Ness County Hospital

All Charges

Charge

Type

Setting

Price

BACKCHECK SET IV

Facility

$62.00

Hospital Charge Code	2580199
Hospital Revenue Code	270
Min. Negotiated Rate	$28.64
Max. Negotiated Rate	$60.14
Rate for Payer: Cash Price	$46.95
Rate for Payer: Celtic Commercial/Exchange	$28.64
Rate for Payer: Health Partners Plans Commercial	$58.90
Rate for Payer: UnitedHealthcare Commercial	$60.14
Rate for Payer: WPPA Commercial	$52.08

BACKCHECK SET IV

Facility

$62.00

Hospital Charge Code	2580199
Hospital Revenue Code	270
Min. Negotiated Rate	$50.84
Max. Negotiated Rate	$60.14
Rate for Payer: Cash Price	$46.95
Rate for Payer: Health Partners Plans Commercial	$58.90
Rate for Payer: UnitedHealthcare Commercial	$60.14
Rate for Payer: WPPA Commercial	$50.84

BACKCHECK VALVE

Facility

$5.00

Hospital Charge Code	2709159
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

BACKCHECK VALVE

Facility

$5.00

Hospital Charge Code	2709159
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

BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC

Facility

$22,253.57

Service Code	MSDRG 095
Min. Negotiated Rate	$22,253.57
Max. Negotiated Rate	$22,253.57
Rate for Payer: BCBS Commercial	$22,253.57

BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC

Facility

$32,288.20

Service Code	MSDRG 094
Min. Negotiated Rate	$32,288.20
Max. Negotiated Rate	$32,288.20
Rate for Payer: BCBS Commercial	$32,288.20

BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC

Facility

$20,703.89

Service Code	MSDRG 096
Min. Negotiated Rate	$20,703.89
Max. Negotiated Rate	$20,703.89
Rate for Payer: BCBS Commercial	$20,703.89

BACTERIAL VIRAL FILTER

Facility

$5.00

Hospital Charge Code	2702257
Hospital Revenue Code	272
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

BACTERIAL VIRAL FILTER

Facility

$5.00

Hospital Charge Code	2702257
Hospital Revenue Code	272
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

BACTRIM OS (SULFAMETHOXAOLE/TRIMETHOPRIM) 20 ML U.D.

Facility

$28.00

Service Code	NDC 00121085416
Hospital Charge Code	2511251
Hospital Revenue Code	250
Min. Negotiated Rate	$12.94
Max. Negotiated Rate	$27.16
Rate for Payer: Cash Price	$21.08
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

BACTRIM OS (SULFAMETHOXAOLE/TRIMETHOPRIM) 20 ML U.D.

Facility

$28.00

Service Code	NDC 00121085416
Hospital Charge Code	2511251
Hospital Revenue Code	250
Min. Negotiated Rate	$22.96
Max. Negotiated Rate	$27.16
Rate for Payer: Cash Price	$21.08
Rate for Payer: Health Partners Plans Commercial	$26.60
Rate for Payer: UnitedHealthcare Commercial	$27.16
Rate for Payer: WPPA Commercial	$22.96

BACTRIM SS TAB (SULFA/TRIMETH-400/80 MG TAB)

Facility

$2.00

Service Code	NDC 60687060311
Hospital Charge Code	2519221
Hospital Revenue Code	250
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.50
Rate for Payer: Celtic Commercial/Exchange	$0.92
Rate for Payer: Health Partners Plans Commercial	$1.90
Rate for Payer: UnitedHealthcare Commercial	$1.94
Rate for Payer: WPPA Commercial	$1.68

BACTRIM SS TAB (SULFA/TRIMETH-400/80 MG TAB)

Facility

$2.00

Service Code	NDC 60687060311
Hospital Charge Code	2519221
Hospital Revenue Code	250
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.50
Rate for Payer: Health Partners Plans Commercial	$1.90
Rate for Payer: UnitedHealthcare Commercial	$1.94
Rate for Payer: WPPA Commercial	$1.64

BACTROBAN 2% OINTMENT-22GM(MUPIROCIN)

Facility

$142.00

Service Code	NDC 45802011222
Hospital Charge Code	2512051
Hospital Revenue Code	250
Min. Negotiated Rate	$116.44
Max. Negotiated Rate	$137.74
Rate for Payer: Cash Price	$106.91
Rate for Payer: Health Partners Plans Commercial	$134.90
Rate for Payer: UnitedHealthcare Commercial	$137.74
Rate for Payer: WPPA Commercial	$116.44

BACTROBAN 2% OINTMENT-22GM(MUPIROCIN)

Facility

$142.00

Service Code	NDC 45802011222
Hospital Charge Code	2512051
Hospital Revenue Code	250
Min. Negotiated Rate	$65.60
Max. Negotiated Rate	$137.74
Rate for Payer: Cash Price	$106.91
Rate for Payer: Celtic Commercial/Exchange	$65.60
Rate for Payer: Health Partners Plans Commercial	$134.90
Rate for Payer: UnitedHealthcare Commercial	$137.74
Rate for Payer: WPPA Commercial	$119.28

Bactroban (Mupirocin) 2% UNIT DOSE Tube

Facility

$12.00

Service Code	NDC 51672131201
Hospital Charge Code	2512358
Hospital Revenue Code	250
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$11.64
Rate for Payer: Cash Price	$9.68
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

Bactroban (Mupirocin) 2% UNIT DOSE Tube

Facility

$12.00

Service Code	NDC 51672131201
Hospital Charge Code	2512358
Hospital Revenue Code	250
Min. Negotiated Rate	$9.84
Max. Negotiated Rate	$11.64
Rate for Payer: Cash Price	$9.68
Rate for Payer: Health Partners Plans Commercial	$11.40
Rate for Payer: UnitedHealthcare Commercial	$11.64
Rate for Payer: WPPA Commercial	$9.84

BAIR HUGGER WARMING BLANKET

Facility

$25.00

Hospital Charge Code	2706899
Hospital Revenue Code	272
Min. Negotiated Rate	$20.50
Max. Negotiated Rate	$24.25
Rate for Payer: Cash Price	$18.75
Rate for Payer: Health Partners Plans Commercial	$23.75
Rate for Payer: UnitedHealthcare Commercial	$24.25
Rate for Payer: WPPA Commercial	$20.50

BAIR HUGGER WARMING BLANKET

Facility

$25.00

Hospital Charge Code	2706899
Hospital Revenue Code	272
Min. Negotiated Rate	$11.55
Max. Negotiated Rate	$24.25
Rate for Payer: Cash Price	$18.75
Rate for Payer: Celtic Commercial/Exchange	$11.55
Rate for Payer: Health Partners Plans Commercial	$23.75
Rate for Payer: UnitedHealthcare Commercial	$24.25
Rate for Payer: WPPA Commercial	$21.00

BALLOON DILATATION DEVICE

Facility

$900.00

Hospital Charge Code	2706143
Hospital Revenue Code	272
Min. Negotiated Rate	$415.80
Max. Negotiated Rate	$873.00
Rate for Payer: Cash Price	$675.00
Rate for Payer: Celtic Commercial/Exchange	$415.80
Rate for Payer: Health Partners Plans Commercial	$855.00
Rate for Payer: UnitedHealthcare Commercial	$873.00
Rate for Payer: WPPA Commercial	$756.00

BALLOON DILATATION DEVICE

Facility

$828.00

Hospital Charge Code	2706142
Hospital Revenue Code	270
Min. Negotiated Rate	$678.96
Max. Negotiated Rate	$803.16
Rate for Payer: Cash Price	$621.00
Rate for Payer: Health Partners Plans Commercial	$786.60
Rate for Payer: UnitedHealthcare Commercial	$803.16
Rate for Payer: WPPA Commercial	$678.96

BALLOON DILATATION DEVICE

Facility

$900.00

Hospital Charge Code	2706143
Hospital Revenue Code	272
Min. Negotiated Rate	$738.00
Max. Negotiated Rate	$873.00
Rate for Payer: Cash Price	$675.00
Rate for Payer: Health Partners Plans Commercial	$855.00
Rate for Payer: UnitedHealthcare Commercial	$873.00
Rate for Payer: WPPA Commercial	$738.00

BALLOON DILATATION DEVICE

Facility

$828.00

Hospital Charge Code	2706142
Hospital Revenue Code	270
Min. Negotiated Rate	$382.54
Max. Negotiated Rate	$803.16
Rate for Payer: Cash Price	$621.00
Rate for Payer: Celtic Commercial/Exchange	$382.54
Rate for Payer: Health Partners Plans Commercial	$786.60
Rate for Payer: UnitedHealthcare Commercial	$803.16
Rate for Payer: WPPA Commercial	$695.52

BANDAGE EZE-BAND 3" S-CLOSE

Facility

$9.00

Hospital Charge Code	2725060
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

BANDAGE EZE-BAND 3" S-CLOSE

Facility

$9.00

Hospital Charge Code	2725060
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

Know your out-of-pocket cost for care.

All Charges