Ness County Hospital

All Charges

Charge

Type

Setting

Price

CETAPHIL LOTION

Facility

$24.00

Service Code	NDC 00299392116
Hospital Charge Code	2513505
Hospital Revenue Code	250
Min. Negotiated Rate	$19.68
Max. Negotiated Rate	$23.28
Rate for Payer: Cash Price	$18.67
Rate for Payer: Health Partners Plans Commercial	$22.80
Rate for Payer: UnitedHealthcare Commercial	$23.28
Rate for Payer: WPPA Commercial	$19.68

CETAPHIL LOTION

Facility

$24.00

Service Code	NDC 00299392116
Hospital Charge Code	2513505
Hospital Revenue Code	250
Min. Negotiated Rate	$11.09
Max. Negotiated Rate	$23.28
Rate for Payer: Cash Price	$18.67
Rate for Payer: Celtic Commercial/Exchange	$11.09
Rate for Payer: Health Partners Plans Commercial	$22.80
Rate for Payer: UnitedHealthcare Commercial	$23.28
Rate for Payer: WPPA Commercial	$20.16

CHAIR ALARM

Facility

$50.00

Hospital Charge Code	9991100
Hospital Revenue Code	990
Min. Negotiated Rate	$41.00
Max. Negotiated Rate	$48.50
Rate for Payer: Cash Price	$37.50
Rate for Payer: Health Partners Plans Commercial	$47.50
Rate for Payer: UnitedHealthcare Commercial	$48.50
Rate for Payer: WPPA Commercial	$41.00

CHAIR ALARM

Facility

$80.00

Hospital Charge Code	2707168
Hospital Revenue Code	270
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

CHAIR ALARM

Facility

$50.00

Hospital Charge Code	9991100
Hospital Revenue Code	990
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$48.50
Rate for Payer: Cash Price	$37.50
Rate for Payer: Celtic Commercial/Exchange	$23.10
Rate for Payer: Health Partners Plans Commercial	$47.50
Rate for Payer: UnitedHealthcare Commercial	$48.50
Rate for Payer: WPPA Commercial	$42.00

CHAIR ALARM

Facility

$80.00

Hospital Charge Code	2707168
Hospital Revenue Code	270
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

CHAIR MONITOR

Facility

$105.00

Hospital Charge Code	2707079
Hospital Revenue Code	270
Min. Negotiated Rate	$48.51
Max. Negotiated Rate	$101.85
Rate for Payer: Cash Price	$78.75
Rate for Payer: Celtic Commercial/Exchange	$48.51
Rate for Payer: Health Partners Plans Commercial	$99.75
Rate for Payer: UnitedHealthcare Commercial	$101.85
Rate for Payer: WPPA Commercial	$88.20

CHAIR MONITOR

Facility

$105.00

Hospital Charge Code	2707079
Hospital Revenue Code	270
Min. Negotiated Rate	$86.10
Max. Negotiated Rate	$101.85
Rate for Payer: Cash Price	$78.75
Rate for Payer: Health Partners Plans Commercial	$99.75
Rate for Payer: UnitedHealthcare Commercial	$101.85
Rate for Payer: WPPA Commercial	$86.10

CHAIR MONITOR PAD

Facility

$33.00

Hospital Charge Code	2707169
Hospital Revenue Code	270
Min. Negotiated Rate	$15.25
Max. Negotiated Rate	$32.01
Rate for Payer: Cash Price	$25.31
Rate for Payer: Celtic Commercial/Exchange	$15.25
Rate for Payer: Health Partners Plans Commercial	$31.35
Rate for Payer: UnitedHealthcare Commercial	$32.01
Rate for Payer: WPPA Commercial	$27.72

CHAIR MONITOR PAD

Facility

$33.00

Hospital Charge Code	2707169
Hospital Revenue Code	270
Min. Negotiated Rate	$27.06
Max. Negotiated Rate	$32.01
Rate for Payer: Cash Price	$25.31
Rate for Payer: Health Partners Plans Commercial	$31.35
Rate for Payer: UnitedHealthcare Commercial	$32.01
Rate for Payer: WPPA Commercial	$27.06

CHANGE CYSTOSTOMY TUBE-SIMPLE

Facility

$272.00

Service Code	HCPCS 51705
Hospital Charge Code	5170500
Hospital Revenue Code	761
Min. Negotiated Rate	$223.04
Max. Negotiated Rate	$263.84
Rate for Payer: Cash Price	$204.00
Rate for Payer: Health Partners Plans Commercial	$258.40
Rate for Payer: UnitedHealthcare Commercial	$263.84
Rate for Payer: WPPA Commercial	$223.04

CHANGE CYSTOSTOMY TUBE-SIMPLE

Facility

$272.00

Service Code	HCPCS 51705
Hospital Charge Code	5170500
Hospital Revenue Code	761
Min. Negotiated Rate	$125.66
Max. Negotiated Rate	$304.01
Rate for Payer: BCBS Commercial	$304.01
Rate for Payer: Cash Price	$204.00
Rate for Payer: Cash Price	$204.00
Rate for Payer: Celtic Commercial/Exchange	$125.66
Rate for Payer: Health Partners Plans Commercial	$258.40
Rate for Payer: UnitedHealthcare Commercial	$263.84
Rate for Payer: WPPA Commercial	$228.48

CHANGE OF GASTROSTOMY TUBE

Facility

$700.00

Service Code	HCPCS 43760
Hospital Charge Code	4376000
Hospital Revenue Code	761
Min. Negotiated Rate	$323.40
Max. Negotiated Rate	$679.00
Rate for Payer: Cash Price	$525.00
Rate for Payer: Celtic Commercial/Exchange	$323.40
Rate for Payer: Health Partners Plans Commercial	$665.00
Rate for Payer: UnitedHealthcare Commercial	$679.00
Rate for Payer: WPPA Commercial	$588.00

CHANGE OF GASTROSTOMY TUBE

Facility

$700.00

Service Code	HCPCS 43760
Hospital Charge Code	4376000
Hospital Revenue Code	761
Min. Negotiated Rate	$574.00
Max. Negotiated Rate	$679.00
Rate for Payer: Cash Price	$525.00
Rate for Payer: Health Partners Plans Commercial	$665.00
Rate for Payer: UnitedHealthcare Commercial	$679.00
Rate for Payer: WPPA Commercial	$574.00

CHARCOAL ACTIVATED ORAL

Facility

$50.00

Service Code	NDC 00574052174
Hospital Charge Code	2501351
Hospital Revenue Code	250
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$48.50
Rate for Payer: Cash Price	$37.61
Rate for Payer: Celtic Commercial/Exchange	$23.10
Rate for Payer: Health Partners Plans Commercial	$47.50
Rate for Payer: UnitedHealthcare Commercial	$48.50
Rate for Payer: WPPA Commercial	$42.00

CHARCOAL ACTIVATED ORAL

Facility

$50.00

Service Code	NDC 00574052174
Hospital Charge Code	2501351
Hospital Revenue Code	250
Min. Negotiated Rate	$41.00
Max. Negotiated Rate	$48.50
Rate for Payer: Cash Price	$37.61
Rate for Payer: Health Partners Plans Commercial	$47.50
Rate for Payer: UnitedHealthcare Commercial	$48.50
Rate for Payer: WPPA Commercial	$41.00

CHEMICAL CAUTERY OF TISSUE

Facility

$418.00

Service Code	HCPCS 17250
Hospital Charge Code	1725023
Hospital Revenue Code	761
Min. Negotiated Rate	$342.76
Max. Negotiated Rate	$405.46
Rate for Payer: Cash Price	$313.50
Rate for Payer: Health Partners Plans Commercial	$397.10
Rate for Payer: UnitedHealthcare Commercial	$405.46
Rate for Payer: WPPA Commercial	$342.76

CHEMICAL CAUTERY OF TISSUE

Facility

$418.00

Service Code	HCPCS 17250
Hospital Charge Code	1725023
Hospital Revenue Code	761
Min. Negotiated Rate	$193.12
Max. Negotiated Rate	$405.46
Rate for Payer: BCBS Commercial	$388.85
Rate for Payer: Cash Price	$313.50
Rate for Payer: Cash Price	$313.50
Rate for Payer: Celtic Commercial/Exchange	$193.12
Rate for Payer: Health Partners Plans Commercial	$397.10
Rate for Payer: UnitedHealthcare Commercial	$405.46
Rate for Payer: WPPA Commercial	$351.12

CHEMILUMINESCENT ASSAY

Facility

$105.00

Service Code	HCPCS 82397
Hospital Charge Code	8239700
Hospital Revenue Code	301
Min. Negotiated Rate	$40.93
Max. Negotiated Rate	$101.85
Rate for Payer: BCBS Commercial	$40.93
Rate for Payer: Cash Price	$78.75
Rate for Payer: Cash Price	$78.75
Rate for Payer: Celtic Commercial/Exchange	$48.51
Rate for Payer: Health Partners Plans Commercial	$99.75
Rate for Payer: UnitedHealthcare Commercial	$101.85
Rate for Payer: WPPA Commercial	$88.20

CHEMILUMINESCENT ASSAY

Facility

$105.00

Service Code	HCPCS 82397
Hospital Charge Code	8239700
Hospital Revenue Code	301
Min. Negotiated Rate	$86.10
Max. Negotiated Rate	$101.85
Rate for Payer: Cash Price	$78.75
Rate for Payer: Health Partners Plans Commercial	$99.75
Rate for Payer: UnitedHealthcare Commercial	$101.85
Rate for Payer: WPPA Commercial	$86.10

CHEMO ADMIN-IV INFUS-ADDTL HRS

Facility

$196.00

Service Code	HCPCS 96415
Hospital Charge Code	9641500
Hospital Revenue Code	761
Min. Negotiated Rate	$160.72
Max. Negotiated Rate	$190.12
Rate for Payer: Cash Price	$147.00
Rate for Payer: Health Partners Plans Commercial	$186.20
Rate for Payer: UnitedHealthcare Commercial	$190.12
Rate for Payer: WPPA Commercial	$160.72

CHEMO ADMIN-IV INFUS-ADDTL HRS

Facility

$196.00

Service Code	HCPCS 96415
Hospital Charge Code	9641500
Hospital Revenue Code	761
Min. Negotiated Rate	$90.55
Max. Negotiated Rate	$195.94
Rate for Payer: BCBS Commercial	$195.94
Rate for Payer: Cash Price	$147.00
Rate for Payer: Cash Price	$147.00
Rate for Payer: Celtic Commercial/Exchange	$90.55
Rate for Payer: Health Partners Plans Commercial	$186.20
Rate for Payer: UnitedHealthcare Commercial	$190.12
Rate for Payer: WPPA Commercial	$164.64

CHEMO ADMIN,IV INFUSION, 1 HR

Facility

$359.00

Service Code	HCPCS 96413
Hospital Charge Code	9641300
Hospital Revenue Code	761
Min. Negotiated Rate	$294.38
Max. Negotiated Rate	$348.23
Rate for Payer: Cash Price	$269.25
Rate for Payer: Health Partners Plans Commercial	$341.05
Rate for Payer: UnitedHealthcare Commercial	$348.23
Rate for Payer: WPPA Commercial	$294.38

CHEMO ADMIN,IV INFUSION, 1 HR

Facility

$359.00

Service Code	HCPCS 96413
Hospital Charge Code	9641300
Hospital Revenue Code	761
Min. Negotiated Rate	$165.86
Max. Negotiated Rate	$358.20
Rate for Payer: BCBS Commercial	$358.20
Rate for Payer: Cash Price	$269.25
Rate for Payer: Cash Price	$269.25
Rate for Payer: Celtic Commercial/Exchange	$165.86
Rate for Payer: Health Partners Plans Commercial	$341.05
Rate for Payer: UnitedHealthcare Commercial	$348.23
Rate for Payer: WPPA Commercial	$301.56

CHEMO ADM, SQ/IM, NONHORMONAL

Facility

$100.00

Service Code	HCPCS 96401
Hospital Charge Code	9640100
Hospital Revenue Code	760
Min. Negotiated Rate	$46.20
Max. Negotiated Rate	$97.00
Rate for Payer: BCBS Commercial	$83.90
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

Know your out-of-pocket cost for care.

All Charges