Ness County Hospital

All Charges

Charge

Type

Setting

Price

TATOO INK CARTRIDGE

Facility

$88.00

Hospital Charge Code	2705712
Hospital Revenue Code	270
Min. Negotiated Rate	$72.16
Max. Negotiated Rate	$85.36
Rate for Payer: Cash Price	$66.56
Rate for Payer: Health Partners Plans Commercial	$83.60
Rate for Payer: UnitedHealthcare Commercial	$85.36
Rate for Payer: WPPA Commercial	$72.16

TATOO INK CARTRIDGE

Facility

$88.00

Hospital Charge Code	2705712
Hospital Revenue Code	270
Min. Negotiated Rate	$40.66
Max. Negotiated Rate	$85.36
Rate for Payer: Cash Price	$66.56
Rate for Payer: Celtic Commercial/Exchange	$40.66
Rate for Payer: Health Partners Plans Commercial	$83.60
Rate for Payer: UnitedHealthcare Commercial	$85.36
Rate for Payer: WPPA Commercial	$73.92

TATOO NEEDLE/CARTRIDGE

Facility

$500.00

Hospital Charge Code	2705836
Hospital Revenue Code	270
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

TATOO NEEDLE/CARTRIDGE

Facility

$500.00

Hospital Charge Code	2705836
Hospital Revenue Code	270
Min. Negotiated Rate	$231.00
Max. Negotiated Rate	$485.00
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

TATTOO,INTRADERM INTROD OPAQUE

Facility

$581.00

Service Code	HCPCS 11920
Hospital Charge Code	1192000
Hospital Revenue Code	761
Min. Negotiated Rate	$476.42
Max. Negotiated Rate	$563.57
Rate for Payer: Cash Price	$435.75
Rate for Payer: Health Partners Plans Commercial	$551.95
Rate for Payer: UnitedHealthcare Commercial	$563.57
Rate for Payer: WPPA Commercial	$476.42

TATTOO,INTRADERM INTROD OPAQUE

Facility

$581.00

Service Code	HCPCS 11920
Hospital Charge Code	1192000
Hospital Revenue Code	761
Min. Negotiated Rate	$268.42
Max. Negotiated Rate	$563.57
Rate for Payer: Cash Price	$435.75
Rate for Payer: Celtic Commercial/Exchange	$268.42
Rate for Payer: Health Partners Plans Commercial	$551.95
Rate for Payer: UnitedHealthcare Commercial	$563.57
Rate for Payer: WPPA Commercial	$488.04

Tb skin test 0.1ml(tuberculin pur.prot.deriv.)

Facility

$94.00

Service Code	NDC 49281075221
Hospital Charge Code	2513166
Hospital Revenue Code	250
Min. Negotiated Rate	$43.43
Max. Negotiated Rate	$91.18
Rate for Payer: Cash Price	$70.50
Rate for Payer: Celtic Commercial/Exchange	$43.43
Rate for Payer: Health Partners Plans Commercial	$89.30
Rate for Payer: UnitedHealthcare Commercial	$91.18
Rate for Payer: WPPA Commercial	$78.96

Tb skin test 0.1ml(tuberculin pur.prot.deriv.)

Facility

$94.00

Service Code	NDC 49281075221
Hospital Charge Code	2513166
Hospital Revenue Code	250
Min. Negotiated Rate	$77.08
Max. Negotiated Rate	$91.18
Rate for Payer: Cash Price	$70.50
Rate for Payer: Health Partners Plans Commercial	$89.30
Rate for Payer: UnitedHealthcare Commercial	$91.18
Rate for Payer: WPPA Commercial	$77.08

T CELLS;ABSOLUTE CD4 & CD8 CNT

Facility

$238.00

Service Code	HCPCS 86360
Hospital Charge Code	8636000
Hospital Revenue Code	302
Min. Negotiated Rate	$195.16
Max. Negotiated Rate	$230.86
Rate for Payer: Cash Price	$178.50
Rate for Payer: Health Partners Plans Commercial	$226.10
Rate for Payer: UnitedHealthcare Commercial	$230.86
Rate for Payer: WPPA Commercial	$195.16

T CELLS;ABSOLUTE CD4 & CD8 CNT

Facility

$238.00

Service Code	HCPCS 86360
Hospital Charge Code	8636000
Hospital Revenue Code	302
Min. Negotiated Rate	$109.96
Max. Negotiated Rate	$230.86
Rate for Payer: BCBS Commercial	$136.11
Rate for Payer: Cash Price	$178.50
Rate for Payer: Cash Price	$178.50
Rate for Payer: Celtic Commercial/Exchange	$109.96
Rate for Payer: Health Partners Plans Commercial	$226.10
Rate for Payer: UnitedHealthcare Commercial	$230.86
Rate for Payer: WPPA Commercial	$199.92

T CELLS TOTAL COUNT

Facility

$172.00

Service Code	HCPCS 86359
Hospital Charge Code	8635900
Hospital Revenue Code	302
Min. Negotiated Rate	$79.46
Max. Negotiated Rate	$166.84
Rate for Payer: BCBS Commercial	$82.59
Rate for Payer: Cash Price	$129.00
Rate for Payer: Cash Price	$129.00
Rate for Payer: Celtic Commercial/Exchange	$79.46
Rate for Payer: Health Partners Plans Commercial	$163.40
Rate for Payer: UnitedHealthcare Commercial	$166.84
Rate for Payer: WPPA Commercial	$144.48

T CELLS TOTAL COUNT

Facility

$172.00

Service Code	HCPCS 86359
Hospital Charge Code	8635900
Hospital Revenue Code	302
Min. Negotiated Rate	$141.04
Max. Negotiated Rate	$166.84
Rate for Payer: Cash Price	$129.00
Rate for Payer: Health Partners Plans Commercial	$163.40
Rate for Payer: UnitedHealthcare Commercial	$166.84
Rate for Payer: WPPA Commercial	$141.04

Tears Naturale oint. 3.5 gm (artificial tears oint/lubrifresh)

Facility

$23.00

Service Code	NDC 17478006235
Hospital Charge Code	2516235
Hospital Revenue Code	250
Min. Negotiated Rate	$10.63
Max. Negotiated Rate	$22.31
Rate for Payer: Cash Price	$17.77
Rate for Payer: Celtic Commercial/Exchange	$10.63
Rate for Payer: Health Partners Plans Commercial	$21.85
Rate for Payer: UnitedHealthcare Commercial	$22.31
Rate for Payer: WPPA Commercial	$19.32

Tears Naturale oint. 3.5 gm (artificial tears oint/lubrifresh)

Facility

$23.00

Service Code	NDC 17478006235
Hospital Charge Code	2516235
Hospital Revenue Code	250
Min. Negotiated Rate	$18.86
Max. Negotiated Rate	$22.31
Rate for Payer: Cash Price	$17.77
Rate for Payer: Health Partners Plans Commercial	$21.85
Rate for Payer: UnitedHealthcare Commercial	$22.31
Rate for Payer: WPPA Commercial	$18.86

TECH SUPPORT-CONNECT HOLTOR

Facility

$146.00

Service Code	HCPCS 93229
Hospital Charge Code	9322900
Hospital Revenue Code	730
Min. Negotiated Rate	$67.45
Max. Negotiated Rate	$389.25
Rate for Payer: BCBS Commercial	$389.25
Rate for Payer: Cash Price	$109.50
Rate for Payer: Cash Price	$109.50
Rate for Payer: Celtic Commercial/Exchange	$67.45
Rate for Payer: Health Partners Plans Commercial	$138.70
Rate for Payer: UnitedHealthcare Commercial	$141.62
Rate for Payer: WPPA Commercial	$122.64

TECH SUPPORT-CONNECT HOLTOR

Facility

$146.00

Service Code	HCPCS 93229
Hospital Charge Code	9322900
Hospital Revenue Code	730
Min. Negotiated Rate	$119.72
Max. Negotiated Rate	$141.62
Rate for Payer: Cash Price	$109.50
Rate for Payer: Health Partners Plans Commercial	$138.70
Rate for Payer: UnitedHealthcare Commercial	$141.62
Rate for Payer: WPPA Commercial	$119.72

TED HOSE LTC

Facility

$22.00

Hospital Charge Code	2700060LTC
Hospital Revenue Code	272
Min. Negotiated Rate	$10.16
Max. Negotiated Rate	$21.34
Rate for Payer: Cash Price	$16.88
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

TED HOSE LTC

Facility

$22.00

Hospital Charge Code	2700060LTC
Hospital Revenue Code	272
Min. Negotiated Rate	$18.04
Max. Negotiated Rate	$21.34
Rate for Payer: Cash Price	$16.88
Rate for Payer: Health Partners Plans Commercial	$20.90
Rate for Payer: UnitedHealthcare Commercial	$21.34
Rate for Payer: WPPA Commercial	$18.04

Teflaro (ceftaroline fosamil) IV recon soln

Facility

$1,365.00

Service Code	NDC 00456040010
Hospital Charge Code	2512432
Hospital Revenue Code	250
Min. Negotiated Rate	$1,119.30
Max. Negotiated Rate	$1,324.05
Rate for Payer: Cash Price	$1,023.75
Rate for Payer: Health Partners Plans Commercial	$1,296.75
Rate for Payer: UnitedHealthcare Commercial	$1,324.05
Rate for Payer: WPPA Commercial	$1,119.30

Teflaro (ceftaroline fosamil) IV recon soln

Facility

$1,365.00

Service Code	NDC 00456040010
Hospital Charge Code	2512432
Hospital Revenue Code	250
Min. Negotiated Rate	$630.63
Max. Negotiated Rate	$1,324.05
Rate for Payer: Cash Price	$1,023.75
Rate for Payer: Celtic Commercial/Exchange	$630.63
Rate for Payer: Health Partners Plans Commercial	$1,296.75
Rate for Payer: UnitedHealthcare Commercial	$1,324.05
Rate for Payer: WPPA Commercial	$1,146.60

TEGADERM

Facility

$9.00

Hospital Charge Code	2500006
Hospital Revenue Code	270
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$6.75
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

TEGADERM

Facility

$9.00

Hospital Charge Code	2500006
Hospital Revenue Code	270
Min. Negotiated Rate	$7.38
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$6.75
Rate for Payer: Health Partners Plans Commercial	$8.55
Rate for Payer: UnitedHealthcare Commercial	$8.73
Rate for Payer: WPPA Commercial	$7.38

Tegaderm 2 3/4 transparent

Facility

$9.00

Hospital Charge Code	2725911LTC
Hospital Revenue Code	272
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$6.75
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

Tegaderm 2 3/4 transparent

Facility

$9.00

Hospital Charge Code	2725911LTC
Hospital Revenue Code	272
Min. Negotiated Rate	$7.38
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$6.75
Rate for Payer: Health Partners Plans Commercial	$8.55
Rate for Payer: UnitedHealthcare Commercial	$8.73
Rate for Payer: WPPA Commercial	$7.38

TEGADERM 2 3/8 TRANSPARENT

Facility

$9.00

Hospital Charge Code	2725911
Hospital Revenue Code	272
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$6.75
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

Know your out-of-pocket cost for care.

All Charges