Ness County Hospital

All Charges

Charge

Type

Setting

Price

3D BILATERAL SCREENING MAMMO

Facility

$127.00

Service Code	HCPCS 77063
Hospital Charge Code	7706300
Hospital Revenue Code	403
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

3D BILATERAL SCREENING MAMMO

Facility

$127.00

Service Code	HCPCS 77063
Hospital Charge Code	7706300
Hospital Revenue Code	403
Min. Negotiated Rate	$58.67
Max. Negotiated Rate	$123.19
Rate for Payer: BCBS Commercial	$80.10
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

3 ML HEPARIN LOCK FLUSH (DAILY) PICC LINE

Facility

$70.00

Service Code	NDC 82903006423
Hospital Charge Code	2517878
Hospital Revenue Code	250
Min. Negotiated Rate	$57.40
Max. Negotiated Rate	$67.90
Rate for Payer: Cash Price	$52.50
Rate for Payer: Health Partners Plans Commercial	$66.50
Rate for Payer: UnitedHealthcare Commercial	$67.90
Rate for Payer: WPPA Commercial	$57.40

3 ML HEPARIN LOCK FLUSH (DAILY) PICC LINE

Facility

$70.00

Service Code	NDC 82903006423
Hospital Charge Code	2517878
Hospital Revenue Code	250
Min. Negotiated Rate	$32.34
Max. Negotiated Rate	$67.90
Rate for Payer: Cash Price	$52.50
Rate for Payer: Celtic Commercial/Exchange	$32.34
Rate for Payer: Health Partners Plans Commercial	$66.50
Rate for Payer: UnitedHealthcare Commercial	$67.90
Rate for Payer: WPPA Commercial	$58.80

3 PRONG LOOP FORCEPS DISP

Facility

$660.00

Hospital Charge Code	2706888
Hospital Revenue Code	270
Min. Negotiated Rate	$304.92
Max. Negotiated Rate	$640.20
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

3 PRONG LOOP FORCEPS DISP

Facility

$660.00

Hospital Charge Code	2706888
Hospital Revenue Code	270
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

3% Sodium Chloride 500 ML Injection

Facility

$65.00

Service Code	NDC 00264780510
Hospital Charge Code	2517217
Hospital Revenue Code	250
Min. Negotiated Rate	$30.03
Max. Negotiated Rate	$63.05
Rate for Payer: Cash Price	$49.09
Rate for Payer: Celtic Commercial/Exchange	$30.03
Rate for Payer: Health Partners Plans Commercial	$61.75
Rate for Payer: UnitedHealthcare Commercial	$63.05
Rate for Payer: WPPA Commercial	$54.60

3% Sodium Chloride 500 ML Injection

Facility

$65.00

Service Code	NDC 00264780510
Hospital Charge Code	2517217
Hospital Revenue Code	250
Min. Negotiated Rate	$53.30
Max. Negotiated Rate	$63.05
Rate for Payer: Cash Price	$49.09
Rate for Payer: Health Partners Plans Commercial	$61.75
Rate for Payer: UnitedHealthcare Commercial	$63.05
Rate for Payer: WPPA Commercial	$53.30

3 WAY COCK-UP

Facility

$5.00

Hospital Charge Code	2709112
Hospital Revenue Code	270
Min. Negotiated Rate	$4.10
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$3.75
Rate for Payer: Health Partners Plans Commercial	$4.75
Rate for Payer: UnitedHealthcare Commercial	$4.85
Rate for Payer: WPPA Commercial	$4.10

3 WAY COCK-UP

Facility

$5.00

Hospital Charge Code	2709112
Hospital Revenue Code	270
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$3.75
Rate for Payer: Celtic Commercial/Exchange	$2.31
Rate for Payer: Health Partners Plans Commercial	$4.75
Rate for Payer: UnitedHealthcare Commercial	$4.85
Rate for Payer: WPPA Commercial	$4.20

>41 ROUND TRIP MILES OF NC

Facility

$30.00

Hospital Charge Code	5710891
Hospital Revenue Code	990
Min. Negotiated Rate	$13.86
Max. Negotiated Rate	$29.10
Rate for Payer: Cash Price	$22.50
Rate for Payer: Celtic Commercial/Exchange	$13.86
Rate for Payer: Health Partners Plans Commercial	$28.50
Rate for Payer: UnitedHealthcare Commercial	$29.10
Rate for Payer: WPPA Commercial	$25.20

>41 ROUND TRIP MILES OF NC

Facility

$30.00

Hospital Charge Code	5710891
Hospital Revenue Code	990
Min. Negotiated Rate	$24.60
Max. Negotiated Rate	$29.10
Rate for Payer: Cash Price	$22.50
Rate for Payer: Health Partners Plans Commercial	$28.50
Rate for Payer: UnitedHealthcare Commercial	$29.10
Rate for Payer: WPPA Commercial	$24.60

4x4 2 PACK GAUZE

Facility

$9.00

Hospital Charge Code	2720803LTC
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

4x4 2 PACK GAUZE

Facility

$9.00

Hospital Charge Code	2720803LTC
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

4X4 NONSTERILE PKG

Facility

$23.00

Hospital Charge Code	2702272
Hospital Revenue Code	270
Min. Negotiated Rate	$10.63
Max. Negotiated Rate	$22.31
Rate for Payer: Cash Price	$17.74
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

4X4 NONSTERILE PKG

Facility

$23.00

Hospital Charge Code	2702272
Hospital Revenue Code	270
Min. Negotiated Rate	$18.86
Max. Negotiated Rate	$22.31
Rate for Payer: Cash Price	$17.74
Rate for Payer: Health Partners Plans Commercial	$21.85
Rate for Payer: UnitedHealthcare Commercial	$22.31
Rate for Payer: WPPA Commercial	$18.86

4X4 SPONGE 10 PK

Facility

$9.00

Hospital Charge Code	2720811
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

4X4 SPONGE 10 PK

Facility

$9.00

Hospital Charge Code	2720811
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

4X4 SPONGE 2 PK

Facility

$9.00

Hospital Charge Code	2720803
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

4X4 SPONGE 2 PK

Facility

$9.00

Hospital Charge Code	2720803
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

5.1TO7.5CM SIMPLE REPAIR/SUPER

Facility

$307.00

Service Code	HCPCS 12014
Hospital Charge Code	1201400
Hospital Revenue Code	450
Min. Negotiated Rate	$251.74
Max. Negotiated Rate	$297.79
Rate for Payer: Cash Price	$230.25
Rate for Payer: Health Partners Plans Commercial	$291.65
Rate for Payer: UnitedHealthcare Commercial	$297.79
Rate for Payer: WPPA Commercial	$251.74

5.1TO7.5CM SIMPLE REPAIR/SUPER

Facility

$307.00

Service Code	HCPCS 12014
Hospital Charge Code	1201400
Hospital Revenue Code	450
Min. Negotiated Rate	$141.83
Max. Negotiated Rate	$475.71
Rate for Payer: BCBS Commercial	$475.71
Rate for Payer: Cash Price	$230.25
Rate for Payer: Cash Price	$230.25
Rate for Payer: Celtic Commercial/Exchange	$141.83
Rate for Payer: Health Partners Plans Commercial	$291.65
Rate for Payer: UnitedHealthcare Commercial	$297.79
Rate for Payer: WPPA Commercial	$257.88

5 ML HEPARIN LOCK FLUSH (DAILY) PORT-A-CATH

Facility

$80.00

Service Code	NDC 82903006424
Hospital Charge Code	2517118
Hospital Revenue Code	250
Min. Negotiated Rate	$36.96
Max. Negotiated Rate	$77.60
Rate for Payer: Cash Price	$60.00
Rate for Payer: Celtic Commercial/Exchange	$36.96
Rate for Payer: Health Partners Plans Commercial	$76.00
Rate for Payer: UnitedHealthcare Commercial	$77.60
Rate for Payer: WPPA Commercial	$67.20

5 ML HEPARIN LOCK FLUSH (DAILY) PORT-A-CATH

Facility

$80.00

Service Code	NDC 82903006424
Hospital Charge Code	2517118
Hospital Revenue Code	250
Min. Negotiated Rate	$65.60
Max. Negotiated Rate	$77.60
Rate for Payer: Cash Price	$60.00
Rate for Payer: Health Partners Plans Commercial	$76.00
Rate for Payer: UnitedHealthcare Commercial	$77.60
Rate for Payer: WPPA Commercial	$65.60

5X5 BORDER GAUZE

Facility

$15.00

Hospital Charge Code	2725611
Hospital Revenue Code	272
Min. Negotiated Rate	$6.93
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$11.25
Rate for Payer: Celtic Commercial/Exchange	$6.93
Rate for Payer: Health Partners Plans Commercial	$14.25
Rate for Payer: UnitedHealthcare Commercial	$14.55
Rate for Payer: WPPA Commercial	$12.60

Know your out-of-pocket cost for care.

All Charges