Ness County Hospital

All Charges

Charge

Type

Setting

Price

RIBS LT W CHEST

Facility

$349.00

Service Code	HCPCS 71101 LT
Hospital Charge Code	7111103
Hospital Revenue Code	320
Min. Negotiated Rate	$161.24
Max. Negotiated Rate	$338.53
Rate for Payer: BCBS Commercial	$199.78
Rate for Payer: Cash Price	$261.75
Rate for Payer: Cash Price	$261.75
Rate for Payer: Celtic Commercial/Exchange	$161.24
Rate for Payer: Health Partners Plans Commercial	$331.55
Rate for Payer: UnitedHealthcare Commercial	$338.53
Rate for Payer: WPPA Commercial	$293.16

RIBS RT 2V

Facility

$196.00

Service Code	HCPCS 71100 RT
Hospital Charge Code	7111104
Hospital Revenue Code	320
Min. Negotiated Rate	$90.55
Max. Negotiated Rate	$190.12
Rate for Payer: BCBS Commercial	$133.80
Rate for Payer: Cash Price	$147.68
Rate for Payer: Cash Price	$147.68
Rate for Payer: Celtic Commercial/Exchange	$90.55
Rate for Payer: Health Partners Plans Commercial	$186.20
Rate for Payer: UnitedHealthcare Commercial	$190.12
Rate for Payer: WPPA Commercial	$164.64

RIBS RT 2V

Facility

$196.00

Service Code	HCPCS 71100 RT
Hospital Charge Code	7111104
Hospital Revenue Code	320
Min. Negotiated Rate	$160.72
Max. Negotiated Rate	$190.12
Rate for Payer: Cash Price	$147.68
Rate for Payer: Health Partners Plans Commercial	$186.20
Rate for Payer: UnitedHealthcare Commercial	$190.12
Rate for Payer: WPPA Commercial	$160.72

RIBS RT W CHEST

Facility

$349.00

Service Code	HCPCS 71101 RT
Hospital Charge Code	7111102
Hospital Revenue Code	320
Min. Negotiated Rate	$286.18
Max. Negotiated Rate	$338.53
Rate for Payer: Cash Price	$261.75
Rate for Payer: Health Partners Plans Commercial	$331.55
Rate for Payer: UnitedHealthcare Commercial	$338.53
Rate for Payer: WPPA Commercial	$286.18

RIBS RT W CHEST

Facility

$349.00

Service Code	HCPCS 71101 RT
Hospital Charge Code	7111102
Hospital Revenue Code	320
Min. Negotiated Rate	$161.24
Max. Negotiated Rate	$338.53
Rate for Payer: BCBS Commercial	$199.78
Rate for Payer: Cash Price	$261.75
Rate for Payer: Cash Price	$261.75
Rate for Payer: Celtic Commercial/Exchange	$161.24
Rate for Payer: Health Partners Plans Commercial	$331.55
Rate for Payer: UnitedHealthcare Commercial	$338.53
Rate for Payer: WPPA Commercial	$293.16

RICELYTE /PEDIALYTE / ORALYTE 33.8 OZ.

Facility

$19.00

Service Code	NDC 10006073130
Hospital Charge Code	2511392
Hospital Revenue Code	250
Min. Negotiated Rate	$8.78
Max. Negotiated Rate	$18.43
Rate for Payer: Cash Price	$14.81
Rate for Payer: Celtic Commercial/Exchange	$8.78
Rate for Payer: Health Partners Plans Commercial	$18.05
Rate for Payer: UnitedHealthcare Commercial	$18.43
Rate for Payer: WPPA Commercial	$15.96

RICELYTE /PEDIALYTE / ORALYTE 33.8 OZ.

Facility

$19.00

Service Code	NDC 10006073130
Hospital Charge Code	2511392
Hospital Revenue Code	250
Min. Negotiated Rate	$15.58
Max. Negotiated Rate	$18.43
Rate for Payer: Cash Price	$14.81
Rate for Payer: Health Partners Plans Commercial	$18.05
Rate for Payer: UnitedHealthcare Commercial	$18.43
Rate for Payer: WPPA Commercial	$15.58

Rifampin 150 mg cap

Facility

$9.00

Service Code	NDC 60687057521
Hospital Charge Code	2514180
Hospital Revenue Code	250
Min. Negotiated Rate	$7.38
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$7.28
Rate for Payer: Health Partners Plans Commercial	$8.55
Rate for Payer: UnitedHealthcare Commercial	$8.73
Rate for Payer: WPPA Commercial	$7.38

Rifampin 150 mg cap

Facility

$9.00

Service Code	NDC 60687057521
Hospital Charge Code	2514180
Hospital Revenue Code	250
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$7.28
Rate for Payer: Celtic Commercial/Exchange	$4.16
Rate for Payer: Health Partners Plans Commercial	$8.55
Rate for Payer: UnitedHealthcare Commercial	$8.73
Rate for Payer: WPPA Commercial	$7.56

RISPERDAL 0.25 MG TAB (RISPERIDONE)

Facility

$12.00

Service Code	NDC 68084027011
Hospital Charge Code	2513547
Hospital Revenue Code	250
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$11.64
Rate for Payer: Cash Price	$9.15
Rate for Payer: Celtic Commercial/Exchange	$5.54
Rate for Payer: Health Partners Plans Commercial	$11.40
Rate for Payer: UnitedHealthcare Commercial	$11.64
Rate for Payer: WPPA Commercial	$10.08

RISPERDAL 0.25 MG TAB (RISPERIDONE)

Facility

$12.00

Service Code	NDC 68084027011
Hospital Charge Code	2513547
Hospital Revenue Code	250
Min. Negotiated Rate	$9.84
Max. Negotiated Rate	$11.64
Rate for Payer: Cash Price	$9.15
Rate for Payer: Health Partners Plans Commercial	$11.40
Rate for Payer: UnitedHealthcare Commercial	$11.64
Rate for Payer: WPPA Commercial	$9.84

RN SUPPORT PP 1/4 HR

Facility

$15.00

Service Code	HCPCS G0299
Hospital Charge Code	5710005
Hospital Revenue Code	550
Min. Negotiated Rate	$12.30
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$11.25
Rate for Payer: Health Partners Plans Commercial	$14.25
Rate for Payer: UnitedHealthcare Commercial	$14.55
Rate for Payer: WPPA Commercial	$12.30

RN SUPPORT PP 1/4 HR

Facility

$15.00

Service Code	HCPCS G0299
Hospital Charge Code	5710005
Hospital Revenue Code	550
Min. Negotiated Rate	$6.93
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$11.25
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

ROBINUL 0.2 MG/1 ML INJ. (GLYCOPYRROLATE)

Facility

$54.00

Service Code	NDC 16729047108
Hospital Charge Code	2504256
Hospital Revenue Code	250
Min. Negotiated Rate	$24.95
Max. Negotiated Rate	$52.38
Rate for Payer: Cash Price	$40.50
Rate for Payer: Celtic Commercial/Exchange	$24.95
Rate for Payer: Health Partners Plans Commercial	$51.30
Rate for Payer: UnitedHealthcare Commercial	$52.38
Rate for Payer: WPPA Commercial	$45.36

ROBINUL 0.2 MG/1 ML INJ. (GLYCOPYRROLATE)

Facility

$54.00

Service Code	NDC 16729047108
Hospital Charge Code	2504256
Hospital Revenue Code	250
Min. Negotiated Rate	$44.28
Max. Negotiated Rate	$52.38
Rate for Payer: Cash Price	$40.50
Rate for Payer: Health Partners Plans Commercial	$51.30
Rate for Payer: UnitedHealthcare Commercial	$52.38
Rate for Payer: WPPA Commercial	$44.28

ROBITUSSIN AC 10/100 MG/5 ML (CODEINE + GUAIFENESIN)

Facility

$2.00

Service Code	NDC 00121177500
Hospital Charge Code	2508398
Hospital Revenue Code	250
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.61
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

ROBITUSSIN AC 10/100 MG/5 ML (CODEINE + GUAIFENESIN)

Facility

$2.00

Service Code	NDC 00121177500
Hospital Charge Code	2508398
Hospital Revenue Code	250
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.61
Rate for Payer: Health Partners Plans Commercial	$1.90
Rate for Payer: UnitedHealthcare Commercial	$1.94
Rate for Payer: WPPA Commercial	$1.64

ROBITUSSIN DM 10/100 MG/10 ML SUGAR FREE SYRUP (GUAIFENESIN + DEXROMETHORPHANE)

Facility

$2.00

Service Code	NDC 00904675920
Hospital Charge Code	2511681
Hospital Revenue Code	250
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$2.21
Rate for Payer: Health Partners Plans Commercial	$1.90
Rate for Payer: UnitedHealthcare Commercial	$1.94
Rate for Payer: WPPA Commercial	$1.64

ROBITUSSIN DM 10/100 MG/10 ML SUGAR FREE SYRUP (GUAIFENESIN + DEXROMETHORPHANE)

Facility

$2.00

Service Code	NDC 00904675920
Hospital Charge Code	2511681
Hospital Revenue Code	250
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$2.21
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

ROBITUSSIN DM 5 ML U.D. (DEXTROMETHORPHAN-GUAIFENESIN)

Facility

$7.00

Service Code	NDC 69339014919
Hospital Charge Code	2508422
Hospital Revenue Code	250
Min. Negotiated Rate	$3.23
Max. Negotiated Rate	$6.79
Rate for Payer: Cash Price	$5.62
Rate for Payer: Celtic Commercial/Exchange	$3.23
Rate for Payer: Health Partners Plans Commercial	$6.65
Rate for Payer: UnitedHealthcare Commercial	$6.79
Rate for Payer: WPPA Commercial	$5.88

ROBITUSSIN DM 5 ML U.D. (DEXTROMETHORPHAN-GUAIFENESIN)

Facility

$7.00

Service Code	NDC 69339014919
Hospital Charge Code	2508422
Hospital Revenue Code	250
Min. Negotiated Rate	$5.74
Max. Negotiated Rate	$6.79
Rate for Payer: Cash Price	$5.62
Rate for Payer: Health Partners Plans Commercial	$6.65
Rate for Payer: UnitedHealthcare Commercial	$6.79
Rate for Payer: WPPA Commercial	$5.74

ROBITUSSIN SYRUP 200 MG/10 ML U.D. (GUAIFENESIN)

Facility

$4.00

Service Code	NDC 00121148800
Hospital Charge Code	2508406
Hospital Revenue Code	250
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$3.28
Rate for Payer: Celtic Commercial/Exchange	$1.85
Rate for Payer: Health Partners Plans Commercial	$3.80
Rate for Payer: UnitedHealthcare Commercial	$3.88
Rate for Payer: WPPA Commercial	$3.36

ROBITUSSIN SYRUP 200 MG/10 ML U.D. (GUAIFENESIN)

Facility

$4.00

Service Code	NDC 00121148800
Hospital Charge Code	2508406
Hospital Revenue Code	250
Min. Negotiated Rate	$3.28
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$3.28
Rate for Payer: Health Partners Plans Commercial	$3.80
Rate for Payer: UnitedHealthcare Commercial	$3.88
Rate for Payer: WPPA Commercial	$3.28

Rocephin 1 GM ADV (ceftriaxone)

Facility

$138.00

Service Code	NDC 00409733304
Hospital Charge Code	2517795
Hospital Revenue Code	250
Min. Negotiated Rate	$113.16
Max. Negotiated Rate	$133.86
Rate for Payer: Cash Price	$103.50
Rate for Payer: Health Partners Plans Commercial	$131.10
Rate for Payer: UnitedHealthcare Commercial	$133.86
Rate for Payer: WPPA Commercial	$113.16

Rocephin 1 GM ADV (ceftriaxone)

Facility

$138.00

Service Code	NDC 00409733304
Hospital Charge Code	2517795
Hospital Revenue Code	250
Min. Negotiated Rate	$63.76
Max. Negotiated Rate	$133.86
Rate for Payer: Cash Price	$103.50
Rate for Payer: Celtic Commercial/Exchange	$63.76
Rate for Payer: Health Partners Plans Commercial	$131.10
Rate for Payer: UnitedHealthcare Commercial	$133.86
Rate for Payer: WPPA Commercial	$115.92

Know your out-of-pocket cost for care.

All Charges