Ness County Hospital

All Charges

Charge

Type

Setting

Price

ANTISTREPTOLYSIS 0 SCREEN

Facility

$51.00

Service Code	HCPCS 86063
Hospital Charge Code	8606300
Hospital Revenue Code	302
Min. Negotiated Rate	$23.56
Max. Negotiated Rate	$49.47
Rate for Payer: BCBS Commercial	$27.30
Rate for Payer: Cash Price	$38.25
Rate for Payer: Cash Price	$38.25
Rate for Payer: Celtic Commercial/Exchange	$23.56
Rate for Payer: Health Partners Plans Commercial	$48.45
Rate for Payer: UnitedHealthcare Commercial	$49.47
Rate for Payer: WPPA Commercial	$42.84

ANTISTREPTOLYSIS 0 SCREEN

Facility

$51.00

Service Code	HCPCS 86063
Hospital Charge Code	8606300
Hospital Revenue Code	302
Min. Negotiated Rate	$41.82
Max. Negotiated Rate	$49.47
Rate for Payer: Cash Price	$38.25
Rate for Payer: Health Partners Plans Commercial	$48.45
Rate for Payer: UnitedHealthcare Commercial	$49.47
Rate for Payer: WPPA Commercial	$41.82

ANTITHROMBIN 3 ACTIVITY/ANTIGN

Facility

$112.00

Hospital Charge Code	8888953
Hospital Revenue Code	305
Min. Negotiated Rate	$91.84
Max. Negotiated Rate	$108.64
Rate for Payer: Cash Price	$84.00
Rate for Payer: Health Partners Plans Commercial	$106.40
Rate for Payer: UnitedHealthcare Commercial	$108.64
Rate for Payer: WPPA Commercial	$91.84

ANTITHROMBIN 3 ACTIVITY/ANTIGN

Facility

$112.00

Hospital Charge Code	8888953
Hospital Revenue Code	305
Min. Negotiated Rate	$51.74
Max. Negotiated Rate	$108.64
Rate for Payer: Cash Price	$84.00
Rate for Payer: Celtic Commercial/Exchange	$51.74
Rate for Payer: Health Partners Plans Commercial	$106.40
Rate for Payer: UnitedHealthcare Commercial	$108.64
Rate for Payer: WPPA Commercial	$94.08

ANTIVERT 12.5MG TAB (MECLIZINE)

Facility

$2.00

Service Code	NDC 60687077511
Hospital Charge Code	2500502
Hospital Revenue Code	250
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.95
Rate for Payer: Health Partners Plans Commercial	$1.90
Rate for Payer: UnitedHealthcare Commercial	$1.94
Rate for Payer: WPPA Commercial	$1.64

ANTIVERT 12.5MG TAB (MECLIZINE)

Facility

$2.00

Service Code	NDC 60687077511
Hospital Charge Code	2500502
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

ANTOBODY: ENCEPHALITIS,STLOUIS

Facility

$82.00

Service Code	HCPCS 86653
Hospital Charge Code	8665300
Hospital Revenue Code	302
Min. Negotiated Rate	$37.88
Max. Negotiated Rate	$79.54
Rate for Payer: BCBS Commercial	$56.99
Rate for Payer: Cash Price	$61.50
Rate for Payer: Cash Price	$61.50
Rate for Payer: Celtic Commercial/Exchange	$37.88
Rate for Payer: Health Partners Plans Commercial	$77.90
Rate for Payer: UnitedHealthcare Commercial	$79.54
Rate for Payer: WPPA Commercial	$68.88

ANTOBODY: ENCEPHALITIS,STLOUIS

Facility

$82.00

Service Code	HCPCS 86653
Hospital Charge Code	8665300
Hospital Revenue Code	302
Min. Negotiated Rate	$67.24
Max. Negotiated Rate	$79.54
Rate for Payer: Cash Price	$61.50
Rate for Payer: Health Partners Plans Commercial	$77.90
Rate for Payer: UnitedHealthcare Commercial	$79.54
Rate for Payer: WPPA Commercial	$67.24

ANUSOL HC 2.5% CREAM(PROCTOZONE)

Facility

$262.00

Service Code	NDC 62559043130
Hospital Charge Code	2513745
Hospital Revenue Code	250
Min. Negotiated Rate	$214.84
Max. Negotiated Rate	$254.14
Rate for Payer: Cash Price	$196.50
Rate for Payer: Health Partners Plans Commercial	$248.90
Rate for Payer: UnitedHealthcare Commercial	$254.14
Rate for Payer: WPPA Commercial	$214.84

ANUSOL HC 2.5% CREAM(PROCTOZONE)

Facility

$262.00

Service Code	NDC 62559043130
Hospital Charge Code	2513745
Hospital Revenue Code	250
Min. Negotiated Rate	$121.04
Max. Negotiated Rate	$254.14
Rate for Payer: Cash Price	$196.50
Rate for Payer: Celtic Commercial/Exchange	$121.04
Rate for Payer: Health Partners Plans Commercial	$248.90
Rate for Payer: UnitedHealthcare Commercial	$254.14
Rate for Payer: WPPA Commercial	$220.08

Anusol HC 25 mg supp (hydrocortisone acetate)

Facility

$43.00

Service Code	NDC 69367024312
Hospital Charge Code	2500544
Hospital Revenue Code	250
Min. Negotiated Rate	$35.26
Max. Negotiated Rate	$41.71
Rate for Payer: Cash Price	$32.47
Rate for Payer: Health Partners Plans Commercial	$40.85
Rate for Payer: UnitedHealthcare Commercial	$41.71
Rate for Payer: WPPA Commercial	$35.26

Anusol HC 25 mg supp (hydrocortisone acetate)

Facility

$43.00

Service Code	NDC 69367024312
Hospital Charge Code	2500544
Hospital Revenue Code	250
Min. Negotiated Rate	$19.87
Max. Negotiated Rate	$41.71
Rate for Payer: Cash Price	$32.47
Rate for Payer: Celtic Commercial/Exchange	$19.87
Rate for Payer: Health Partners Plans Commercial	$40.85
Rate for Payer: UnitedHealthcare Commercial	$41.71
Rate for Payer: WPPA Commercial	$36.12

AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC

Facility

$61,802.83

Service Code	MSDRG 268
Min. Negotiated Rate	$61,802.83
Max. Negotiated Rate	$61,802.83
Rate for Payer: BCBS Commercial	$61,802.83

AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC

Facility

$38,298.71

Service Code	MSDRG 269
Min. Negotiated Rate	$38,298.71
Max. Negotiated Rate	$38,298.71
Rate for Payer: BCBS Commercial	$38,298.71

APLIGRAF 44SQ CM

Facility

$1,412.00

Service Code	HCPCS Q4101
Hospital Charge Code	Q410123
Hospital Revenue Code	636
Min. Negotiated Rate	$29.23
Max. Negotiated Rate	$1,369.64
Rate for Payer: BCBS Commercial	$29.23
Rate for Payer: Cash Price	$1,059.38
Rate for Payer: Cash Price	$1,059.38
Rate for Payer: Celtic Commercial/Exchange	$652.34
Rate for Payer: Health Partners Plans Commercial	$1,341.40
Rate for Payer: UnitedHealthcare Commercial	$1,369.64
Rate for Payer: WPPA Commercial	$1,186.08

APLIGRAF 44SQ CM

Facility

$1,412.00

Service Code	HCPCS Q4101
Hospital Charge Code	Q410123
Hospital Revenue Code	636
Min. Negotiated Rate	$1,157.84
Max. Negotiated Rate	$1,369.64
Rate for Payer: Cash Price	$1,059.38
Rate for Payer: Health Partners Plans Commercial	$1,341.40
Rate for Payer: UnitedHealthcare Commercial	$1,369.64
Rate for Payer: WPPA Commercial	$1,157.84

APPENDIX PROCEDURES WITH CC

Facility

$13,244.22

Service Code	MSDRG 398
Min. Negotiated Rate	$13,244.22
Max. Negotiated Rate	$13,244.22
Rate for Payer: BCBS Commercial	$13,244.22

APPENDIX PROCEDURES WITH MCC

Facility

$20,708.69

Service Code	MSDRG 397
Min. Negotiated Rate	$20,708.69
Max. Negotiated Rate	$20,708.69
Rate for Payer: BCBS Commercial	$20,708.69

APPENDIX PROCEDURES WITHOUT CC/MCC

Facility

$10,026.34

Service Code	MSDRG 399
Min. Negotiated Rate	$10,026.34
Max. Negotiated Rate	$10,026.34
Rate for Payer: BCBS Commercial	$10,026.34

APPLICATION CAST;SHOULDER/HAND

Facility

$428.00

Service Code	HCPCS 29065
Hospital Charge Code	2906500
Hospital Revenue Code	450
Min. Negotiated Rate	$350.96
Max. Negotiated Rate	$415.16
Rate for Payer: Cash Price	$321.00
Rate for Payer: Health Partners Plans Commercial	$406.60
Rate for Payer: UnitedHealthcare Commercial	$415.16
Rate for Payer: WPPA Commercial	$350.96

APPLICATION CAST;SHOULDER/HAND

Facility

$428.00

Service Code	HCPCS 29065
Hospital Charge Code	2906500
Hospital Revenue Code	450
Min. Negotiated Rate	$197.74
Max. Negotiated Rate	$432.28
Rate for Payer: BCBS Commercial	$432.28
Rate for Payer: Cash Price	$321.00
Rate for Payer: Cash Price	$321.00
Rate for Payer: Celtic Commercial/Exchange	$197.74
Rate for Payer: Health Partners Plans Commercial	$406.60
Rate for Payer: UnitedHealthcare Commercial	$415.16
Rate for Payer: WPPA Commercial	$359.52

APPLICATION HAND/LOWR ARM CAST

Facility

$585.00

Service Code	HCPCS 29085
Hospital Charge Code	2908500
Hospital Revenue Code	761
Min. Negotiated Rate	$479.70
Max. Negotiated Rate	$567.45
Rate for Payer: Cash Price	$438.75
Rate for Payer: Health Partners Plans Commercial	$555.75
Rate for Payer: UnitedHealthcare Commercial	$567.45
Rate for Payer: WPPA Commercial	$479.70

APPLICATION HAND/LOWR ARM CAST

Facility

$585.00

Service Code	HCPCS 29085
Hospital Charge Code	2908500
Hospital Revenue Code	761
Min. Negotiated Rate	$270.27
Max. Negotiated Rate	$567.45
Rate for Payer: BCBS Commercial	$432.28
Rate for Payer: Cash Price	$438.75
Rate for Payer: Cash Price	$438.75
Rate for Payer: Celtic Commercial/Exchange	$270.27
Rate for Payer: Health Partners Plans Commercial	$555.75
Rate for Payer: UnitedHealthcare Commercial	$567.45
Rate for Payer: WPPA Commercial	$491.40

Application Multi-Layer Compression System to Lower Extremity

Facility

$375.00

Service Code	HCPCS 29581
Hospital Charge Code	2958101
Hospital Revenue Code	450
Min. Negotiated Rate	$173.25
Max. Negotiated Rate	$363.75
Rate for Payer: BCBS Commercial	$277.75
Rate for Payer: Cash Price	$281.25
Rate for Payer: Cash Price	$281.25
Rate for Payer: Celtic Commercial/Exchange	$173.25
Rate for Payer: Health Partners Plans Commercial	$356.25
Rate for Payer: UnitedHealthcare Commercial	$363.75
Rate for Payer: WPPA Commercial	$315.00

Application Multi-Layer Compression System to Lower Extremity

Facility

$375.00

Service Code	HCPCS 29581
Hospital Charge Code	2958101
Hospital Revenue Code	450
Min. Negotiated Rate	$307.50
Max. Negotiated Rate	$363.75
Rate for Payer: Cash Price	$281.25
Rate for Payer: Health Partners Plans Commercial	$356.25
Rate for Payer: UnitedHealthcare Commercial	$363.75
Rate for Payer: WPPA Commercial	$307.50

Know your out-of-pocket cost for care.

All Charges