Ness County Hospital

All Charges

Charge

Type

Setting

Price

CANALITH REPOSITIONING,PER DAY

Facility

$65.00

Service Code	HCPCS 95992 GP
Hospital Charge Code	4200916
Hospital Revenue Code	420
Min. Negotiated Rate	$30.03
Max. Negotiated Rate	$63.05
Rate for Payer: BCBS Commercial	$40.14
Rate for Payer: Cash Price	$48.75
Rate for Payer: Cash Price	$48.75
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

CANALITH REPOSITION PROC-EPLEY

Facility

$107.00

Service Code	HCPCS 95992 GP
Hospital Charge Code	4202378
Hospital Revenue Code	420
Min. Negotiated Rate	$40.14
Max. Negotiated Rate	$103.79
Rate for Payer: BCBS Commercial	$40.14
Rate for Payer: Cash Price	$80.25
Rate for Payer: Cash Price	$80.25
Rate for Payer: Celtic Commercial/Exchange	$49.43
Rate for Payer: Health Partners Plans Commercial	$101.65
Rate for Payer: UnitedHealthcare Commercial	$103.79
Rate for Payer: WPPA Commercial	$89.88

CANALITH REPOSITION PROC-EPLEY

Facility

$107.00

Service Code	HCPCS 95992 GP
Hospital Charge Code	4202378
Hospital Revenue Code	420
Min. Negotiated Rate	$87.74
Max. Negotiated Rate	$103.79
Rate for Payer: Cash Price	$80.25
Rate for Payer: Health Partners Plans Commercial	$101.65
Rate for Payer: UnitedHealthcare Commercial	$103.79
Rate for Payer: WPPA Commercial	$87.74

CANDIDA ANTIGEN DETECTION

Facility

$60.00

Service Code	HCPCS 86403
Hospital Charge Code	8640301
Hospital Revenue Code	302
Min. Negotiated Rate	$21.88
Max. Negotiated Rate	$58.20
Rate for Payer: BCBS Commercial	$21.88
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Celtic Commercial/Exchange	$27.72
Rate for Payer: Health Partners Plans Commercial	$57.00
Rate for Payer: UnitedHealthcare Commercial	$58.20
Rate for Payer: WPPA Commercial	$50.40

CANDIDA ANTIGEN DETECTION

Facility

$60.00

Service Code	HCPCS 86403
Hospital Charge Code	8640301
Hospital Revenue Code	302
Min. Negotiated Rate	$49.20
Max. Negotiated Rate	$58.20
Rate for Payer: Cash Price	$45.00
Rate for Payer: Health Partners Plans Commercial	$57.00
Rate for Payer: UnitedHealthcare Commercial	$58.20
Rate for Payer: WPPA Commercial	$49.20

CANISTER LINER

Facility

$11.00

Hospital Charge Code	2700094
Hospital Revenue Code	270
Min. Negotiated Rate	$5.08
Max. Negotiated Rate	$10.67
Rate for Payer: Cash Price	$8.25
Rate for Payer: Celtic Commercial/Exchange	$5.08
Rate for Payer: Health Partners Plans Commercial	$10.45
Rate for Payer: UnitedHealthcare Commercial	$10.67
Rate for Payer: WPPA Commercial	$9.24

CANISTER LINER

Facility

$11.00

Hospital Charge Code	2700094
Hospital Revenue Code	270
Min. Negotiated Rate	$9.02
Max. Negotiated Rate	$10.67
Rate for Payer: Cash Price	$8.25
Rate for Payer: Health Partners Plans Commercial	$10.45
Rate for Payer: UnitedHealthcare Commercial	$10.67
Rate for Payer: WPPA Commercial	$9.02

CANNABOINOIDS, NATURAL

Facility

$124.00

Service Code	HCPCS 80349
Hospital Charge Code	8034900
Hospital Revenue Code	301
Min. Negotiated Rate	$101.68
Max. Negotiated Rate	$120.28
Rate for Payer: Cash Price	$93.00
Rate for Payer: Health Partners Plans Commercial	$117.80
Rate for Payer: UnitedHealthcare Commercial	$120.28
Rate for Payer: WPPA Commercial	$101.68

CANNABOINOIDS, NATURAL

Facility

$124.00

Service Code	HCPCS 80349
Hospital Charge Code	8034900
Hospital Revenue Code	301
Min. Negotiated Rate	$23.88
Max. Negotiated Rate	$120.28
Rate for Payer: BCBS Commercial	$23.88
Rate for Payer: Cash Price	$93.00
Rate for Payer: Cash Price	$93.00
Rate for Payer: Celtic Commercial/Exchange	$57.29
Rate for Payer: Health Partners Plans Commercial	$117.80
Rate for Payer: UnitedHealthcare Commercial	$120.28
Rate for Payer: WPPA Commercial	$104.16

CANNULA-NASAL ADULT

Facility

$15.00

Hospital Charge Code	4100160
Hospital Revenue Code	270
Min. Negotiated Rate	$12.30
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$11.25
Rate for Payer: Health Partners Plans Commercial	$14.25
Rate for Payer: UnitedHealthcare Commercial	$14.55
Rate for Payer: WPPA Commercial	$12.30

CANNULA-NASAL ADULT

Facility

$15.00

Hospital Charge Code	4100160
Hospital Revenue Code	270
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

CANNULA-NASAL (PEDS)

Facility

$4.00

Hospital Charge Code	4100178
Hospital Revenue Code	270
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$3.00
Rate for Payer: Celtic Commercial/Exchange	$1.85
Rate for Payer: Health Partners Plans Commercial	$3.80
Rate for Payer: UnitedHealthcare Commercial	$3.88
Rate for Payer: WPPA Commercial	$3.36

CANNULA-NASAL (PEDS)

Facility

$4.00

Hospital Charge Code	4100178
Hospital Revenue Code	270
Min. Negotiated Rate	$3.28
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$3.00
Rate for Payer: Health Partners Plans Commercial	$3.80
Rate for Payer: UnitedHealthcare Commercial	$3.88
Rate for Payer: WPPA Commercial	$3.28

CANOPIES MAXICOIL

Facility

$27.00

Hospital Charge Code	4100186
Hospital Revenue Code	270
Min. Negotiated Rate	$12.47
Max. Negotiated Rate	$26.19
Rate for Payer: Cash Price	$20.62
Rate for Payer: Celtic Commercial/Exchange	$12.47
Rate for Payer: Health Partners Plans Commercial	$25.65
Rate for Payer: UnitedHealthcare Commercial	$26.19
Rate for Payer: WPPA Commercial	$22.68

CANOPIES MAXICOIL

Facility

$27.00

Hospital Charge Code	4100186
Hospital Revenue Code	270
Min. Negotiated Rate	$22.14
Max. Negotiated Rate	$26.19
Rate for Payer: Cash Price	$20.62
Rate for Payer: Health Partners Plans Commercial	$25.65
Rate for Payer: UnitedHealthcare Commercial	$26.19
Rate for Payer: WPPA Commercial	$22.14

Canthotomy

Facility

$275.00

Service Code	HCPCS 67715
Hospital Charge Code	6771500
Hospital Revenue Code	450
Min. Negotiated Rate	$127.05
Max. Negotiated Rate	$266.75
Rate for Payer: Cash Price	$206.25
Rate for Payer: Celtic Commercial/Exchange	$127.05
Rate for Payer: Health Partners Plans Commercial	$261.25
Rate for Payer: UnitedHealthcare Commercial	$266.75
Rate for Payer: WPPA Commercial	$231.00

Canthotomy

Facility

$275.00

Service Code	HCPCS 67715
Hospital Charge Code	6771500
Hospital Revenue Code	450
Min. Negotiated Rate	$225.50
Max. Negotiated Rate	$266.75
Rate for Payer: Cash Price	$206.25
Rate for Payer: Health Partners Plans Commercial	$261.25
Rate for Payer: UnitedHealthcare Commercial	$266.75
Rate for Payer: WPPA Commercial	$225.50

CAPNOLINE SMART O2 PLUS

Facility

$34.00

Hospital Charge Code	2708146
Hospital Revenue Code	270
Min. Negotiated Rate	$27.88
Max. Negotiated Rate	$32.98
Rate for Payer: Cash Price	$25.50
Rate for Payer: Health Partners Plans Commercial	$32.30
Rate for Payer: UnitedHealthcare Commercial	$32.98
Rate for Payer: WPPA Commercial	$27.88

CAPNOLINE SMART O2 PLUS

Facility

$34.00

Hospital Charge Code	2708146
Hospital Revenue Code	270
Min. Negotiated Rate	$15.71
Max. Negotiated Rate	$32.98
Rate for Payer: Cash Price	$25.50
Rate for Payer: Celtic Commercial/Exchange	$15.71
Rate for Payer: Health Partners Plans Commercial	$32.30
Rate for Payer: UnitedHealthcare Commercial	$32.98
Rate for Payer: WPPA Commercial	$28.56

CARAFATE 10 ML SUSPENSION (SUCRALFATE)

Facility

$42.00

Service Code	NDC 50268074511
Hospital Charge Code	2512788
Hospital Revenue Code	250
Min. Negotiated Rate	$34.44
Max. Negotiated Rate	$40.74
Rate for Payer: Cash Price	$31.54
Rate for Payer: Health Partners Plans Commercial	$39.90
Rate for Payer: UnitedHealthcare Commercial	$40.74
Rate for Payer: WPPA Commercial	$34.44

CARAFATE 10 ML SUSPENSION (SUCRALFATE)

Facility

$42.00

Service Code	NDC 50268074511
Hospital Charge Code	2512788
Hospital Revenue Code	250
Min. Negotiated Rate	$19.40
Max. Negotiated Rate	$40.74
Rate for Payer: Cash Price	$31.54
Rate for Payer: Celtic Commercial/Exchange	$19.40
Rate for Payer: Health Partners Plans Commercial	$39.90
Rate for Payer: UnitedHealthcare Commercial	$40.74
Rate for Payer: WPPA Commercial	$35.28

CARAFATE 1GM TAB (SUCRALFATE)

Facility

$6.00

Service Code	NDC 60687069511
Hospital Charge Code	2501229
Hospital Revenue Code	250
Min. Negotiated Rate	$2.77
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$4.50
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

CARAFATE 1GM TAB (SUCRALFATE)

Facility

$6.00

Service Code	NDC 60687069511
Hospital Charge Code	2501229
Hospital Revenue Code	250
Min. Negotiated Rate	$4.92
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$4.50
Rate for Payer: Health Partners Plans Commercial	$5.70
Rate for Payer: UnitedHealthcare Commercial	$5.82
Rate for Payer: WPPA Commercial	$4.92

CARBAMAZEPINE TOTAL

Facility

$93.00

Service Code	HCPCS 80156
Hospital Charge Code	8015600
Hospital Revenue Code	301
Min. Negotiated Rate	$42.97
Max. Negotiated Rate	$91.63
Rate for Payer: BCBS Commercial	$91.63
Rate for Payer: Cash Price	$69.75
Rate for Payer: Cash Price	$69.75
Rate for Payer: Celtic Commercial/Exchange	$42.97
Rate for Payer: Health Partners Plans Commercial	$88.35
Rate for Payer: UnitedHealthcare Commercial	$90.21
Rate for Payer: WPPA Commercial	$78.12

CARBAMAZEPINE TOTAL

Facility

$93.00

Service Code	HCPCS 80156
Hospital Charge Code	8015600
Hospital Revenue Code	301
Min. Negotiated Rate	$76.26
Max. Negotiated Rate	$90.21
Rate for Payer: Cash Price	$69.75
Rate for Payer: Health Partners Plans Commercial	$88.35
Rate for Payer: UnitedHealthcare Commercial	$90.21
Rate for Payer: WPPA Commercial	$76.26

Know your out-of-pocket cost for care.

All Charges