Ness County Hospital

All Charges

Charge

Type

Setting

Price

Rocephin 1 gm duplex bag(ceftriaxone)

Facility

$65.00

Service Code	NDC 00264315311
Hospital Charge Code	2519536
Hospital Revenue Code	250
Min. Negotiated Rate	$53.30
Max. Negotiated Rate	$63.05
Rate for Payer: Cash Price	$49.24
Rate for Payer: Health Partners Plans Commercial	$61.75
Rate for Payer: UnitedHealthcare Commercial	$63.05
Rate for Payer: WPPA Commercial	$53.30

Rocephin 1 gm duplex bag(ceftriaxone)

Facility

$65.00

Service Code	NDC 00264315311
Hospital Charge Code	2519536
Hospital Revenue Code	250
Min. Negotiated Rate	$30.03
Max. Negotiated Rate	$63.05
Rate for Payer: Cash Price	$49.24
Rate for Payer: Celtic Commercial/Exchange	$30.03
Rate for Payer: Health Partners Plans Commercial	$61.75
Rate for Payer: UnitedHealthcare Commercial	$63.05
Rate for Payer: WPPA Commercial	$54.60

ROCEPHIN 1GM INJ ADV

Facility

$158.00

Hospital Charge Code	2510261
Hospital Revenue Code	250
Min. Negotiated Rate	$73.00
Max. Negotiated Rate	$153.26
Rate for Payer: Cash Price	$118.72
Rate for Payer: Celtic Commercial/Exchange	$73.00
Rate for Payer: Health Partners Plans Commercial	$150.10
Rate for Payer: UnitedHealthcare Commercial	$153.26
Rate for Payer: WPPA Commercial	$132.72

ROCEPHIN 1GM INJ ADV

Facility

$158.00

Hospital Charge Code	2510261
Hospital Revenue Code	250
Min. Negotiated Rate	$129.56
Max. Negotiated Rate	$153.26
Rate for Payer: Cash Price	$118.72
Rate for Payer: Health Partners Plans Commercial	$150.10
Rate for Payer: UnitedHealthcare Commercial	$153.26
Rate for Payer: WPPA Commercial	$129.56

Rocephin 1 GM inj. (ceftriaxone)

Facility

$138.00

Service Code	NDC 00409733221
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 inj. (ceftriaxone)

Facility

$138.00

Service Code	NDC 00409733221
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

ROCEPHIN 250 MG INJ (CEFTRIAXONE)

Facility

$49.00

Service Code	NDC 00409733701
Hospital Charge Code	2515567
Hospital Revenue Code	250
Min. Negotiated Rate	$22.64
Max. Negotiated Rate	$47.53
Rate for Payer: Cash Price	$37.09
Rate for Payer: Celtic Commercial/Exchange	$22.64
Rate for Payer: Health Partners Plans Commercial	$46.55
Rate for Payer: UnitedHealthcare Commercial	$47.53
Rate for Payer: WPPA Commercial	$41.16

ROCEPHIN 250 MG INJ (CEFTRIAXONE)

Facility

$49.00

Service Code	NDC 00409733701
Hospital Charge Code	2515567
Hospital Revenue Code	250
Min. Negotiated Rate	$40.18
Max. Negotiated Rate	$47.53
Rate for Payer: Cash Price	$37.09
Rate for Payer: Health Partners Plans Commercial	$46.55
Rate for Payer: UnitedHealthcare Commercial	$47.53
Rate for Payer: WPPA Commercial	$40.18

Rocephin 2 gm Duplex (ceftriaxone)

Facility

$99.00

Service Code	NDC 00264315511
Hospital Charge Code	2519742
Hospital Revenue Code	250
Min. Negotiated Rate	$45.74
Max. Negotiated Rate	$96.03
Rate for Payer: Cash Price	$74.25
Rate for Payer: Celtic Commercial/Exchange	$45.74
Rate for Payer: Health Partners Plans Commercial	$94.05
Rate for Payer: UnitedHealthcare Commercial	$96.03
Rate for Payer: WPPA Commercial	$83.16

Rocephin 2 gm Duplex (ceftriaxone)

Facility

$99.00

Service Code	NDC 00264315511
Hospital Charge Code	2519742
Hospital Revenue Code	250
Min. Negotiated Rate	$81.18
Max. Negotiated Rate	$96.03
Rate for Payer: Cash Price	$74.25
Rate for Payer: Health Partners Plans Commercial	$94.05
Rate for Payer: UnitedHealthcare Commercial	$96.03
Rate for Payer: WPPA Commercial	$81.18

ROCEPHIN 2 GM INJ ADV

Facility

$312.00

Hospital Charge Code	2514792
Hospital Revenue Code	250
Min. Negotiated Rate	$255.84
Max. Negotiated Rate	$302.64
Rate for Payer: Cash Price	$234.45
Rate for Payer: Health Partners Plans Commercial	$296.40
Rate for Payer: UnitedHealthcare Commercial	$302.64
Rate for Payer: WPPA Commercial	$255.84

ROCEPHIN 2 GM INJ ADV

Facility

$312.00

Hospital Charge Code	2514792
Hospital Revenue Code	250
Min. Negotiated Rate	$144.14
Max. Negotiated Rate	$302.64
Rate for Payer: Cash Price	$234.45
Rate for Payer: Celtic Commercial/Exchange	$144.14
Rate for Payer: Health Partners Plans Commercial	$296.40
Rate for Payer: UnitedHealthcare Commercial	$302.64
Rate for Payer: WPPA Commercial	$262.08

ROCEPHIN 500 MG INJ. (CEFTRIAXONE)

Facility

$89.00

Service Code	NDC 00409733820
Hospital Charge Code	2512978
Hospital Revenue Code	250
Min. Negotiated Rate	$41.12
Max. Negotiated Rate	$86.33
Rate for Payer: Cash Price	$67.20
Rate for Payer: Celtic Commercial/Exchange	$41.12
Rate for Payer: Health Partners Plans Commercial	$84.55
Rate for Payer: UnitedHealthcare Commercial	$86.33
Rate for Payer: WPPA Commercial	$74.76

ROCEPHIN 500 MG INJ. (CEFTRIAXONE)

Facility

$89.00

Service Code	NDC 00409733820
Hospital Charge Code	2512978
Hospital Revenue Code	250
Min. Negotiated Rate	$72.98
Max. Negotiated Rate	$86.33
Rate for Payer: Cash Price	$67.20
Rate for Payer: Health Partners Plans Commercial	$84.55
Rate for Payer: UnitedHealthcare Commercial	$86.33
Rate for Payer: WPPA Commercial	$72.98

ROMA (TM)

Facility

$450.00

Service Code	HCPCS 86305
Hospital Charge Code	8630500
Hospital Revenue Code	302
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

ROMA (TM)

Facility

$450.00

Service Code	HCPCS 86305
Hospital Charge Code	8630500
Hospital Revenue Code	302
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

ROMAZICON 0.5 MG/5 ML INJ (FLUMAZENIL)

Facility

$279.00

Service Code	NDC 00143968410
Hospital Charge Code	2511855
Hospital Revenue Code	250
Min. Negotiated Rate	$228.78
Max. Negotiated Rate	$270.63
Rate for Payer: Cash Price	$209.92
Rate for Payer: Health Partners Plans Commercial	$265.05
Rate for Payer: UnitedHealthcare Commercial	$270.63
Rate for Payer: WPPA Commercial	$228.78

ROMAZICON 0.5 MG/5 ML INJ (FLUMAZENIL)

Facility

$279.00

Service Code	NDC 00143968410
Hospital Charge Code	2511855
Hospital Revenue Code	250
Min. Negotiated Rate	$128.90
Max. Negotiated Rate	$270.63
Rate for Payer: Cash Price	$209.92
Rate for Payer: Celtic Commercial/Exchange	$128.90
Rate for Payer: Health Partners Plans Commercial	$265.05
Rate for Payer: UnitedHealthcare Commercial	$270.63
Rate for Payer: WPPA Commercial	$234.36

ROM MEAS.,EA EXTREM/TRUNK

Facility

$54.00

Service Code	HCPCS 95851 GP
Hospital Charge Code	4201665
Hospital Revenue Code	420
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

ROM MEAS.,EA EXTREM/TRUNK

Facility

$54.00

Service Code	HCPCS 95851 GP
Hospital Charge Code	4201665
Hospital Revenue Code	420
Min. Negotiated Rate	$23.83
Max. Negotiated Rate	$52.38
Rate for Payer: BCBS Commercial	$23.83
Rate for Payer: Cash Price	$40.50
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

ROM MEASUREMENT, HAND

Facility

$54.00

Service Code	HCPCS 95852 GP
Hospital Charge Code	4201720
Hospital Revenue Code	420
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

ROM MEASUREMENT, HAND

Facility

$54.00

Service Code	HCPCS 95852 GP
Hospital Charge Code	4201720
Hospital Revenue Code	420
Min. Negotiated Rate	$16.01
Max. Negotiated Rate	$52.38
Rate for Payer: BCBS Commercial	$16.01
Rate for Payer: Cash Price	$40.50
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

ROOM & BOARD SEMI-PRIVATE

Facility

$1,570.00

Hospital Charge Code	1100007
Hospital Revenue Code	110
Min. Negotiated Rate	$1,287.40
Max. Negotiated Rate	$4,738.80
Rate for Payer: Cash Price	$1,177.50
Rate for Payer: Cash Price	$1,177.50
Rate for Payer: Celtic Commercial/Exchange	$4,738.80
Rate for Payer: Health Partners Plans Commercial	$1,491.50
Rate for Payer: UnitedHealthcare Commercial	$1,522.90
Rate for Payer: WPPA Commercial	$1,287.40

ROOM & BOARD-SKILLED SWING BED

Facility

$1,075.00

Hospital Charge Code	5500004
Hospital Revenue Code	110
Min. Negotiated Rate	$881.50
Max. Negotiated Rate	$4,738.80
Rate for Payer: Cash Price	$806.25
Rate for Payer: Cash Price	$806.25
Rate for Payer: Celtic Commercial/Exchange	$4,738.80
Rate for Payer: Health Partners Plans Commercial	$1,021.25
Rate for Payer: UnitedHealthcare Commercial	$1,042.75
Rate for Payer: WPPA Commercial	$881.50

ROXANOL 20 mg/ML (MORPHINE SULFATE IR CONCENTRATED ORAL SOLUTION)

Facility

$3.00

Service Code	NDC 00406800330
Hospital Charge Code	2512325
Hospital Revenue Code	250
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.47
Rate for Payer: Celtic Commercial/Exchange	$1.39
Rate for Payer: Health Partners Plans Commercial	$2.85
Rate for Payer: UnitedHealthcare Commercial	$2.91
Rate for Payer: WPPA Commercial	$2.52

Know your out-of-pocket cost for care.

All Charges