Ness County Hospital

All Charges

Charge

Type

Setting

Price

TMJ BIL. OPEN AND CLOSED

Facility

$160.00

Service Code	HCPCS 70330
Hospital Charge Code	3260012
Hospital Revenue Code	320
Min. Negotiated Rate	$73.92
Max. Negotiated Rate	$155.20
Rate for Payer: BCBS Commercial	$110.06
Rate for Payer: Cash Price	$120.45
Rate for Payer: Cash Price	$120.45
Rate for Payer: Celtic Commercial/Exchange	$73.92
Rate for Payer: Health Partners Plans Commercial	$152.00
Rate for Payer: UnitedHealthcare Commercial	$155.20
Rate for Payer: WPPA Commercial	$134.40

TMJ BIL. OPEN AND CLOSED

Facility

$160.00

Service Code	HCPCS 70330
Hospital Charge Code	3260012
Hospital Revenue Code	320
Min. Negotiated Rate	$131.20
Max. Negotiated Rate	$155.20
Rate for Payer: Cash Price	$120.45
Rate for Payer: Health Partners Plans Commercial	$152.00
Rate for Payer: UnitedHealthcare Commercial	$155.20
Rate for Payer: WPPA Commercial	$131.20

TNK-ASE 25MG INJ. (TENECTEPLASE) IV (STROKE)

Facility

$23,395.00

Service Code	NDC 50242001403
Hospital Charge Code	2510840
Hospital Revenue Code	250
Min. Negotiated Rate	$19,183.90
Max. Negotiated Rate	$22,693.15
Rate for Payer: Cash Price	$17,546.59
Rate for Payer: Health Partners Plans Commercial	$22,225.25
Rate for Payer: UnitedHealthcare Commercial	$22,693.15
Rate for Payer: WPPA Commercial	$19,183.90

TNK-ASE 25MG INJ. (TENECTEPLASE) IV (STROKE)

Facility

$23,395.00

Service Code	NDC 50242001403
Hospital Charge Code	2510840
Hospital Revenue Code	250
Min. Negotiated Rate	$10,808.49
Max. Negotiated Rate	$22,693.15
Rate for Payer: Cash Price	$17,546.59
Rate for Payer: Celtic Commercial/Exchange	$10,808.49
Rate for Payer: Health Partners Plans Commercial	$22,225.25
Rate for Payer: UnitedHealthcare Commercial	$22,693.15
Rate for Payer: WPPA Commercial	$19,651.80

TNK-ASE 50 MG INJ. (TENECTEPLASE) (HEART)

Facility

$23,395.00

Service Code	NDC 50242012047
Hospital Charge Code	2513828
Hospital Revenue Code	250
Min. Negotiated Rate	$19,183.90
Max. Negotiated Rate	$22,693.15
Rate for Payer: Cash Price	$17,546.59
Rate for Payer: Health Partners Plans Commercial	$22,225.25
Rate for Payer: UnitedHealthcare Commercial	$22,693.15
Rate for Payer: WPPA Commercial	$19,183.90

TNK-ASE 50 MG INJ. (TENECTEPLASE) (HEART)

Facility

$23,395.00

Service Code	NDC 50242012047
Hospital Charge Code	2513828
Hospital Revenue Code	250
Min. Negotiated Rate	$10,808.49
Max. Negotiated Rate	$22,693.15
Rate for Payer: Cash Price	$17,546.59
Rate for Payer: Celtic Commercial/Exchange	$10,808.49
Rate for Payer: Health Partners Plans Commercial	$22,225.25
Rate for Payer: UnitedHealthcare Commercial	$22,693.15
Rate for Payer: WPPA Commercial	$19,651.80

TOAD FINGER SPLINT MD

Facility

$12.00

Hospital Charge Code	2701480
Hospital Revenue Code	270
Min. Negotiated Rate	$9.84
Max. Negotiated Rate	$11.64
Rate for Payer: Cash Price	$9.38
Rate for Payer: Health Partners Plans Commercial	$11.40
Rate for Payer: UnitedHealthcare Commercial	$11.64
Rate for Payer: WPPA Commercial	$9.84

TOAD FINGER SPLINT MD

Facility

$12.00

Hospital Charge Code	2701480
Hospital Revenue Code	270
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$11.64
Rate for Payer: Cash Price	$9.38
Rate for Payer: Celtic Commercial/Exchange	$5.54
Rate for Payer: Health Partners Plans Commercial	$11.40
Rate for Payer: UnitedHealthcare Commercial	$11.64
Rate for Payer: WPPA Commercial	$10.08

TOBRADEX OPTHALMIC OINTMENT 3.5 GM

Facility

$948.00

Service Code	NDC 00078087601
Hospital Charge Code	2515328
Hospital Revenue Code	250
Min. Negotiated Rate	$437.98
Max. Negotiated Rate	$919.56
Rate for Payer: Cash Price	$711.02
Rate for Payer: Celtic Commercial/Exchange	$437.98
Rate for Payer: Health Partners Plans Commercial	$900.60
Rate for Payer: UnitedHealthcare Commercial	$919.56
Rate for Payer: WPPA Commercial	$796.32

TOBRADEX OPTHALMIC OINTMENT 3.5 GM

Facility

$948.00

Service Code	NDC 00078087601
Hospital Charge Code	2515328
Hospital Revenue Code	250
Min. Negotiated Rate	$777.36
Max. Negotiated Rate	$919.56
Rate for Payer: Cash Price	$711.02
Rate for Payer: Health Partners Plans Commercial	$900.60
Rate for Payer: UnitedHealthcare Commercial	$919.56
Rate for Payer: WPPA Commercial	$777.36

Tobradex Opth Sol'n-5ML

Facility

$74.00

Hospital Charge Code	2513836
Hospital Revenue Code	250
Min. Negotiated Rate	$60.68
Max. Negotiated Rate	$71.78
Rate for Payer: Cash Price	$55.88
Rate for Payer: Health Partners Plans Commercial	$70.30
Rate for Payer: UnitedHealthcare Commercial	$71.78
Rate for Payer: WPPA Commercial	$60.68

Tobradex Opth Sol'n-5ML

Facility

$74.00

Hospital Charge Code	2513836
Hospital Revenue Code	250
Min. Negotiated Rate	$34.19
Max. Negotiated Rate	$71.78
Rate for Payer: Cash Price	$55.88
Rate for Payer: Celtic Commercial/Exchange	$34.19
Rate for Payer: Health Partners Plans Commercial	$70.30
Rate for Payer: UnitedHealthcare Commercial	$71.78
Rate for Payer: WPPA Commercial	$62.16

TOBRAMYCIN

Facility

$73.00

Service Code	HCPCS 80200
Hospital Charge Code	8020000
Hospital Revenue Code	301
Min. Negotiated Rate	$59.86
Max. Negotiated Rate	$70.81
Rate for Payer: Cash Price	$54.75
Rate for Payer: Health Partners Plans Commercial	$69.35
Rate for Payer: UnitedHealthcare Commercial	$70.81
Rate for Payer: WPPA Commercial	$59.86

TOBRAMYCIN

Facility

$73.00

Service Code	HCPCS 80200
Hospital Charge Code	8020000
Hospital Revenue Code	301
Min. Negotiated Rate	$33.73
Max. Negotiated Rate	$70.81
Rate for Payer: BCBS Commercial	$34.59
Rate for Payer: Cash Price	$54.75
Rate for Payer: Cash Price	$54.75
Rate for Payer: Celtic Commercial/Exchange	$33.73
Rate for Payer: Health Partners Plans Commercial	$69.35
Rate for Payer: UnitedHealthcare Commercial	$70.81
Rate for Payer: WPPA Commercial	$61.32

TOBRAMYCIN 40MG/ML 30 ML VIAL

Facility

$82.00

Hospital Charge Code	2519197
Hospital Revenue Code	250
Min. Negotiated Rate	$67.24
Max. Negotiated Rate	$79.54
Rate for Payer: Cash Price	$61.88
Rate for Payer: Health Partners Plans Commercial	$77.90
Rate for Payer: UnitedHealthcare Commercial	$79.54
Rate for Payer: WPPA Commercial	$67.24

TOBRAMYCIN 40MG/ML 30 ML VIAL

Facility

$82.00

Hospital Charge Code	2519197
Hospital Revenue Code	250
Min. Negotiated Rate	$37.88
Max. Negotiated Rate	$79.54
Rate for Payer: Cash Price	$61.88
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

TOBRAMYCIN 80 MG/2 ML VIAL

Facility

$7.00

Service Code	NDC 67457047322
Hospital Charge Code	2510196
Hospital Revenue Code	250
Min. Negotiated Rate	$3.23
Max. Negotiated Rate	$6.79
Rate for Payer: Cash Price	$5.59
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

TOBRAMYCIN 80 MG/2 ML VIAL

Facility

$7.00

Service Code	NDC 67457047322
Hospital Charge Code	2510196
Hospital Revenue Code	250
Min. Negotiated Rate	$5.74
Max. Negotiated Rate	$6.79
Rate for Payer: Cash Price	$5.59
Rate for Payer: Health Partners Plans Commercial	$6.65
Rate for Payer: UnitedHealthcare Commercial	$6.79
Rate for Payer: WPPA Commercial	$5.74

TOBREX OPTHALMIC OINTMENT 3.5 GM

Facility

$771.00

Service Code	NDC 00065064435
Hospital Charge Code	2510808
Hospital Revenue Code	250
Min. Negotiated Rate	$356.20
Max. Negotiated Rate	$747.87
Rate for Payer: Cash Price	$578.85
Rate for Payer: Celtic Commercial/Exchange	$356.20
Rate for Payer: Health Partners Plans Commercial	$732.45
Rate for Payer: UnitedHealthcare Commercial	$747.87
Rate for Payer: WPPA Commercial	$647.64

TOBREX OPTHALMIC OINTMENT 3.5 GM

Facility

$771.00

Service Code	NDC 00065064435
Hospital Charge Code	2510808
Hospital Revenue Code	250
Min. Negotiated Rate	$632.22
Max. Negotiated Rate	$747.87
Rate for Payer: Cash Price	$578.85
Rate for Payer: Health Partners Plans Commercial	$732.45
Rate for Payer: UnitedHealthcare Commercial	$747.87
Rate for Payer: WPPA Commercial	$632.22

TOBREX OPTHMALIC SOLUTION 0.3% - 5 ML (TOBRAMYCIN SULFATE)

Facility

$273.00

Service Code	NDC 00574403105
Hospital Charge Code	2514214
Hospital Revenue Code	250
Min. Negotiated Rate	$126.13
Max. Negotiated Rate	$264.81
Rate for Payer: Cash Price	$205.33
Rate for Payer: Celtic Commercial/Exchange	$126.13
Rate for Payer: Health Partners Plans Commercial	$259.35
Rate for Payer: UnitedHealthcare Commercial	$264.81
Rate for Payer: WPPA Commercial	$229.32

TOBREX OPTHMALIC SOLUTION 0.3% - 5 ML (TOBRAMYCIN SULFATE)

Facility

$273.00

Service Code	NDC 00574403105
Hospital Charge Code	2514214
Hospital Revenue Code	250
Min. Negotiated Rate	$223.86
Max. Negotiated Rate	$264.81
Rate for Payer: Cash Price	$205.33
Rate for Payer: Health Partners Plans Commercial	$259.35
Rate for Payer: UnitedHealthcare Commercial	$264.81
Rate for Payer: WPPA Commercial	$223.86

TOES LT

Facility

$205.00

Service Code	HCPCS 73660 LT
Hospital Charge Code	3290003
Hospital Revenue Code	320
Min. Negotiated Rate	$168.10
Max. Negotiated Rate	$198.85
Rate for Payer: Cash Price	$153.75
Rate for Payer: Health Partners Plans Commercial	$194.75
Rate for Payer: UnitedHealthcare Commercial	$198.85
Rate for Payer: WPPA Commercial	$168.10

TOES LT

Facility

$205.00

Service Code	HCPCS 73660 LT
Hospital Charge Code	3290003
Hospital Revenue Code	320
Min. Negotiated Rate	$94.71
Max. Negotiated Rate	$198.85
Rate for Payer: BCBS Commercial	$110.06
Rate for Payer: Cash Price	$153.75
Rate for Payer: Cash Price	$153.75
Rate for Payer: Celtic Commercial/Exchange	$94.71
Rate for Payer: Health Partners Plans Commercial	$194.75
Rate for Payer: UnitedHealthcare Commercial	$198.85
Rate for Payer: WPPA Commercial	$172.20

TOES RT

Facility

$205.00

Service Code	HCPCS 73660 RT
Hospital Charge Code	3290002
Hospital Revenue Code	320
Min. Negotiated Rate	$168.10
Max. Negotiated Rate	$198.85
Rate for Payer: Cash Price	$153.75
Rate for Payer: Health Partners Plans Commercial	$194.75
Rate for Payer: UnitedHealthcare Commercial	$198.85
Rate for Payer: WPPA Commercial	$168.10

Know your out-of-pocket cost for care.

All Charges