtic Commercial/Exchange	$207.90
Rate for Payer: Health Partners Plans Commercial	$427.50
Rate for Payer: UnitedHealthcare Commercial	$436.50
Rate for Payer: WPPA Commercial	$378.00

RED BLOOD CELLS, IRRADIATED

Facility

$450.00

Service Code	HCPCS 86945
Hospital Charge Code	P903800
Hospital Revenue Code	390
Min. Negotiated Rate	$369.00
Max. Negotiated Rate	$436.50
Rate for Payer: Cash Price	$337.50
Rate for Payer: Health Partners Plans Commercial	$427.50
Rate for Payer: UnitedHealthcare Commercial	$436.50
Rate for Payer: WPPA Commercial	$369.00

RED DOT ELECTRODE

Facility

$10.00

Hospital Charge Code	2700790
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

RED DOT ELECTRODE

Facility

$10.00

Hospital Charge Code	2700790
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

REGLAN 10 MG/2 ML INJ. (METOCLOPRAMIDE)

Facility

$17.00

Service Code	NDC 00703450294
Hospital Charge Code	2506160
Hospital Revenue Code	250
Min. Negotiated Rate	$13.94
Max. Negotiated Rate	$16.49
Rate for Payer: Cash Price	$12.75
Rate for Payer: Health Partners Plans Commercial	$16.15
Rate for Payer: UnitedHealthcare Commercial	$16.49
Rate for Payer: WPPA Commercial	$13.94

REGLAN 10 MG/2 ML INJ. (METOCLOPRAMIDE)

Facility

$17.00

Service Code	NDC 00703450294
Hospital Charge Code	2506160
Hospital Revenue Code	250
Min. Negotiated Rate	$7.85
Max. Negotiated Rate	$16.49
Rate for Payer: Cash Price	$12.75
Rate for Payer: Celtic Commercial/Exchange	$7.85
Rate for Payer: Health Partners Plans Commercial	$16.15
Rate for Payer: UnitedHealthcare Commercial	$16.49
Rate for Payer: WPPA Commercial	$14.28

REGLAN 10 MG TAB (METOCLOPRAMIDE)

Facility

$2.00

Service Code	NDC 60687063111
Hospital Charge Code	2506178
Hospital Revenue Code	250
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.65
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

REGLAN 10 MG TAB (METOCLOPRAMIDE)

Facility

$2.00

Service Code	NDC 60687063111
Hospital Charge Code	2506178
Hospital Revenue Code	250
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.65
Rate for Payer: Health Partners Plans Commercial	$1.90
Rate for Payer: UnitedHealthcare Commercial	$1.94
Rate for Payer: WPPA Commercial	$1.64

Regular Insulin 100 U/ml - 10 ml vial

Facility

$495.00

Service Code	NDC 00169183311
Hospital Charge Code	2512812
Hospital Revenue Code	250
Min. Negotiated Rate	$228.69
Max. Negotiated Rate	$480.15
Rate for Payer: Cash Price	$371.78
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

Regular Insulin 100 U/ml - 10 ml vial

Facility

$495.00

Service Code	NDC 00169183311
Hospital Charge Code	2512812
Hospital Revenue Code	250
Min. Negotiated Rate	$405.90
Max. Negotiated Rate	$480.15
Rate for Payer: Cash Price	$371.78
Rate for Payer: Health Partners Plans Commercial	$470.25
Rate for Payer: UnitedHealthcare Commercial	$480.15
Rate for Payer: WPPA Commercial	$405.90

REHABILITATION WITH CC/MCC

Facility

$16,763.57

Service Code	MSDRG 945
Min. Negotiated Rate	$16,763.57
Max. Negotiated Rate	$16,763.57
Rate for Payer: BCBS Commercial	$16,763.57

REHABILITATION WITHOUT CC/MCC

Facility

$11,165.06

Service Code	MSDRG 946
Min. Negotiated Rate	$11,165.06
Max. Negotiated Rate	$11,165.06
Rate for Payer: BCBS Commercial	$11,165.06

REIMPLANTATION OR STAB-TOOTH

Facility

$108.00

Service Code	HCPCS D7270
Hospital Charge Code	D727000
Hospital Revenue Code	450
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

REIMPLANTATION OR STAB-TOOTH

Facility

$108.00

Service Code	HCPCS D7270
Hospital Charge Code	D727000
Hospital Revenue Code	450
Min. Negotiated Rate	$49.90
Max. Negotiated Rate	$104.76
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

Remdesivir 100 mg vial

Facility

$1,872.00

Service Code	NDC 61958290101
Hospital Charge Code	2519759
Hospital Revenue Code	250
Min. Negotiated Rate	$864.86
Max. Negotiated Rate	$1,815.84
Rate for Payer: Cash Price	$1,404.00
Rate for Payer: Celtic Commercial/Exchange	$864.86
Rate for Payer: Health Partners Plans Commercial	$1,778.40
Rate for Payer: UnitedHealthcare Commercial	$1,815.84
Rate for Payer: WPPA Commercial	$1,572.48

Remdesivir 100 mg vial

Facility

$1,872.00

Service Code	NDC 61958290101
Hospital Charge Code	2519759
Hospital Revenue Code	250
Min. Negotiated Rate	$1,535.04
Max. Negotiated Rate	$1,815.84
Rate for Payer: Cash Price	$1,404.00
Rate for Payer: Health Partners Plans Commercial	$1,778.40
Rate for Payer: UnitedHealthcare Commercial	$1,815.84
Rate for Payer: WPPA Commercial	$1,535.04

REM DEVITLZ TIS SECLT <=20SQCM

Facility

$297.00

Service Code	HCPCS 97597
Hospital Charge Code	9760100
Hospital Revenue Code	450
Min. Negotiated Rate	$137.21
Max. Negotiated Rate	$288.09
Rate for Payer: BCBS Commercial	$278.76
Rate for Payer: Cash Price	$222.75
Rate for Payer: Cash Price	$222.75
Rate for Payer: Celtic Commercial/Exchange	$137.21
Rate for Payer: Health Partners Plans Commercial	$282.15
Rate for Payer: UnitedHealthcare Commercial	$288.09
Rate for Payer: WPPA Commercial	$249.48

REM DEVITLZ TIS SECLT <=20SQCM

Facility

$297.00

Service Code	HCPCS 97597
Hospital Charge Code	9760100
Hospital Revenue Code	450
Min. Negotiated Rate	$243.54
Max. Negotiated Rate	$288.09
Rate for Payer: Cash Price	$222.75
Rate for Payer: Health Partners Plans Commercial	$282.15
Rate for Payer: UnitedHealthcare Commercial	$288.09
Rate for Payer: WPPA Commercial	$243.54

REMERON 15 MG TAB (MIRTAZAPINE)

Facility

$8.00

Service Code	NDC 68084011911
Hospital Charge Code	2515088
Hospital Revenue Code	250
Min. Negotiated Rate	$3.70
Max. Negotiated Rate	$7.76
Rate for Payer: Cash Price	$6.15
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

Know your out-of-pocket cost for care.

All Charges