Ness County Hospital

All Charges

Charge

Type

Setting

Price

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	$2.46
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.47
Rate for Payer: Health Partners Plans Commercial	$2.85
Rate for Payer: UnitedHealthcare Commercial	$2.91
Rate for Payer: WPPA Commercial	$2.46

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

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	$2.46
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.47
Rate for Payer: Health Partners Plans Commercial	$2.85
Rate for Payer: UnitedHealthcare Commercial	$2.91
Rate for Payer: WPPA Commercial	$2.46

RPR (DIAGNOSIS)W/REFLEX TITER

Facility

$45.00

Service Code	HCPCS 86592
Hospital Charge Code	8659201
Hospital Revenue Code	302
Min. Negotiated Rate	$16.26
Max. Negotiated Rate	$43.65
Rate for Payer: BCBS Commercial	$16.26
Rate for Payer: Cash Price	$33.75
Rate for Payer: Cash Price	$33.75
Rate for Payer: Celtic Commercial/Exchange	$20.79
Rate for Payer: Health Partners Plans Commercial	$42.75
Rate for Payer: UnitedHealthcare Commercial	$43.65
Rate for Payer: WPPA Commercial	$37.80

RPR (DIAGNOSIS)W/REFLEX TITER

Facility

$45.00

Service Code	HCPCS 86592
Hospital Charge Code	8659201
Hospital Revenue Code	302
Min. Negotiated Rate	$36.90
Max. Negotiated Rate	$43.65
Rate for Payer: Cash Price	$33.75
Rate for Payer: Health Partners Plans Commercial	$42.75
Rate for Payer: UnitedHealthcare Commercial	$43.65
Rate for Payer: WPPA Commercial	$36.90

RT - 0.9% - 3 ml NSS U.D. (SODIUM CHLORIDE)

Facility

$1.00

Service Code	NDC 00487930133
Hospital Charge Code	4100394
Hospital Revenue Code	250
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$1.01
Rate for Payer: Health Partners Plans Commercial	$0.95
Rate for Payer: UnitedHealthcare Commercial	$0.97
Rate for Payer: WPPA Commercial	$0.82

RT - 0.9% - 3 ml NSS U.D. (SODIUM CHLORIDE)

Facility

$1.00

Service Code	NDC 00487930133
Hospital Charge Code	4100394
Hospital Revenue Code	250
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$1.01
Rate for Payer: Celtic Commercial/Exchange	$0.46
Rate for Payer: Health Partners Plans Commercial	$0.95
Rate for Payer: UnitedHealthcare Commercial	$0.97
Rate for Payer: WPPA Commercial	$0.84

RT 3D UNIL DIAG MAMMOGRAM

Facility

$32.00

Service Code	HCPCS 77061 RT
Hospital Charge Code	7706101
Hospital Revenue Code	401
Min. Negotiated Rate	$26.24
Max. Negotiated Rate	$31.04
Rate for Payer: Cash Price	$24.00
Rate for Payer: Health Partners Plans Commercial	$30.40
Rate for Payer: UnitedHealthcare Commercial	$31.04
Rate for Payer: WPPA Commercial	$26.24

RT 3D UNIL DIAG MAMMOGRAM

Facility

$32.00

Service Code	HCPCS 77061 RT
Hospital Charge Code	7706101
Hospital Revenue Code	401
Min. Negotiated Rate	$14.78
Max. Negotiated Rate	$31.04
Rate for Payer: BCBS Commercial	$16.00
Rate for Payer: Cash Price	$24.00
Rate for Payer: Cash Price	$24.00
Rate for Payer: Celtic Commercial/Exchange	$14.78
Rate for Payer: Health Partners Plans Commercial	$30.40
Rate for Payer: UnitedHealthcare Commercial	$31.04
Rate for Payer: WPPA Commercial	$26.88

RT - ALBUTEROL 2.5 MG/3 ML U.D. (VENTOLIN/PROVENTIL)

Facility

$5.00

Service Code	NDC 76204020060
Hospital Charge Code	4100332
Hospital Revenue Code	250
Min. Negotiated Rate	$4.10
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$3.79
Rate for Payer: Health Partners Plans Commercial	$4.75
Rate for Payer: UnitedHealthcare Commercial	$4.85
Rate for Payer: WPPA Commercial	$4.10

RT - ALBUTEROL 2.5 MG/3 ML U.D. (VENTOLIN/PROVENTIL)

Facility

$5.00

Service Code	NDC 76204020060
Hospital Charge Code	4100332
Hospital Revenue Code	250
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$3.79
Rate for Payer: Celtic Commercial/Exchange	$2.31
Rate for Payer: Health Partners Plans Commercial	$4.75
Rate for Payer: UnitedHealthcare Commercial	$4.85
Rate for Payer: WPPA Commercial	$4.20

RT ALBUTEROL SOL'N 0.25 ML

Facility

$9.00

Hospital Charge Code	4100320
Hospital Revenue Code	250
Min. Negotiated Rate	$7.38
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$6.79
Rate for Payer: Health Partners Plans Commercial	$8.55
Rate for Payer: UnitedHealthcare Commercial	$8.73
Rate for Payer: WPPA Commercial	$7.38

RT ALBUTEROL SOL'N 0.25 ML

Facility

$9.00

Hospital Charge Code	4100320
Hospital Revenue Code	250
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$6.79
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

RT - ATROVENT SOLUTION 0.5 MG/2.5 ML U.D. (IPRATROPIUM BROMIDE)

Facility

$7.00

Service Code	NDC 76204010030
Hospital Charge Code	4100362
Hospital Revenue Code	250
Min. Negotiated Rate	$3.23
Max. Negotiated Rate	$6.79
Rate for Payer: Cash Price	$5.85
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

RT - ATROVENT SOLUTION 0.5 MG/2.5 ML U.D. (IPRATROPIUM BROMIDE)

Facility

$7.00

Service Code	NDC 76204010030
Hospital Charge Code	4100362
Hospital Revenue Code	250
Min. Negotiated Rate	$5.74
Max. Negotiated Rate	$6.79
Rate for Payer: Cash Price	$5.85
Rate for Payer: Health Partners Plans Commercial	$6.65
Rate for Payer: UnitedHealthcare Commercial	$6.79
Rate for Payer: WPPA Commercial	$5.74

RT - Brovana U.D. (arformoterol) Inhl Solution for Nebulization

Facility

$64.00

Service Code	NDC 69097016848
Hospital Charge Code	2517977
Hospital Revenue Code	250
Min. Negotiated Rate	$29.57
Max. Negotiated Rate	$62.08
Rate for Payer: Cash Price	$48.30
Rate for Payer: Celtic Commercial/Exchange	$29.57
Rate for Payer: Health Partners Plans Commercial	$60.80
Rate for Payer: UnitedHealthcare Commercial	$62.08
Rate for Payer: WPPA Commercial	$53.76

RT - Brovana U.D. (arformoterol) Inhl Solution for Nebulization

Facility

$64.00

Service Code	NDC 69097016848
Hospital Charge Code	2517977
Hospital Revenue Code	250
Min. Negotiated Rate	$52.48
Max. Negotiated Rate	$62.08
Rate for Payer: Cash Price	$48.30
Rate for Payer: Health Partners Plans Commercial	$60.80
Rate for Payer: UnitedHealthcare Commercial	$62.08
Rate for Payer: WPPA Commercial	$52.48

RT. COLLES SPLINT

Facility

$19.00

Hospital Charge Code	2702330
Hospital Revenue Code	270
Min. Negotiated Rate	$8.78
Max. Negotiated Rate	$18.43
Rate for Payer: Cash Price	$14.25
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

RT. COLLES SPLINT

Facility

$19.00

Hospital Charge Code	2702330
Hospital Revenue Code	270
Min. Negotiated Rate	$15.58
Max. Negotiated Rate	$18.43
Rate for Payer: Cash Price	$14.25
Rate for Payer: Health Partners Plans Commercial	$18.05
Rate for Payer: UnitedHealthcare Commercial	$18.43
Rate for Payer: WPPA Commercial	$15.58

RT DIAGNOSTIC MAMMO WITH CAD

Facility

$289.00

Service Code	HCPCS 77065 RT
Hospital Charge Code	7706501
Hospital Revenue Code	401
Min. Negotiated Rate	$236.98
Max. Negotiated Rate	$280.33
Rate for Payer: Cash Price	$216.75
Rate for Payer: Health Partners Plans Commercial	$274.55
Rate for Payer: UnitedHealthcare Commercial	$280.33
Rate for Payer: WPPA Commercial	$236.98

RT DIAGNOSTIC MAMMO WITH CAD

Facility

$289.00

Service Code	HCPCS 77065 RT
Hospital Charge Code	7706501
Hospital Revenue Code	401
Min. Negotiated Rate	$123.22
Max. Negotiated Rate	$280.33
Rate for Payer: BCBS Commercial	$123.22
Rate for Payer: Cash Price	$216.75
Rate for Payer: Cash Price	$216.75
Rate for Payer: Celtic Commercial/Exchange	$133.52
Rate for Payer: Health Partners Plans Commercial	$274.55
Rate for Payer: UnitedHealthcare Commercial	$280.33
Rate for Payer: WPPA Commercial	$242.76

RT - DUONEB 0.5 MG/3 MG/3 ML U.D. (IPRATROPIUM BROMIDE + ALBUTEROL)

Facility

$8.00

Service Code	NDC 76204060060
Hospital Charge Code	4100441
Hospital Revenue Code	270
Min. Negotiated Rate	$6.56
Max. Negotiated Rate	$7.76
Rate for Payer: Cash Price	$6.19
Rate for Payer: Health Partners Plans Commercial	$7.60
Rate for Payer: UnitedHealthcare Commercial	$7.76
Rate for Payer: WPPA Commercial	$6.56

RT - DUONEB 0.5 MG/3 MG/3 ML U.D. (IPRATROPIUM BROMIDE + ALBUTEROL)

Facility

$8.00

Service Code	NDC 76204060060
Hospital Charge Code	4100441
Hospital Revenue Code	270
Min. Negotiated Rate	$3.70
Max. Negotiated Rate	$7.76
Rate for Payer: Cash Price	$6.19
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

RT FULL VOLUME LOOP

Facility

$506.00

Service Code	HCPCS 94375
Hospital Charge Code	9437500
Hospital Revenue Code	410
Min. Negotiated Rate	$85.19
Max. Negotiated Rate	$490.82
Rate for Payer: BCBS Commercial	$85.19
Rate for Payer: Cash Price	$379.50
Rate for Payer: Cash Price	$379.50
Rate for Payer: Celtic Commercial/Exchange	$233.77
Rate for Payer: Health Partners Plans Commercial	$480.70
Rate for Payer: UnitedHealthcare Commercial	$490.82
Rate for Payer: WPPA Commercial	$425.04

RT FULL VOLUME LOOP

Facility

$506.00

Service Code	HCPCS 94375
Hospital Charge Code	9437500
Hospital Revenue Code	410
Min. Negotiated Rate	$414.92
Max. Negotiated Rate	$490.82
Rate for Payer: Cash Price	$379.50
Rate for Payer: Health Partners Plans Commercial	$480.70
Rate for Payer: UnitedHealthcare Commercial	$490.82
Rate for Payer: WPPA Commercial	$414.92

Know your out-of-pocket cost for care.

All Charges