Ness County Hospital

All Charges

Charge

Type

Setting

Price

U-BAG PED SPECIMAN COLLECTOR

Facility

$10.00

Hospital Charge Code	2720282
Hospital Revenue Code	272
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

U-BAG PED SPECIMAN COLLECTOR

Facility

$10.00

Hospital Charge Code	2720282
Hospital Revenue Code	272
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

UDENYCA 6MG SQ (PEGFILGRASTIM-CBQV) SYRINGE

Facility

$15,030.00

Service Code	NDC 70114010101
Hospital Charge Code	2511046
Hospital Revenue Code	250
Min. Negotiated Rate	$12,324.60
Max. Negotiated Rate	$14,579.10
Rate for Payer: Cash Price	$11,272.50
Rate for Payer: Health Partners Plans Commercial	$14,278.50
Rate for Payer: UnitedHealthcare Commercial	$14,579.10
Rate for Payer: WPPA Commercial	$12,324.60

UDENYCA 6MG SQ (PEGFILGRASTIM-CBQV) SYRINGE

Facility

$15,030.00

Service Code	NDC 70114010101
Hospital Charge Code	2511046
Hospital Revenue Code	250
Min. Negotiated Rate	$6,943.86
Max. Negotiated Rate	$14,579.10
Rate for Payer: Cash Price	$11,272.50
Rate for Payer: Celtic Commercial/Exchange	$6,943.86
Rate for Payer: Health Partners Plans Commercial	$14,278.50
Rate for Payer: UnitedHealthcare Commercial	$14,579.10
Rate for Payer: WPPA Commercial	$12,625.20

ULORIC 40 MG TAB

Facility

$36.00

Hospital Charge Code	2518744
Hospital Revenue Code	250
Min. Negotiated Rate	$29.52
Max. Negotiated Rate	$34.92
Rate for Payer: Cash Price	$27.22
Rate for Payer: Health Partners Plans Commercial	$34.20
Rate for Payer: UnitedHealthcare Commercial	$34.92
Rate for Payer: WPPA Commercial	$29.52

ULORIC 40 MG TAB

Facility

$36.00

Hospital Charge Code	2518744
Hospital Revenue Code	250
Min. Negotiated Rate	$16.63
Max. Negotiated Rate	$34.92
Rate for Payer: Cash Price	$27.22
Rate for Payer: Celtic Commercial/Exchange	$16.63
Rate for Payer: Health Partners Plans Commercial	$34.20
Rate for Payer: UnitedHealthcare Commercial	$34.92
Rate for Payer: WPPA Commercial	$30.24

ULTRACET 37.5/325 TAB (TRAMADOL HYDROCHLORIDE + ACETAMINOPHEN)

Facility

$3.00

Service Code	NDC 50268077415
Hospital Charge Code	2516227
Hospital Revenue Code	250
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.66
Rate for Payer: Health Partners Plans Commercial	$2.85
Rate for Payer: UnitedHealthcare Commercial	$2.91
Rate for Payer: WPPA Commercial	$2.46

ULTRACET 37.5/325 TAB (TRAMADOL HYDROCHLORIDE + ACETAMINOPHEN)

Facility

$3.00

Service Code	NDC 50268077415
Hospital Charge Code	2516227
Hospital Revenue Code	250
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.66
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

ULTRAM 50 MG TAB (TRAMADOL HCL)

Facility

$3.00

Service Code	NDC 60687079511
Hospital Charge Code	2514102
Hospital Revenue Code	250
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.25
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

ULTRAM 50 MG TAB (TRAMADOL HCL)

Facility

$3.00

Service Code	NDC 60687079511
Hospital Charge Code	2514102
Hospital Revenue Code	250
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.25
Rate for Payer: Health Partners Plans Commercial	$2.85
Rate for Payer: UnitedHealthcare Commercial	$2.91
Rate for Payer: WPPA Commercial	$2.46

ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITH MCC

Facility

$47,577.63

Service Code	MSDRG 278
Min. Negotiated Rate	$47,577.63
Max. Negotiated Rate	$47,577.63
Rate for Payer: BCBS Commercial	$47,577.63

ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITHOUT MCC

Facility

$33,907.06

Service Code	MSDRG 279
Min. Negotiated Rate	$33,907.06
Max. Negotiated Rate	$33,907.06
Rate for Payer: BCBS Commercial	$33,907.06

ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS WITH PRINCIPAL DIAGNOSIS PULMONARY EMBOLISM

Facility

$32,576.45

Service Code	MSDRG 173
Min. Negotiated Rate	$32,576.45
Max. Negotiated Rate	$32,576.45
Rate for Payer: BCBS Commercial	$32,576.45

ULTRASOUND & HOT/COLD PACKS

Facility

$136.00

Service Code	HCPCS 97035 GP
Hospital Charge Code	4200087
Hospital Revenue Code	420
Min. Negotiated Rate	$111.52
Max. Negotiated Rate	$131.92
Rate for Payer: Cash Price	$102.00
Rate for Payer: Health Partners Plans Commercial	$129.20
Rate for Payer: UnitedHealthcare Commercial	$131.92
Rate for Payer: WPPA Commercial	$111.52

ULTRASOUND & HOT/COLD PACKS

Facility

$136.00

Service Code	HCPCS 97035 GP
Hospital Charge Code	4200087
Hospital Revenue Code	420
Min. Negotiated Rate	$29.29
Max. Negotiated Rate	$131.92
Rate for Payer: BCBS Commercial	$29.29
Rate for Payer: Cash Price	$102.00
Rate for Payer: Cash Price	$102.00
Rate for Payer: Celtic Commercial/Exchange	$62.83
Rate for Payer: Health Partners Plans Commercial	$129.20
Rate for Payer: UnitedHealthcare Commercial	$131.92
Rate for Payer: WPPA Commercial	$114.24

ULTRASOUND, PER 15 MIN.

Facility

$88.00

Service Code	HCPCS 97035 GP
Hospital Charge Code	4200077
Hospital Revenue Code	420
Min. Negotiated Rate	$29.29
Max. Negotiated Rate	$85.36
Rate for Payer: BCBS Commercial	$29.29
Rate for Payer: Cash Price	$66.00
Rate for Payer: Cash Price	$66.00
Rate for Payer: Celtic Commercial/Exchange	$40.66
Rate for Payer: Health Partners Plans Commercial	$83.60
Rate for Payer: UnitedHealthcare Commercial	$85.36
Rate for Payer: WPPA Commercial	$73.92

ULTRASOUND, PER 15 MIN.

Facility

$88.00

Service Code	HCPCS 97035 GP
Hospital Charge Code	4200077
Hospital Revenue Code	420
Min. Negotiated Rate	$72.16
Max. Negotiated Rate	$85.36
Rate for Payer: Cash Price	$66.00
Rate for Payer: Health Partners Plans Commercial	$83.60
Rate for Payer: UnitedHealthcare Commercial	$85.36
Rate for Payer: WPPA Commercial	$72.16

ULTRASOUND, PER 15 MIN.

Facility

$100.00

Service Code	HCPCS 97035 GO
Hospital Charge Code	9703500
Hospital Revenue Code	430
Min. Negotiated Rate	$29.29
Max. Negotiated Rate	$97.00
Rate for Payer: BCBS Commercial	$29.29
Rate for Payer: Cash Price	$75.00
Rate for Payer: Cash Price	$75.00
Rate for Payer: Celtic Commercial/Exchange	$46.20
Rate for Payer: Health Partners Plans Commercial	$95.00
Rate for Payer: UnitedHealthcare Commercial	$97.00
Rate for Payer: WPPA Commercial	$84.00

ULTRASOUND, PER 15 MIN.

Facility

$100.00

Service Code	HCPCS 97035 GO
Hospital Charge Code	9703500
Hospital Revenue Code	430
Min. Negotiated Rate	$82.00
Max. Negotiated Rate	$97.00
Rate for Payer: Cash Price	$75.00
Rate for Payer: Health Partners Plans Commercial	$95.00
Rate for Payer: UnitedHealthcare Commercial	$97.00
Rate for Payer: WPPA Commercial	$82.00

UNCOMPLICATED PEPTIC ULCER WITH MCC

Facility

$10,485.77

Service Code	MSDRG 383
Min. Negotiated Rate	$10,485.77
Max. Negotiated Rate	$10,485.77
Rate for Payer: BCBS Commercial	$10,485.77

UNCOMPLICATED PEPTIC ULCER WITHOUT MCC

Facility

$7,924.03

Service Code	MSDRG 384
Min. Negotiated Rate	$7,924.03
Max. Negotiated Rate	$7,924.03
Rate for Payer: BCBS Commercial	$7,924.03

UNIVERSAL ARM SLING

Facility

$55.00

Hospital Charge Code	2701837
Hospital Revenue Code	270
Min. Negotiated Rate	$25.41
Max. Negotiated Rate	$53.35
Rate for Payer: Cash Price	$41.25
Rate for Payer: Celtic Commercial/Exchange	$25.41
Rate for Payer: Health Partners Plans Commercial	$52.25
Rate for Payer: UnitedHealthcare Commercial	$53.35
Rate for Payer: WPPA Commercial	$46.20

UNIVERSAL ARM SLING

Facility

$55.00

Hospital Charge Code	2701837
Hospital Revenue Code	270
Min. Negotiated Rate	$45.10
Max. Negotiated Rate	$53.35
Rate for Payer: Cash Price	$41.25
Rate for Payer: Health Partners Plans Commercial	$52.25
Rate for Payer: UnitedHealthcare Commercial	$53.35
Rate for Payer: WPPA Commercial	$45.10

UNIVERSAL FOAM CERVICAL COLLAR

Facility

$35.00

Hospital Charge Code	2701183
Hospital Revenue Code	270
Min. Negotiated Rate	$28.70
Max. Negotiated Rate	$33.95
Rate for Payer: Cash Price	$26.44
Rate for Payer: Health Partners Plans Commercial	$33.25
Rate for Payer: UnitedHealthcare Commercial	$33.95
Rate for Payer: WPPA Commercial	$28.70

UNIVERSAL FOAM CERVICAL COLLAR

Facility

$35.00

Hospital Charge Code	2701183
Hospital Revenue Code	270
Min. Negotiated Rate	$16.17
Max. Negotiated Rate	$33.95
Rate for Payer: Cash Price	$26.44
Rate for Payer: Celtic Commercial/Exchange	$16.17
Rate for Payer: Health Partners Plans Commercial	$33.25
Rate for Payer: UnitedHealthcare Commercial	$33.95
Rate for Payer: WPPA Commercial	$29.40

Know your out-of-pocket cost for care.

All Charges