Ness County Hospital

All Charges

Charge

Type

Setting

Price

TESTOSTERONE TOTAL

Facility

$211.00

Service Code	HCPCS 84403
Hospital Charge Code	8440300
Hospital Revenue Code	301
Min. Negotiated Rate	$97.48
Max. Negotiated Rate	$204.67
Rate for Payer: BCBS Commercial	$104.86
Rate for Payer: Cash Price	$158.25
Rate for Payer: Cash Price	$158.25
Rate for Payer: Celtic Commercial/Exchange	$97.48
Rate for Payer: Health Partners Plans Commercial	$200.45
Rate for Payer: UnitedHealthcare Commercial	$204.67
Rate for Payer: WPPA Commercial	$177.24

Tetanus/diptheria (tetanus-diphtheria toxoids-Td) IM Suspension

Facility

$118.00

Service Code	NDC 00006413341
Hospital Charge Code	2510055
Hospital Revenue Code	250
Min. Negotiated Rate	$96.76
Max. Negotiated Rate	$114.46
Rate for Payer: Cash Price	$88.50
Rate for Payer: Health Partners Plans Commercial	$112.10
Rate for Payer: UnitedHealthcare Commercial	$114.46
Rate for Payer: WPPA Commercial	$96.76

Tetanus/diptheria (tetanus-diphtheria toxoids-Td) IM Suspension

Facility

$118.00

Service Code	NDC 00006413341
Hospital Charge Code	2510055
Hospital Revenue Code	250
Min. Negotiated Rate	$54.52
Max. Negotiated Rate	$114.46
Rate for Payer: Cash Price	$88.50
Rate for Payer: Celtic Commercial/Exchange	$54.52
Rate for Payer: Health Partners Plans Commercial	$112.10
Rate for Payer: UnitedHealthcare Commercial	$114.46
Rate for Payer: WPPA Commercial	$99.12

TEXAS CATHETER

Facility

$10.00

Hospital Charge Code	2700979
Hospital Revenue Code	270
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$7.69
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

TEXAS CATHETER

Facility

$10.00

Hospital Charge Code	2700979
Hospital Revenue Code	270
Min. Negotiated Rate	$8.20
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$7.69
Rate for Payer: Health Partners Plans Commercial	$9.50
Rate for Payer: UnitedHealthcare Commercial	$9.70
Rate for Payer: WPPA Commercial	$8.20

THEOPHYLLINE

Facility

$113.00

Service Code	HCPCS 80198
Hospital Charge Code	8019800
Hospital Revenue Code	301
Min. Negotiated Rate	$52.21
Max. Negotiated Rate	$109.61
Rate for Payer: BCBS Commercial	$60.54
Rate for Payer: Cash Price	$84.75
Rate for Payer: Cash Price	$84.75
Rate for Payer: Celtic Commercial/Exchange	$52.21
Rate for Payer: Health Partners Plans Commercial	$107.35
Rate for Payer: UnitedHealthcare Commercial	$109.61
Rate for Payer: WPPA Commercial	$94.92

THEOPHYLLINE

Facility

$113.00

Service Code	HCPCS 80198
Hospital Charge Code	8019800
Hospital Revenue Code	301
Min. Negotiated Rate	$92.66
Max. Negotiated Rate	$109.61
Rate for Payer: Cash Price	$84.75
Rate for Payer: Health Partners Plans Commercial	$107.35
Rate for Payer: UnitedHealthcare Commercial	$109.61
Rate for Payer: WPPA Commercial	$92.66

THER ACTIV.-DIR CONTCT-FUNCTNL

Facility

$113.00

Service Code	HCPCS 97530 GP
Hospital Charge Code	4202012
Hospital Revenue Code	420
Min. Negotiated Rate	$52.21
Max. Negotiated Rate	$109.61
Rate for Payer: BCBS Commercial	$56.91
Rate for Payer: Cash Price	$84.75
Rate for Payer: Cash Price	$84.75
Rate for Payer: Celtic Commercial/Exchange	$52.21
Rate for Payer: Health Partners Plans Commercial	$107.35
Rate for Payer: UnitedHealthcare Commercial	$109.61
Rate for Payer: WPPA Commercial	$94.92

THER ACTIV.-DIR CONTCT-FUNCTNL

Facility

$113.00

Service Code	HCPCS 97530 GP
Hospital Charge Code	4202012
Hospital Revenue Code	420
Min. Negotiated Rate	$92.66
Max. Negotiated Rate	$109.61
Rate for Payer: Cash Price	$84.75
Rate for Payer: Health Partners Plans Commercial	$107.35
Rate for Payer: UnitedHealthcare Commercial	$109.61
Rate for Payer: WPPA Commercial	$92.66

THER ACTIVITY,1 ON 1,EA 15 MIN

Facility

$108.00

Service Code	HCPCS 97530 GO
Hospital Charge Code	9753000
Hospital Revenue Code	430
Min. Negotiated Rate	$49.90
Max. Negotiated Rate	$104.76
Rate for Payer: BCBS Commercial	$56.91
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

THER ACTIVITY,1 ON 1,EA 15 MIN

Facility

$108.00

Service Code	HCPCS 97530 GO
Hospital Charge Code	9753000
Hospital Revenue Code	430
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

THERAPEUTIC ENEMA CONTRAST/AIR

Facility

$494.00

Service Code	HCPCS 74283
Hospital Charge Code	7428300
Hospital Revenue Code	450
Min. Negotiated Rate	$228.23
Max. Negotiated Rate	$479.18
Rate for Payer: Cash Price	$370.50
Rate for Payer: Celtic Commercial/Exchange	$228.23
Rate for Payer: Health Partners Plans Commercial	$469.30
Rate for Payer: UnitedHealthcare Commercial	$479.18
Rate for Payer: WPPA Commercial	$414.96

THERAPEUTIC ENEMA CONTRAST/AIR

Facility

$494.00

Service Code	HCPCS 74283
Hospital Charge Code	7428300
Hospital Revenue Code	450
Min. Negotiated Rate	$405.08
Max. Negotiated Rate	$479.18
Rate for Payer: Cash Price	$370.50
Rate for Payer: Health Partners Plans Commercial	$469.30
Rate for Payer: UnitedHealthcare Commercial	$479.18
Rate for Payer: WPPA Commercial	$405.08

THER DRUG ASSAY-ACETAMINOPHEN

Facility

$345.00

Service Code	HCPCS 80143
Hospital Charge Code	8014300
Hospital Revenue Code	300
Min. Negotiated Rate	$282.90
Max. Negotiated Rate	$334.65
Rate for Payer: Cash Price	$258.75
Rate for Payer: Health Partners Plans Commercial	$327.75
Rate for Payer: UnitedHealthcare Commercial	$334.65
Rate for Payer: WPPA Commercial	$282.90

THER DRUG ASSAY-ACETAMINOPHEN

Facility

$345.00

Service Code	HCPCS 80143
Hospital Charge Code	8014300
Hospital Revenue Code	300
Min. Negotiated Rate	$29.09
Max. Negotiated Rate	$334.65
Rate for Payer: BCBS Commercial	$29.09
Rate for Payer: Cash Price	$258.75
Rate for Payer: Cash Price	$258.75
Rate for Payer: Celtic Commercial/Exchange	$159.39
Rate for Payer: Health Partners Plans Commercial	$327.75
Rate for Payer: UnitedHealthcare Commercial	$334.65
Rate for Payer: WPPA Commercial	$289.80

THER DRUG ASSAY-GABAPENTIN PLS

Facility

$60.00

Service Code	HCPCS 80171
Hospital Charge Code	8017100
Hospital Revenue Code	300
Min. Negotiated Rate	$49.20
Max. Negotiated Rate	$58.20
Rate for Payer: Cash Price	$45.00
Rate for Payer: Health Partners Plans Commercial	$57.00
Rate for Payer: UnitedHealthcare Commercial	$58.20
Rate for Payer: WPPA Commercial	$49.20

THER DRUG ASSAY-GABAPENTIN PLS

Facility

$60.00

Service Code	HCPCS 80171
Hospital Charge Code	8017100
Hospital Revenue Code	300
Min. Negotiated Rate	$27.72
Max. Negotiated Rate	$58.20
Rate for Payer: BCBS Commercial	$36.44
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Celtic Commercial/Exchange	$27.72
Rate for Payer: Health Partners Plans Commercial	$57.00
Rate for Payer: UnitedHealthcare Commercial	$58.20
Rate for Payer: WPPA Commercial	$50.40

THER DRUG ASSAY-SALICYLATE

Facility

$358.00

Service Code	HCPCS 80179
Hospital Charge Code	8017900
Hospital Revenue Code	300
Min. Negotiated Rate	$293.56
Max. Negotiated Rate	$347.26
Rate for Payer: Cash Price	$268.50
Rate for Payer: Health Partners Plans Commercial	$340.10
Rate for Payer: UnitedHealthcare Commercial	$347.26
Rate for Payer: WPPA Commercial	$293.56

THER DRUG ASSAY-SALICYLATE

Facility

$358.00

Service Code	HCPCS 80179
Hospital Charge Code	8017900
Hospital Revenue Code	300
Min. Negotiated Rate	$29.09
Max. Negotiated Rate	$347.26
Rate for Payer: BCBS Commercial	$29.09
Rate for Payer: Cash Price	$268.50
Rate for Payer: Cash Price	$268.50
Rate for Payer: Celtic Commercial/Exchange	$165.40
Rate for Payer: Health Partners Plans Commercial	$340.10
Rate for Payer: UnitedHealthcare Commercial	$347.26
Rate for Payer: WPPA Commercial	$300.72

THER DRUG ASSY-ETHOSUXIMIDE

Facility

$137.00

Service Code	HCPCS 80168
Hospital Charge Code	8016800
Hospital Revenue Code	300
Min. Negotiated Rate	$49.59
Max. Negotiated Rate	$132.89
Rate for Payer: BCBS Commercial	$49.59
Rate for Payer: Cash Price	$102.75
Rate for Payer: Cash Price	$102.75
Rate for Payer: Celtic Commercial/Exchange	$63.29
Rate for Payer: Health Partners Plans Commercial	$130.15
Rate for Payer: UnitedHealthcare Commercial	$132.89
Rate for Payer: WPPA Commercial	$115.08

THER DRUG ASSY-ETHOSUXIMIDE

Facility

$137.00

Service Code	HCPCS 80168
Hospital Charge Code	8016800
Hospital Revenue Code	300
Min. Negotiated Rate	$112.34
Max. Negotiated Rate	$132.89
Rate for Payer: Cash Price	$102.75
Rate for Payer: Health Partners Plans Commercial	$130.15
Rate for Payer: UnitedHealthcare Commercial	$132.89
Rate for Payer: WPPA Commercial	$112.34

THER EXERCISE PER 15 MIN

Facility

$116.00

Service Code	HCPCS 97110 GP
Hospital Charge Code	4200940
Hospital Revenue Code	420
Min. Negotiated Rate	$95.12
Max. Negotiated Rate	$112.52
Rate for Payer: Cash Price	$87.00
Rate for Payer: Health Partners Plans Commercial	$110.20
Rate for Payer: UnitedHealthcare Commercial	$112.52
Rate for Payer: WPPA Commercial	$95.12

THER EXERCISE PER 15 MIN

Facility

$111.00

Service Code	HCPCS 97110 GO
Hospital Charge Code	9711000
Hospital Revenue Code	430
Min. Negotiated Rate	$51.28
Max. Negotiated Rate	$107.67
Rate for Payer: BCBS Commercial	$56.91
Rate for Payer: Cash Price	$83.25
Rate for Payer: Cash Price	$83.25
Rate for Payer: Celtic Commercial/Exchange	$51.28
Rate for Payer: Health Partners Plans Commercial	$105.45
Rate for Payer: UnitedHealthcare Commercial	$107.67
Rate for Payer: WPPA Commercial	$93.24

THER EXERCISE PER 15 MIN

Facility

$111.00

Service Code	HCPCS 97110 GO
Hospital Charge Code	9711000
Hospital Revenue Code	430
Min. Negotiated Rate	$91.02
Max. Negotiated Rate	$107.67
Rate for Payer: Cash Price	$83.25
Rate for Payer: Health Partners Plans Commercial	$105.45
Rate for Payer: UnitedHealthcare Commercial	$107.67
Rate for Payer: WPPA Commercial	$91.02

THER EXERCISE PER 15 MIN

Facility

$116.00

Service Code	HCPCS 97110 GP
Hospital Charge Code	4200940
Hospital Revenue Code	420
Min. Negotiated Rate	$53.59
Max. Negotiated Rate	$112.52
Rate for Payer: BCBS Commercial	$56.91
Rate for Payer: Cash Price	$87.00
Rate for Payer: Cash Price	$87.00
Rate for Payer: Celtic Commercial/Exchange	$53.59
Rate for Payer: Health Partners Plans Commercial	$110.20
Rate for Payer: UnitedHealthcare Commercial	$112.52
Rate for Payer: WPPA Commercial	$97.44

Know your out-of-pocket cost for care.

All Charges