Ness County Hospital

All Charges

Charge

Type

Setting

Price

WALKER MAXTRAX 2.0 AIR TALL MEDIUM

Facility

$136.00

Hospital Charge Code	2702397
Hospital Revenue Code	270
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

WALKER MAXTRAX 2.0 AIR TALL SMALL

Facility

$136.00

Hospital Charge Code	2702396
Hospital Revenue Code	270
Min. Negotiated Rate	$62.83
Max. Negotiated Rate	$131.92
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

WALKER MAXTRAX 2.0 AIR TALL SMALL

Facility

$136.00

Hospital Charge Code	2702396
Hospital Revenue Code	270
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

WALKER MAXTRAX 2.0 AIR TALL XLARGE

Facility

$136.00

Hospital Charge Code	2702399
Hospital Revenue Code	270
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

WALKER MAXTRAX 2.0 AIR TALL XLARGE

Facility

$136.00

Hospital Charge Code	2702399
Hospital Revenue Code	270
Min. Negotiated Rate	$62.83
Max. Negotiated Rate	$131.92
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

WALKER MAXTRAX 2.0 AIR TALL XSMALL

Facility

$136.00

Hospital Charge Code	2702395
Hospital Revenue Code	270
Min. Negotiated Rate	$62.83
Max. Negotiated Rate	$131.92
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

WALKER MAXTRAX 2.0 AIR TALL XSMALL

Facility

$136.00

Hospital Charge Code	2702395
Hospital Revenue Code	270
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

WATERMELON (RF329) IGE

Facility

$28.00

Service Code	HCPCS 86003
Hospital Charge Code	8600305
Hospital Revenue Code	302
Min. Negotiated Rate	$12.94
Max. Negotiated Rate	$27.16
Rate for Payer: BCBS Commercial	$15.51
Rate for Payer: Cash Price	$21.00
Rate for Payer: Cash Price	$21.00
Rate for Payer: Celtic Commercial/Exchange	$12.94
Rate for Payer: Health Partners Plans Commercial	$26.60
Rate for Payer: UnitedHealthcare Commercial	$27.16
Rate for Payer: WPPA Commercial	$23.52

WATERMELON (RF329) IGE

Facility

$28.00

Service Code	HCPCS 86003
Hospital Charge Code	8600305
Hospital Revenue Code	302
Min. Negotiated Rate	$22.96
Max. Negotiated Rate	$27.16
Rate for Payer: Cash Price	$21.00
Rate for Payer: Health Partners Plans Commercial	$26.60
Rate for Payer: UnitedHealthcare Commercial	$27.16
Rate for Payer: WPPA Commercial	$22.96

WATER STERILE 500 ML IRRIGATION

Facility

$19.00

Service Code	NDC 00338000403
Hospital Charge Code	2517134
Hospital Revenue Code	250
Min. Negotiated Rate	$8.78
Max. Negotiated Rate	$18.43
Rate for Payer: Cash Price	$14.31
Rate for Payer: Celtic Commercial/Exchange	$8.78
Rate for Payer: Health Partners Plans Commercial	$18.05
Rate for Payer: UnitedHealthcare Commercial	$18.43
Rate for Payer: WPPA Commercial	$15.96

WATER STERILE 500 ML IRRIGATION

Facility

$19.00

Service Code	NDC 00338000403
Hospital Charge Code	2517134
Hospital Revenue Code	250
Min. Negotiated Rate	$15.58
Max. Negotiated Rate	$18.43
Rate for Payer: Cash Price	$14.31
Rate for Payer: Health Partners Plans Commercial	$18.05
Rate for Payer: UnitedHealthcare Commercial	$18.43
Rate for Payer: WPPA Commercial	$15.58

Water sterile for inj. 10 ml

Facility

$10.00

Service Code	NDC 00409488710
Hospital Charge Code	2507911
Hospital Revenue Code	250
Min. Negotiated Rate	$8.20
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$7.50
Rate for Payer: Health Partners Plans Commercial	$9.50
Rate for Payer: UnitedHealthcare Commercial	$9.70
Rate for Payer: WPPA Commercial	$8.20

Water sterile for inj. 10 ml

Facility

$10.00

Service Code	NDC 00409488710
Hospital Charge Code	2507911
Hospital Revenue Code	250
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$7.50
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

Water sterile for inj. - 20 ml

Facility

$10.00

Service Code	NDC 00409488720
Hospital Charge Code	2508000
Hospital Revenue Code	250
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$7.50
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

Water sterile for inj. - 20 ml

Facility

$10.00

Service Code	NDC 00409488720
Hospital Charge Code	2508000
Hospital Revenue Code	250
Min. Negotiated Rate	$8.20
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$7.50
Rate for Payer: Health Partners Plans Commercial	$9.50
Rate for Payer: UnitedHealthcare Commercial	$9.70
Rate for Payer: WPPA Commercial	$8.20

WC Dress/debride burns w/o anes; small

Facility

$150.00

Service Code	HCPCS 16020
Hospital Charge Code	16020WC
Hospital Revenue Code	983
Min. Negotiated Rate	$123.00
Max. Negotiated Rate	$145.50
Rate for Payer: Cash Price	$112.50
Rate for Payer: Health Partners Plans Commercial	$142.50
Rate for Payer: UnitedHealthcare Commercial	$145.50
Rate for Payer: WPPA Commercial	$123.00

WC Dress/debride burns w/o anes; small

Facility

$150.00

Service Code	HCPCS 16020
Hospital Charge Code	16020WC
Hospital Revenue Code	983
Min. Negotiated Rate	$69.30
Max. Negotiated Rate	$371.68
Rate for Payer: BCBS Commercial	$371.68
Rate for Payer: Cash Price	$112.50
Rate for Payer: Cash Price	$112.50
Rate for Payer: Celtic Commercial/Exchange	$69.30
Rate for Payer: Health Partners Plans Commercial	$142.50
Rate for Payer: UnitedHealthcare Commercial	$145.50
Rate for Payer: WPPA Commercial	$126.00

WEEKEND AIDE VISIT-PER 1/4 HR

Facility

$10.00

Service Code	HCPCS G0156
Hospital Charge Code	5710829
Hospital Revenue Code	570
Min. Negotiated Rate	$8.20
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$7.50
Rate for Payer: Health Partners Plans Commercial	$9.50
Rate for Payer: UnitedHealthcare Commercial	$9.70
Rate for Payer: WPPA Commercial	$8.20

WEEKEND AIDE VISIT-PER 1/4 HR

Facility

$10.00

Service Code	HCPCS G0156
Hospital Charge Code	5710829
Hospital Revenue Code	570
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$7.50
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

WEEKEND SKLD NURSE VISIT-1/4HR

Facility

$20.00

Hospital Charge Code	5710820
Hospital Revenue Code	550
Min. Negotiated Rate	$9.24
Max. Negotiated Rate	$19.40
Rate for Payer: Cash Price	$15.00
Rate for Payer: Celtic Commercial/Exchange	$9.24
Rate for Payer: Health Partners Plans Commercial	$19.00
Rate for Payer: UnitedHealthcare Commercial	$19.40
Rate for Payer: WPPA Commercial	$16.80

WEEKEND SKLD NURSE VISIT-1/4HR

Facility

$20.00

Hospital Charge Code	5710820
Hospital Revenue Code	550
Min. Negotiated Rate	$16.40
Max. Negotiated Rate	$19.40
Rate for Payer: Cash Price	$15.00
Rate for Payer: Health Partners Plans Commercial	$19.00
Rate for Payer: UnitedHealthcare Commercial	$19.40
Rate for Payer: WPPA Commercial	$16.40

WELLBUTRIN XL 150 MG TAB (BUPROPION HCL XL)

Facility

$56.00

Service Code	NDC 00904708404
Hospital Charge Code	2516672
Hospital Revenue Code	250
Min. Negotiated Rate	$45.92
Max. Negotiated Rate	$54.32
Rate for Payer: Cash Price	$42.11
Rate for Payer: Health Partners Plans Commercial	$53.20
Rate for Payer: UnitedHealthcare Commercial	$54.32
Rate for Payer: WPPA Commercial	$45.92

WELLBUTRIN XL 150 MG TAB (BUPROPION HCL XL)

Facility

$56.00

Service Code	NDC 00904708404
Hospital Charge Code	2516672
Hospital Revenue Code	250
Min. Negotiated Rate	$25.87
Max. Negotiated Rate	$54.32
Rate for Payer: Cash Price	$42.11
Rate for Payer: Celtic Commercial/Exchange	$25.87
Rate for Payer: Health Partners Plans Commercial	$53.20
Rate for Payer: UnitedHealthcare Commercial	$54.32
Rate for Payer: WPPA Commercial	$47.04

WHEELCHAIR

Facility

$500.00

Hospital Charge Code	5710364
Hospital Revenue Code	292
Min. Negotiated Rate	$231.00
Max. Negotiated Rate	$485.00
Rate for Payer: Cash Price	$375.00
Rate for Payer: Celtic Commercial/Exchange	$231.00
Rate for Payer: Health Partners Plans Commercial	$475.00
Rate for Payer: UnitedHealthcare Commercial	$485.00
Rate for Payer: WPPA Commercial	$420.00

WHEELCHAIR

Facility

$500.00

Hospital Charge Code	5710364
Hospital Revenue Code	292
Min. Negotiated Rate	$410.00
Max. Negotiated Rate	$485.00
Rate for Payer: Cash Price	$375.00
Rate for Payer: Health Partners Plans Commercial	$475.00
Rate for Payer: UnitedHealthcare Commercial	$485.00
Rate for Payer: WPPA Commercial	$410.00

Know your out-of-pocket cost for care.

All Charges