Ness County Hospital

All Charges

Charge

Type

Setting

Price

TOES RT

Facility

$205.00

Service Code	HCPCS 73660 RT
Hospital Charge Code	3290002
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

TOPAMAX 25 MG TAB (TOPIRAMATE)

Facility

$6.00

Service Code	NDC 68084034201
Hospital Charge Code	2519346
Hospital Revenue Code	250
Min. Negotiated Rate	$4.92
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$4.72
Rate for Payer: Health Partners Plans Commercial	$5.70
Rate for Payer: UnitedHealthcare Commercial	$5.82
Rate for Payer: WPPA Commercial	$4.92

TOPAMAX 25 MG TAB (TOPIRAMATE)

Facility

$6.00

Service Code	NDC 68084034201
Hospital Charge Code	2519346
Hospital Revenue Code	250
Min. Negotiated Rate	$2.77
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$4.72
Rate for Payer: Celtic Commercial/Exchange	$2.77
Rate for Payer: Health Partners Plans Commercial	$5.70
Rate for Payer: UnitedHealthcare Commercial	$5.82
Rate for Payer: WPPA Commercial	$5.04

TOPIRAMATE

Facility

$140.00

Service Code	HCPCS 80201
Hospital Charge Code	8020100
Hospital Revenue Code	301
Min. Negotiated Rate	$64.68
Max. Negotiated Rate	$135.80
Rate for Payer: BCBS Commercial	$67.35
Rate for Payer: Cash Price	$105.00
Rate for Payer: Cash Price	$105.00
Rate for Payer: Celtic Commercial/Exchange	$64.68
Rate for Payer: Health Partners Plans Commercial	$133.00
Rate for Payer: UnitedHealthcare Commercial	$135.80
Rate for Payer: WPPA Commercial	$117.60

TOPIRAMATE

Facility

$140.00

Service Code	HCPCS 80201
Hospital Charge Code	8020100
Hospital Revenue Code	301
Min. Negotiated Rate	$114.80
Max. Negotiated Rate	$135.80
Rate for Payer: Cash Price	$105.00
Rate for Payer: Health Partners Plans Commercial	$133.00
Rate for Payer: UnitedHealthcare Commercial	$135.80
Rate for Payer: WPPA Commercial	$114.80

TOPROL XL 25 MG TAB (METOPROLOL SUCCINATE)

Facility

$3.00

Service Code	NDC 60687039001
Hospital Charge Code	2502391
Hospital Revenue Code	250
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.78
Rate for Payer: Celtic Commercial/Exchange	$1.39
Rate for Payer: Health Partners Plans Commercial	$2.85
Rate for Payer: UnitedHealthcare Commercial	$2.91
Rate for Payer: WPPA Commercial	$2.52

TOPROL XL 25 MG TAB (METOPROLOL SUCCINATE)

Facility

$3.00

Service Code	NDC 60687039001
Hospital Charge Code	2502391
Hospital Revenue Code	250
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.78
Rate for Payer: Health Partners Plans Commercial	$2.85
Rate for Payer: UnitedHealthcare Commercial	$2.91
Rate for Payer: WPPA Commercial	$2.46

TORADOL 10 MG TAB (KETOROLAC TROMETHAMINE)

Facility

$6.00

Service Code	NDC 00093031401
Hospital Charge Code	2512655
Hospital Revenue Code	250
Min. Negotiated Rate	$2.77
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$4.88
Rate for Payer: Celtic Commercial/Exchange	$2.77
Rate for Payer: Health Partners Plans Commercial	$5.70
Rate for Payer: UnitedHealthcare Commercial	$5.82
Rate for Payer: WPPA Commercial	$5.04

TORADOL 10 MG TAB (KETOROLAC TROMETHAMINE)

Facility

$6.00

Service Code	NDC 00093031401
Hospital Charge Code	2512655
Hospital Revenue Code	250
Min. Negotiated Rate	$4.92
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$4.88
Rate for Payer: Health Partners Plans Commercial	$5.70
Rate for Payer: UnitedHealthcare Commercial	$5.82
Rate for Payer: WPPA Commercial	$4.92

TORADOL 30 MG/ML (KETOROLAC TROMETHAMINE) INJ.

Facility

$33.00

Service Code	NDC 63323016200
Hospital Charge Code	2511780
Hospital Revenue Code	250
Min. Negotiated Rate	$27.06
Max. Negotiated Rate	$32.01
Rate for Payer: Cash Price	$24.75
Rate for Payer: Health Partners Plans Commercial	$31.35
Rate for Payer: UnitedHealthcare Commercial	$32.01
Rate for Payer: WPPA Commercial	$27.06

TORADOL 30 MG/ML (KETOROLAC TROMETHAMINE) INJ.

Facility

$33.00

Service Code	NDC 63323016200
Hospital Charge Code	2511780
Hospital Revenue Code	250
Min. Negotiated Rate	$15.25
Max. Negotiated Rate	$32.01
Rate for Payer: Cash Price	$24.75
Rate for Payer: Celtic Commercial/Exchange	$15.25
Rate for Payer: Health Partners Plans Commercial	$31.35
Rate for Payer: UnitedHealthcare Commercial	$32.01
Rate for Payer: WPPA Commercial	$27.72

TORADOL 60 MG/2 ML (KETOROLAC TROMETHAMINE) INJ.

Facility

$33.00

Service Code	NDC 25021070102
Hospital Charge Code	2514164
Hospital Revenue Code	250
Min. Negotiated Rate	$27.06
Max. Negotiated Rate	$32.01
Rate for Payer: Cash Price	$24.75
Rate for Payer: Health Partners Plans Commercial	$31.35
Rate for Payer: UnitedHealthcare Commercial	$32.01
Rate for Payer: WPPA Commercial	$27.06

TORADOL 60 MG/2 ML (KETOROLAC TROMETHAMINE) INJ.

Facility

$33.00

Service Code	NDC 25021070102
Hospital Charge Code	2514164
Hospital Revenue Code	250
Min. Negotiated Rate	$15.25
Max. Negotiated Rate	$32.01
Rate for Payer: Cash Price	$24.75
Rate for Payer: Celtic Commercial/Exchange	$15.25
Rate for Payer: Health Partners Plans Commercial	$31.35
Rate for Payer: UnitedHealthcare Commercial	$32.01
Rate for Payer: WPPA Commercial	$27.72

TOTAL CONTACT CAST - LEG

Facility

$247.00

Service Code	HCPCS 29445
Hospital Charge Code	2944523
Hospital Revenue Code	761
Min. Negotiated Rate	$202.54
Max. Negotiated Rate	$239.59
Rate for Payer: Cash Price	$185.25
Rate for Payer: Health Partners Plans Commercial	$234.65
Rate for Payer: UnitedHealthcare Commercial	$239.59
Rate for Payer: WPPA Commercial	$202.54

TOTAL CONTACT CAST - LEG

Facility

$247.00

Service Code	HCPCS 29445
Hospital Charge Code	2944523
Hospital Revenue Code	761
Min. Negotiated Rate	$87.18
Max. Negotiated Rate	$239.59
Rate for Payer: BCBS Commercial	$87.18
Rate for Payer: Cash Price	$185.25
Rate for Payer: Cash Price	$185.25
Rate for Payer: Celtic Commercial/Exchange	$114.11
Rate for Payer: Health Partners Plans Commercial	$234.65
Rate for Payer: UnitedHealthcare Commercial	$239.59
Rate for Payer: WPPA Commercial	$207.48

TOXIN/ANTITOXIN ASSY,TIS CULT.

Facility

$130.00

Service Code	HCPCS 87230
Hospital Charge Code	8723000
Hospital Revenue Code	306
Min. Negotiated Rate	$60.06
Max. Negotiated Rate	$126.10
Rate for Payer: BCBS Commercial	$74.17
Rate for Payer: Cash Price	$97.50
Rate for Payer: Cash Price	$97.50
Rate for Payer: Celtic Commercial/Exchange	$60.06
Rate for Payer: Health Partners Plans Commercial	$123.50
Rate for Payer: UnitedHealthcare Commercial	$126.10
Rate for Payer: WPPA Commercial	$109.20

TOXIN/ANTITOXIN ASSY,TIS CULT.

Facility

$130.00

Service Code	HCPCS 87230
Hospital Charge Code	8723000
Hospital Revenue Code	306
Min. Negotiated Rate	$106.60
Max. Negotiated Rate	$126.10
Rate for Payer: Cash Price	$97.50
Rate for Payer: Health Partners Plans Commercial	$123.50
Rate for Payer: UnitedHealthcare Commercial	$126.10
Rate for Payer: WPPA Commercial	$106.60

TPMP ACTIVITY

Facility

$300.00

Service Code	HCPCS 82657
Hospital Charge Code	8265700
Hospital Revenue Code	301
Min. Negotiated Rate	$246.00
Max. Negotiated Rate	$291.00
Rate for Payer: Cash Price	$225.00
Rate for Payer: Health Partners Plans Commercial	$285.00
Rate for Payer: UnitedHealthcare Commercial	$291.00
Rate for Payer: WPPA Commercial	$246.00

TPMP ACTIVITY

Facility

$300.00

Service Code	HCPCS 82657
Hospital Charge Code	8265700
Hospital Revenue Code	301
Min. Negotiated Rate	$53.11
Max. Negotiated Rate	$291.00
Rate for Payer: BCBS Commercial	$53.11
Rate for Payer: Cash Price	$225.00
Rate for Payer: Cash Price	$225.00
Rate for Payer: Celtic Commercial/Exchange	$138.60
Rate for Payer: Health Partners Plans Commercial	$285.00
Rate for Payer: UnitedHealthcare Commercial	$291.00
Rate for Payer: WPPA Commercial	$252.00

TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC

Facility

$36,184.33

Service Code	MSDRG 012
Min. Negotiated Rate	$36,184.33
Max. Negotiated Rate	$36,184.33
Rate for Payer: BCBS Commercial	$36,184.33

TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC

Facility

$48,519.59

Service Code	MSDRG 011
Min. Negotiated Rate	$48,519.59
Max. Negotiated Rate	$48,519.59
Rate for Payer: BCBS Commercial	$48,519.59

TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CC/MCC

Facility

$24,175.10

Service Code	MSDRG 013
Min. Negotiated Rate	$24,175.10
Max. Negotiated Rate	$24,175.10
Rate for Payer: BCBS Commercial	$24,175.10

TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES

Facility

$108,978.40

Service Code	MSDRG 004
Min. Negotiated Rate	$108,978.40
Max. Negotiated Rate	$108,978.40
Rate for Payer: BCBS Commercial	$108,978.40

TRACTION,PELV. & HOT/COLD PAKS

Facility

$127.00

Service Code	HCPCS 97012 GP
Hospital Charge Code	4200939
Hospital Revenue Code	420
Min. Negotiated Rate	$104.14
Max. Negotiated Rate	$123.19
Rate for Payer: Cash Price	$95.25
Rate for Payer: Health Partners Plans Commercial	$120.65
Rate for Payer: UnitedHealthcare Commercial	$123.19
Rate for Payer: WPPA Commercial	$104.14

TRACTION,PELV. & HOT/COLD PAKS

Facility

$127.00

Service Code	HCPCS 97012 GP
Hospital Charge Code	4200939
Hospital Revenue Code	420
Min. Negotiated Rate	$36.36
Max. Negotiated Rate	$123.19
Rate for Payer: BCBS Commercial	$36.36
Rate for Payer: Cash Price	$95.25
Rate for Payer: Cash Price	$95.25
Rate for Payer: Celtic Commercial/Exchange	$58.67
Rate for Payer: Health Partners Plans Commercial	$120.65
Rate for Payer: UnitedHealthcare Commercial	$123.19
Rate for Payer: WPPA Commercial	$106.68

Know your out-of-pocket cost for care.

All Charges