Ness County Hospital

All Charges

Charge

Type

Setting

Price

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

CHEMO HORMON ANTINEOPL SQ/IM

Facility

$100.00

Service Code	HCPCS 96402
Hospital Charge Code	9640200
Hospital Revenue Code	760
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

CHEMO HORMON ANTINEOPL SQ/IM

Facility

$100.00

Service Code	HCPCS 96402
Hospital Charge Code	9640200
Hospital Revenue Code	760
Min. Negotiated Rate	$35.35
Max. Negotiated Rate	$97.00
Rate for Payer: BCBS Commercial	$35.35
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

CHEMOTHERAPY INTRACAVITARY

Facility

$350.00

Service Code	HCPCS 96440
Hospital Charge Code	9644000
Hospital Revenue Code	761
Min. Negotiated Rate	$287.00
Max. Negotiated Rate	$339.50
Rate for Payer: Cash Price	$262.50
Rate for Payer: Health Partners Plans Commercial	$332.50
Rate for Payer: UnitedHealthcare Commercial	$339.50
Rate for Payer: WPPA Commercial	$287.00

CHEMOTHERAPY INTRACAVITARY

Facility

$350.00

Service Code	HCPCS 96440
Hospital Charge Code	9644000
Hospital Revenue Code	761
Min. Negotiated Rate	$161.70
Max. Negotiated Rate	$339.50
Rate for Payer: Cash Price	$262.50
Rate for Payer: Celtic Commercial/Exchange	$161.70
Rate for Payer: Health Partners Plans Commercial	$332.50
Rate for Payer: UnitedHealthcare Commercial	$339.50
Rate for Payer: WPPA Commercial	$294.00

CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC

Facility

$50,093.07

Service Code	MSDRG 837
Min. Negotiated Rate	$50,093.07
Max. Negotiated Rate	$50,093.07
Rate for Payer: BCBS Commercial	$50,093.07

CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT

Facility

$19,558.40

Service Code	MSDRG 838
Min. Negotiated Rate	$19,558.40
Max. Negotiated Rate	$19,558.40
Rate for Payer: BCBS Commercial	$19,558.40

CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC

Facility

$10,034.06

Service Code	MSDRG 839
Min. Negotiated Rate	$10,034.06
Max. Negotiated Rate	$10,034.06
Rate for Payer: BCBS Commercial	$10,034.06

CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC

Facility

$12,329.65

Service Code	MSDRG 847
Min. Negotiated Rate	$12,329.65
Max. Negotiated Rate	$12,329.65
Rate for Payer: BCBS Commercial	$12,329.65

CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC

Facility

$23,723.34

Service Code	MSDRG 846
Min. Negotiated Rate	$23,723.34
Max. Negotiated Rate	$23,723.34
Rate for Payer: BCBS Commercial	$23,723.34

CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC

Facility

$8,834.68

Service Code	MSDRG 848
Min. Negotiated Rate	$8,834.68
Max. Negotiated Rate	$8,834.68
Rate for Payer: BCBS Commercial	$8,834.68

CHEMOTX ADMIN PRTL CAVITY

Facility

$350.00

Service Code	HCPCS 96446
Hospital Charge Code	9644600
Hospital Revenue Code	761
Min. Negotiated Rate	$287.00
Max. Negotiated Rate	$339.50
Rate for Payer: Cash Price	$262.50
Rate for Payer: Health Partners Plans Commercial	$332.50
Rate for Payer: UnitedHealthcare Commercial	$339.50
Rate for Payer: WPPA Commercial	$287.00

CHEMOTX ADMIN PRTL CAVITY

Facility

$350.00

Service Code	HCPCS 96446
Hospital Charge Code	9644600
Hospital Revenue Code	761
Min. Negotiated Rate	$161.70
Max. Negotiated Rate	$339.50
Rate for Payer: Cash Price	$262.50
Rate for Payer: Celtic Commercial/Exchange	$161.70
Rate for Payer: Health Partners Plans Commercial	$332.50
Rate for Payer: UnitedHealthcare Commercial	$339.50
Rate for Payer: WPPA Commercial	$294.00

CHEST 1 VIEW

Facility

$208.00

Service Code	HCPCS 71045
Hospital Charge Code	3240002
Hospital Revenue Code	320
Min. Negotiated Rate	$96.10
Max. Negotiated Rate	$201.76
Rate for Payer: BCBS Commercial	$123.58
Rate for Payer: Cash Price	$156.00
Rate for Payer: Cash Price	$156.00
Rate for Payer: Celtic Commercial/Exchange	$96.10
Rate for Payer: Health Partners Plans Commercial	$197.60
Rate for Payer: UnitedHealthcare Commercial	$201.76
Rate for Payer: WPPA Commercial	$174.72

CHEST 1 VIEW

Facility

$208.00

Service Code	HCPCS 71045
Hospital Charge Code	3240002
Hospital Revenue Code	320
Min. Negotiated Rate	$170.56
Max. Negotiated Rate	$201.76
Rate for Payer: Cash Price	$156.00
Rate for Payer: Health Partners Plans Commercial	$197.60
Rate for Payer: UnitedHealthcare Commercial	$201.76
Rate for Payer: WPPA Commercial	$170.56

CHEST 2 VIEWS

Facility

$276.00

Service Code	HCPCS 71046
Hospital Charge Code	3240004
Hospital Revenue Code	320
Min. Negotiated Rate	$226.32
Max. Negotiated Rate	$267.72
Rate for Payer: Cash Price	$207.00
Rate for Payer: Health Partners Plans Commercial	$262.20
Rate for Payer: UnitedHealthcare Commercial	$267.72
Rate for Payer: WPPA Commercial	$226.32

CHEST 2 VIEWS

Facility

$276.00

Service Code	HCPCS 71046
Hospital Charge Code	3240004
Hospital Revenue Code	320
Min. Negotiated Rate	$127.51
Max. Negotiated Rate	$267.72
Rate for Payer: BCBS Commercial	$150.77
Rate for Payer: Cash Price	$207.00
Rate for Payer: Cash Price	$207.00
Rate for Payer: Celtic Commercial/Exchange	$127.51
Rate for Payer: Health Partners Plans Commercial	$262.20
Rate for Payer: UnitedHealthcare Commercial	$267.72
Rate for Payer: WPPA Commercial	$231.84

CHEST 3 VIEWS

Facility

$366.00

Service Code	HCPCS 71047
Hospital Charge Code	3240008
Hospital Revenue Code	320
Min. Negotiated Rate	$300.12
Max. Negotiated Rate	$355.02
Rate for Payer: Cash Price	$274.50
Rate for Payer: Health Partners Plans Commercial	$347.70
Rate for Payer: UnitedHealthcare Commercial	$355.02
Rate for Payer: WPPA Commercial	$300.12

CHEST 3 VIEWS

Facility

$366.00

Service Code	HCPCS 71047
Hospital Charge Code	3240008
Hospital Revenue Code	320
Min. Negotiated Rate	$156.95
Max. Negotiated Rate	$355.02
Rate for Payer: BCBS Commercial	$156.95
Rate for Payer: Cash Price	$274.50
Rate for Payer: Cash Price	$274.50
Rate for Payer: Celtic Commercial/Exchange	$169.09
Rate for Payer: Health Partners Plans Commercial	$347.70
Rate for Payer: UnitedHealthcare Commercial	$355.02
Rate for Payer: WPPA Commercial	$307.44

CHEST PAIN

Facility

$6,798.71

Service Code	MSDRG 313
Min. Negotiated Rate	$6,798.71
Max. Negotiated Rate	$6,798.71
Rate for Payer: BCBS Commercial	$6,798.71

CHEST WALL MANIP,CUPP,PERCUSS

Facility

$180.00

Service Code	HCPCS 94668 59
Hospital Charge Code	9466800
Hospital Revenue Code	410
Min. Negotiated Rate	$83.16
Max. Negotiated Rate	$174.60
Rate for Payer: BCBS Commercial	$161.13
Rate for Payer: Cash Price	$135.00
Rate for Payer: Cash Price	$135.00
Rate for Payer: Celtic Commercial/Exchange	$83.16
Rate for Payer: Health Partners Plans Commercial	$171.00
Rate for Payer: UnitedHealthcare Commercial	$174.60
Rate for Payer: WPPA Commercial	$151.20

CHEST WALL MANIP,CUPP,PERCUSS

Facility

$180.00

Service Code	HCPCS 94668 59
Hospital Charge Code	9466800
Hospital Revenue Code	410
Min. Negotiated Rate	$147.60
Max. Negotiated Rate	$174.60
Rate for Payer: Cash Price	$135.00
Rate for Payer: Health Partners Plans Commercial	$171.00
Rate for Payer: UnitedHealthcare Commercial	$174.60
Rate for Payer: WPPA Commercial	$147.60

CHILD ARM SLING

Facility

$31.00

Hospital Charge Code	2700987
Hospital Revenue Code	270
Min. Negotiated Rate	$25.42
Max. Negotiated Rate	$30.07
Rate for Payer: Cash Price	$23.62
Rate for Payer: Health Partners Plans Commercial	$29.45
Rate for Payer: UnitedHealthcare Commercial	$30.07
Rate for Payer: WPPA Commercial	$25.42

CHILD ARM SLING

Facility

$31.00

Hospital Charge Code	2700987
Hospital Revenue Code	270
Min. Negotiated Rate	$14.32
Max. Negotiated Rate	$30.07
Rate for Payer: Cash Price	$23.62
Rate for Payer: Celtic Commercial/Exchange	$14.32
Rate for Payer: Health Partners Plans Commercial	$29.45
Rate for Payer: UnitedHealthcare Commercial	$30.07
Rate for Payer: WPPA Commercial	$26.04

CHILDREN'S DELSYM COUGH 12-HR OS (DEXTROMETHORPAN POLISTIREX ER)

Facility

$1.00

Service Code	NDC 63824017365
Hospital Charge Code	2519429
Hospital Revenue Code	250
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$1.16
Rate for Payer: Health Partners Plans Commercial	$0.95
Rate for Payer: UnitedHealthcare Commercial	$0.97
Rate for Payer: WPPA Commercial	$0.82

Know your out-of-pocket cost for care.

All Charges