Ness County Hospital

All Charges

Charge

Type

Setting

Price

THERMOTABS BUFFERED SALT (NACL / K+)

Facility

$1.00

Service Code	NDC 38485086335
Hospital Charge Code	2506905
Hospital Revenue Code	250
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.75
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

THERMOTABS BUFFERED SALT (NACL / K+)

Facility

$1.00

Service Code	NDC 38485086335
Hospital Charge Code	2506905
Hospital Revenue Code	250
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.75
Rate for Payer: Health Partners Plans Commercial	$0.95
Rate for Payer: UnitedHealthcare Commercial	$0.97
Rate for Payer: WPPA Commercial	$0.82

THER PROC,NEURO RE-ED,EA 15MIN

Facility

$103.00

Service Code	HCPCS 97112 GO
Hospital Charge Code	9711200
Hospital Revenue Code	430
Min. Negotiated Rate	$84.46
Max. Negotiated Rate	$99.91
Rate for Payer: Cash Price	$77.25
Rate for Payer: Health Partners Plans Commercial	$97.85
Rate for Payer: UnitedHealthcare Commercial	$99.91
Rate for Payer: WPPA Commercial	$84.46

THER PROC,NEURO RE-ED,EA 15MIN

Facility

$103.00

Service Code	HCPCS 97112 GO
Hospital Charge Code	9711200
Hospital Revenue Code	430
Min. Negotiated Rate	$47.59
Max. Negotiated Rate	$99.91
Rate for Payer: BCBS Commercial	$50.50
Rate for Payer: Cash Price	$77.25
Rate for Payer: Cash Price	$77.25
Rate for Payer: Celtic Commercial/Exchange	$47.59
Rate for Payer: Health Partners Plans Commercial	$97.85
Rate for Payer: UnitedHealthcare Commercial	$99.91
Rate for Payer: WPPA Commercial	$86.52

THIAMINE 100 MG TAB (VITAMIN B1)

Facility

$2.00

Service Code	NDC 87701040729
Hospital Charge Code	2512648
Hospital Revenue Code	250
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.65
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

THIAMINE 100 MG TAB (VITAMIN B1)

Facility

$2.00

Service Code	NDC 87701040729
Hospital Charge Code	2512648
Hospital Revenue Code	250
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.65
Rate for Payer: Health Partners Plans Commercial	$1.90
Rate for Payer: UnitedHealthcare Commercial	$1.94
Rate for Payer: WPPA Commercial	$1.64

THIAMINE 200 MG/2 ML INJ. (VITAMIN B1)

Facility

$37.00

Service Code	NDC 25021050002
Hospital Charge Code	2507119
Hospital Revenue Code	250
Min. Negotiated Rate	$30.34
Max. Negotiated Rate	$35.89
Rate for Payer: Cash Price	$28.01
Rate for Payer: Health Partners Plans Commercial	$35.15
Rate for Payer: UnitedHealthcare Commercial	$35.89
Rate for Payer: WPPA Commercial	$30.34

THIAMINE 200 MG/2 ML INJ. (VITAMIN B1)

Facility

$37.00

Service Code	NDC 25021050002
Hospital Charge Code	2507119
Hospital Revenue Code	250
Min. Negotiated Rate	$17.09
Max. Negotiated Rate	$35.89
Rate for Payer: Cash Price	$28.01
Rate for Payer: Celtic Commercial/Exchange	$17.09
Rate for Payer: Health Partners Plans Commercial	$35.15
Rate for Payer: UnitedHealthcare Commercial	$35.89
Rate for Payer: WPPA Commercial	$31.08

THIAMINE (VITAMIN B-1)

Facility

$190.00

Service Code	HCPCS 84425
Hospital Charge Code	8442500
Hospital Revenue Code	301
Min. Negotiated Rate	$155.80
Max. Negotiated Rate	$184.30
Rate for Payer: Cash Price	$142.50
Rate for Payer: Health Partners Plans Commercial	$180.50
Rate for Payer: UnitedHealthcare Commercial	$184.30
Rate for Payer: WPPA Commercial	$155.80

THIAMINE (VITAMIN B-1)

Facility

$190.00

Service Code	HCPCS 84425
Hospital Charge Code	8442500
Hospital Revenue Code	301
Min. Negotiated Rate	$72.57
Max. Negotiated Rate	$184.30
Rate for Payer: BCBS Commercial	$72.57
Rate for Payer: Cash Price	$142.50
Rate for Payer: Cash Price	$142.50
Rate for Payer: Celtic Commercial/Exchange	$87.78
Rate for Payer: Health Partners Plans Commercial	$180.50
Rate for Payer: UnitedHealthcare Commercial	$184.30
Rate for Payer: WPPA Commercial	$159.60

THOR-LUM SPINE 2 VIEWS

Facility

$250.00

Service Code	HCPCS 72080
Hospital Charge Code	3270010
Hospital Revenue Code	320
Min. Negotiated Rate	$115.50
Max. Negotiated Rate	$242.50
Rate for Payer: BCBS Commercial	$192.34
Rate for Payer: Cash Price	$187.50
Rate for Payer: Cash Price	$187.50
Rate for Payer: Celtic Commercial/Exchange	$115.50
Rate for Payer: Health Partners Plans Commercial	$237.50
Rate for Payer: UnitedHealthcare Commercial	$242.50
Rate for Payer: WPPA Commercial	$210.00

THOR-LUM SPINE 2 VIEWS

Facility

$250.00

Service Code	HCPCS 72080
Hospital Charge Code	3270010
Hospital Revenue Code	320
Min. Negotiated Rate	$205.00
Max. Negotiated Rate	$242.50
Rate for Payer: Cash Price	$187.50
Rate for Payer: Health Partners Plans Commercial	$237.50
Rate for Payer: UnitedHealthcare Commercial	$242.50
Rate for Payer: WPPA Commercial	$205.00

Throat Viral Panel

Facility

$1,385.00

Service Code	HCPCS 87632
Hospital Charge Code	8763201
Hospital Revenue Code	306
Min. Negotiated Rate	$605.44
Max. Negotiated Rate	$1,343.45
Rate for Payer: BCBS Commercial	$605.44
Rate for Payer: Cash Price	$1,038.75
Rate for Payer: Cash Price	$1,038.75
Rate for Payer: Celtic Commercial/Exchange	$639.87
Rate for Payer: Health Partners Plans Commercial	$1,315.75
Rate for Payer: UnitedHealthcare Commercial	$1,343.45
Rate for Payer: WPPA Commercial	$1,163.40

Throat Viral Panel

Facility

$1,385.00

Service Code	HCPCS 87632
Hospital Charge Code	8763201
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

THROMBIN CLOTTING TIME W/REFLX

Facility

$58.00

Service Code	HCPCS 85675
Hospital Charge Code	8567500
Hospital Revenue Code	305
Min. Negotiated Rate	$47.56
Max. Negotiated Rate	$56.26
Rate for Payer: Cash Price	$43.79
Rate for Payer: Health Partners Plans Commercial	$55.10
Rate for Payer: UnitedHealthcare Commercial	$56.26
Rate for Payer: WPPA Commercial	$47.56

THROMBIN CLOTTING TIME W/REFLX

Facility

$58.00

Service Code	HCPCS 85675
Hospital Charge Code	8567500
Hospital Revenue Code	305
Min. Negotiated Rate	$26.80
Max. Negotiated Rate	$56.26
Rate for Payer: BCBS Commercial	$33.72
Rate for Payer: Cash Price	$43.79
Rate for Payer: Cash Price	$43.79
Rate for Payer: Celtic Commercial/Exchange	$26.80
Rate for Payer: Health Partners Plans Commercial	$55.10
Rate for Payer: UnitedHealthcare Commercial	$56.26
Rate for Payer: WPPA Commercial	$48.72

THROMBIN TIME; PLASMA

Facility

$45.00

Service Code	HCPCS 85670
Hospital Charge Code	8567000
Hospital Revenue Code	305
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

THROMBIN TIME; PLASMA

Facility

$45.00

Service Code	HCPCS 85670
Hospital Charge Code	8567000
Hospital Revenue Code	305
Min. Negotiated Rate	$20.79
Max. Negotiated Rate	$43.65
Rate for Payer: BCBS Commercial	$30.35
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

THROMBOLYTIC ART THERAPY

Facility

$5,150.00

Service Code	HCPCS 37211
Hospital Charge Code	3721100
Hospital Revenue Code	761
Min. Negotiated Rate	$4,223.00
Max. Negotiated Rate	$4,995.50
Rate for Payer: Cash Price	$3,862.50
Rate for Payer: Health Partners Plans Commercial	$4,892.50
Rate for Payer: UnitedHealthcare Commercial	$4,995.50
Rate for Payer: WPPA Commercial	$4,223.00

THROMBOLYTIC ART THERAPY

Facility

$5,150.00

Service Code	HCPCS 37211
Hospital Charge Code	3721100
Hospital Revenue Code	761
Min. Negotiated Rate	$2,379.30
Max. Negotiated Rate	$4,995.50
Rate for Payer: Cash Price	$3,862.50
Rate for Payer: Celtic Commercial/Exchange	$2,379.30
Rate for Payer: Health Partners Plans Commercial	$4,892.50
Rate for Payer: UnitedHealthcare Commercial	$4,995.50
Rate for Payer: WPPA Commercial	$4,326.00

THROMBOLYTIC THERAPY STROKE

Facility

$660.00

Service Code	HCPCS 37195
Hospital Charge Code	3719500
Hospital Revenue Code	761
Min. Negotiated Rate	$541.20
Max. Negotiated Rate	$640.20
Rate for Payer: Cash Price	$495.00
Rate for Payer: Health Partners Plans Commercial	$627.00
Rate for Payer: UnitedHealthcare Commercial	$640.20
Rate for Payer: WPPA Commercial	$541.20

THROMBOLYTIC THERAPY STROKE

Facility

$660.00

Service Code	HCPCS 37195
Hospital Charge Code	3719500
Hospital Revenue Code	761
Min. Negotiated Rate	$304.92
Max. Negotiated Rate	$640.20
Rate for Payer: BCBS Commercial	$414.61
Rate for Payer: Cash Price	$495.00
Rate for Payer: Cash Price	$495.00
Rate for Payer: Celtic Commercial/Exchange	$304.92
Rate for Payer: Health Partners Plans Commercial	$627.00
Rate for Payer: UnitedHealthcare Commercial	$640.20
Rate for Payer: WPPA Commercial	$554.40

THROMBOLYTIC VENOUS THERAPY

Facility

$3,125.00

Service Code	HCPCS 37212
Hospital Charge Code	3721200
Hospital Revenue Code	761
Min. Negotiated Rate	$1,443.75
Max. Negotiated Rate	$3,031.25
Rate for Payer: Cash Price	$2,343.75
Rate for Payer: Celtic Commercial/Exchange	$1,443.75
Rate for Payer: Health Partners Plans Commercial	$2,968.75
Rate for Payer: UnitedHealthcare Commercial	$3,031.25
Rate for Payer: WPPA Commercial	$2,625.00

THROMBOLYTIC VENOUS THERAPY

Facility

$3,125.00

Service Code	HCPCS 37212
Hospital Charge Code	3721200
Hospital Revenue Code	761
Min. Negotiated Rate	$2,562.50
Max. Negotiated Rate	$3,031.25
Rate for Payer: Cash Price	$2,343.75
Rate for Payer: Health Partners Plans Commercial	$2,968.75
Rate for Payer: UnitedHealthcare Commercial	$3,031.25
Rate for Payer: WPPA Commercial	$2,562.50

THROMBOPLASTIN TIME, PARTIAL

Facility

$95.00

Service Code	HCPCS 85730
Hospital Charge Code	8573000
Hospital Revenue Code	305
Min. Negotiated Rate	$22.53
Max. Negotiated Rate	$92.15
Rate for Payer: BCBS Commercial	$22.53
Rate for Payer: Cash Price	$71.25
Rate for Payer: Cash Price	$71.25
Rate for Payer: Celtic Commercial/Exchange	$43.89
Rate for Payer: Health Partners Plans Commercial	$90.25
Rate for Payer: UnitedHealthcare Commercial	$92.15
Rate for Payer: WPPA Commercial	$79.80

Know your out-of-pocket cost for care.

All Charges