Ness County Hospital

All Charges

Charge

Type

Setting

Price

RT GROUP THERAPY OTHER

Facility

$79.00

Service Code	HCPCS G0239
Hospital Charge Code	G023900
Hospital Revenue Code	410
Min. Negotiated Rate	$64.78
Max. Negotiated Rate	$76.63
Rate for Payer: Cash Price	$59.25
Rate for Payer: Health Partners Plans Commercial	$75.05
Rate for Payer: UnitedHealthcare Commercial	$76.63
Rate for Payer: WPPA Commercial	$64.78

RT GROUP THERAPY OTHER

Facility

$79.00

Service Code	HCPCS G0239
Hospital Charge Code	G023900
Hospital Revenue Code	410
Min. Negotiated Rate	$36.50
Max. Negotiated Rate	$76.63
Rate for Payer: BCBS Commercial	$47.47
Rate for Payer: Cash Price	$59.25
Rate for Payer: Cash Price	$59.25
Rate for Payer: Celtic Commercial/Exchange	$36.50
Rate for Payer: Health Partners Plans Commercial	$75.05
Rate for Payer: UnitedHealthcare Commercial	$76.63
Rate for Payer: WPPA Commercial	$66.36

RT LUNG FUNCTION MBC/MVV

Facility

$500.00

Service Code	HCPCS 94200
Hospital Charge Code	9420000
Hospital Revenue Code	410
Min. Negotiated Rate	$61.59
Max. Negotiated Rate	$485.00
Rate for Payer: BCBS Commercial	$61.59
Rate for Payer: Cash Price	$375.00
Rate for Payer: Cash Price	$375.00
Rate for Payer: Celtic Commercial/Exchange	$231.00
Rate for Payer: Health Partners Plans Commercial	$475.00
Rate for Payer: UnitedHealthcare Commercial	$485.00
Rate for Payer: WPPA Commercial	$420.00

RT LUNG FUNCTION MBC/MVV

Facility

$500.00

Service Code	HCPCS 94200
Hospital Charge Code	9420000
Hospital Revenue Code	410
Min. Negotiated Rate	$410.00
Max. Negotiated Rate	$485.00
Rate for Payer: Cash Price	$375.00
Rate for Payer: Health Partners Plans Commercial	$475.00
Rate for Payer: UnitedHealthcare Commercial	$485.00
Rate for Payer: WPPA Commercial	$410.00

RT-MUCOMIST 10% 1ML

Facility

$29.00

Hospital Charge Code	4100378
Hospital Revenue Code	250
Min. Negotiated Rate	$13.40
Max. Negotiated Rate	$28.13
Rate for Payer: Cash Price	$22.42
Rate for Payer: Celtic Commercial/Exchange	$13.40
Rate for Payer: Health Partners Plans Commercial	$27.55
Rate for Payer: UnitedHealthcare Commercial	$28.13
Rate for Payer: WPPA Commercial	$24.36

RT-MUCOMIST 10% 1ML

Facility

$29.00

Hospital Charge Code	4100378
Hospital Revenue Code	250
Min. Negotiated Rate	$23.78
Max. Negotiated Rate	$28.13
Rate for Payer: Cash Price	$22.42
Rate for Payer: Health Partners Plans Commercial	$27.55
Rate for Payer: UnitedHealthcare Commercial	$28.13
Rate for Payer: WPPA Commercial	$23.78

RT - Pulmicort Respules 0.25mg/2ml UD (budesonide)

Facility

$28.00

Service Code	NDC 69097031887
Hospital Charge Code	4100445
Hospital Revenue Code	250
Min. Negotiated Rate	$22.96
Max. Negotiated Rate	$27.16
Rate for Payer: Cash Price	$21.19
Rate for Payer: Health Partners Plans Commercial	$26.60
Rate for Payer: UnitedHealthcare Commercial	$27.16
Rate for Payer: WPPA Commercial	$22.96

RT - Pulmicort Respules 0.25mg/2ml UD (budesonide)

Facility

$28.00

Service Code	NDC 69097031887
Hospital Charge Code	4100445
Hospital Revenue Code	250
Min. Negotiated Rate	$12.94
Max. Negotiated Rate	$27.16
Rate for Payer: Cash Price	$21.19
Rate for Payer: Celtic Commercial/Exchange	$12.94
Rate for Payer: Health Partners Plans Commercial	$26.60
Rate for Payer: UnitedHealthcare Commercial	$27.16
Rate for Payer: WPPA Commercial	$23.52

RT - PULMICORT RESPULES 0.5 MG/2ML U.D. (BUDESONIDE)

Facility

$39.00

Service Code	NDC 00487960101
Hospital Charge Code	4100498
Hospital Revenue Code	250
Min. Negotiated Rate	$18.02
Max. Negotiated Rate	$37.83
Rate for Payer: Cash Price	$29.92
Rate for Payer: Celtic Commercial/Exchange	$18.02
Rate for Payer: Health Partners Plans Commercial	$37.05
Rate for Payer: UnitedHealthcare Commercial	$37.83
Rate for Payer: WPPA Commercial	$32.76

RT - PULMICORT RESPULES 0.5 MG/2ML U.D. (BUDESONIDE)

Facility

$39.00

Service Code	NDC 00487960101
Hospital Charge Code	4100498
Hospital Revenue Code	250
Min. Negotiated Rate	$31.98
Max. Negotiated Rate	$37.83
Rate for Payer: Cash Price	$29.92
Rate for Payer: Health Partners Plans Commercial	$37.05
Rate for Payer: UnitedHealthcare Commercial	$37.83
Rate for Payer: WPPA Commercial	$31.98

RT- SODIUM CHLORIDE 3% - 15 ML

Facility

$10.00

Hospital Charge Code	2517936
Hospital Revenue Code	250
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

RT- SODIUM CHLORIDE 3% - 15 ML

Facility

$10.00

Hospital Charge Code	2517936
Hospital Revenue Code	250
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

RT - VAPONEPHRINE 2.25%/0.5 ML U.D. VIAL (RACEPINEPHRINE)

Facility

$7.00

Service Code	NDC 00487278401
Hospital Charge Code	4100406
Hospital Revenue Code	250
Min. Negotiated Rate	$5.74
Max. Negotiated Rate	$6.79
Rate for Payer: Cash Price	$5.48
Rate for Payer: Health Partners Plans Commercial	$6.65
Rate for Payer: UnitedHealthcare Commercial	$6.79
Rate for Payer: WPPA Commercial	$5.74

RT - VAPONEPHRINE 2.25%/0.5 ML U.D. VIAL (RACEPINEPHRINE)

Facility

$7.00

Service Code	NDC 00487278401
Hospital Charge Code	4100406
Hospital Revenue Code	250
Min. Negotiated Rate	$3.23
Max. Negotiated Rate	$6.79
Rate for Payer: Cash Price	$5.48
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 - XOPENEX 0.63 MG/3 ML U.D. (LEVALBUTEROL HCL)

Facility

$22.00

Service Code	NDC 76204080025
Hospital Charge Code	4100486
Hospital Revenue Code	250
Min. Negotiated Rate	$10.16
Max. Negotiated Rate	$21.34
Rate for Payer: Cash Price	$16.76
Rate for Payer: Celtic Commercial/Exchange	$10.16
Rate for Payer: Health Partners Plans Commercial	$20.90
Rate for Payer: UnitedHealthcare Commercial	$21.34
Rate for Payer: WPPA Commercial	$18.48

RT - XOPENEX 0.63 MG/3 ML U.D. (LEVALBUTEROL HCL)

Facility

$22.00

Service Code	NDC 76204080025
Hospital Charge Code	4100486
Hospital Revenue Code	250
Min. Negotiated Rate	$18.04
Max. Negotiated Rate	$21.34
Rate for Payer: Cash Price	$16.76
Rate for Payer: Health Partners Plans Commercial	$20.90
Rate for Payer: UnitedHealthcare Commercial	$21.34
Rate for Payer: WPPA Commercial	$18.04

RT - XOPENEX 1.25 MG/3 ML U.D. (LEVALBUTEROL HCL)

Facility

$22.00

Service Code	NDC 00115993278
Hospital Charge Code	4100499
Hospital Revenue Code	250
Min. Negotiated Rate	$10.16
Max. Negotiated Rate	$21.34
Rate for Payer: Cash Price	$16.76
Rate for Payer: Celtic Commercial/Exchange	$10.16
Rate for Payer: Health Partners Plans Commercial	$20.90
Rate for Payer: UnitedHealthcare Commercial	$21.34
Rate for Payer: WPPA Commercial	$18.48

RT - XOPENEX 1.25 MG/3 ML U.D. (LEVALBUTEROL HCL)

Facility

$22.00

Service Code	NDC 00115993278
Hospital Charge Code	4100499
Hospital Revenue Code	250
Min. Negotiated Rate	$18.04
Max. Negotiated Rate	$21.34
Rate for Payer: Cash Price	$16.76
Rate for Payer: Health Partners Plans Commercial	$20.90
Rate for Payer: UnitedHealthcare Commercial	$21.34
Rate for Payer: WPPA Commercial	$18.04

RUFINAMIDE (BANZEL)

Facility

$108.00

Service Code	HCPCS 80299
Hospital Charge Code	8029906
Hospital Revenue Code	301
Min. Negotiated Rate	$49.90
Max. Negotiated Rate	$104.76
Rate for Payer: BCBS Commercial	$65.71
Rate for Payer: Cash Price	$81.00
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

RUFINAMIDE (BANZEL)

Facility

$108.00

Service Code	HCPCS 80299
Hospital Charge Code	8029906
Hospital Revenue Code	301
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

RUFINAMIDE/OXCARBAZEPINE

Facility

$222.00

Service Code	HCPCS 80339
Hospital Charge Code	8033900
Hospital Revenue Code	300
Min. Negotiated Rate	$182.04
Max. Negotiated Rate	$215.34
Rate for Payer: Cash Price	$166.50
Rate for Payer: Health Partners Plans Commercial	$210.90
Rate for Payer: UnitedHealthcare Commercial	$215.34
Rate for Payer: WPPA Commercial	$182.04

RUFINAMIDE/OXCARBAZEPINE

Facility

$222.00

Service Code	HCPCS 80339
Hospital Charge Code	8033900
Hospital Revenue Code	300
Min. Negotiated Rate	$59.41
Max. Negotiated Rate	$215.34
Rate for Payer: BCBS Commercial	$59.41
Rate for Payer: Cash Price	$166.50
Rate for Payer: Cash Price	$166.50
Rate for Payer: Celtic Commercial/Exchange	$102.56
Rate for Payer: Health Partners Plans Commercial	$210.90
Rate for Payer: UnitedHealthcare Commercial	$215.34
Rate for Payer: WPPA Commercial	$186.48

RUSSELL VIPER VENOM TIME,DILUT

Facility

$216.00

Service Code	HCPCS 85613
Hospital Charge Code	8561300
Hospital Revenue Code	305
Min. Negotiated Rate	$177.12
Max. Negotiated Rate	$209.52
Rate for Payer: Cash Price	$162.00
Rate for Payer: Health Partners Plans Commercial	$205.20
Rate for Payer: UnitedHealthcare Commercial	$209.52
Rate for Payer: WPPA Commercial	$177.12

RUSSELL VIPER VENOM TIME,DILUT

Facility

$216.00

Service Code	HCPCS 85613
Hospital Charge Code	8561300
Hospital Revenue Code	305
Min. Negotiated Rate	$27.03
Max. Negotiated Rate	$209.52
Rate for Payer: BCBS Commercial	$27.03
Rate for Payer: Cash Price	$162.00
Rate for Payer: Cash Price	$162.00
Rate for Payer: Celtic Commercial/Exchange	$99.79
Rate for Payer: Health Partners Plans Commercial	$205.20
Rate for Payer: UnitedHealthcare Commercial	$209.52
Rate for Payer: WPPA Commercial	$181.44

RVP PANEL

Facility

$1,385.00

Service Code	HCPCS 87633
Hospital Charge Code	8763300
Hospital Revenue Code	306
Min. Negotiated Rate	$1,135.70
Max. Negotiated Rate	$1,343.45
Rate for Payer: Cash Price	$1,038.75
Rate for Payer: Health Partners Plans Commercial	$1,315.75
Rate for Payer: UnitedHealthcare Commercial	$1,343.45
Rate for Payer: WPPA Commercial	$1,135.70

Know your out-of-pocket cost for care.

All Charges