Ness County Hospital

All Charges

Charge

Type

Setting

Price

CIPRO HC OTIC DROPS (CIPROFLOXACIN + HYDROCORTISONE)

Facility

$1,137.00

Service Code	NDC 00065853110
Hospital Charge Code	2509313
Hospital Revenue Code	250
Min. Negotiated Rate	$932.34
Max. Negotiated Rate	$1,102.89
Rate for Payer: Cash Price	$852.82
Rate for Payer: Health Partners Plans Commercial	$1,080.15
Rate for Payer: UnitedHealthcare Commercial	$1,102.89
Rate for Payer: WPPA Commercial	$932.34

CIPRO OPHTH. SOL. 0.3 %/5 ML (CIPROFLOXACIN HCL)

Facility

$141.00

Service Code	NDC 61314065605
Hospital Charge Code	2513687
Hospital Revenue Code	250
Min. Negotiated Rate	$115.62
Max. Negotiated Rate	$136.77
Rate for Payer: Cash Price	$106.46
Rate for Payer: Health Partners Plans Commercial	$133.95
Rate for Payer: UnitedHealthcare Commercial	$136.77
Rate for Payer: WPPA Commercial	$115.62

CIPRO OPHTH. SOL. 0.3 %/5 ML (CIPROFLOXACIN HCL)

Facility

$141.00

Service Code	NDC 61314065605
Hospital Charge Code	2513687
Hospital Revenue Code	250
Min. Negotiated Rate	$65.14
Max. Negotiated Rate	$136.77
Rate for Payer: Cash Price	$106.46
Rate for Payer: Celtic Commercial/Exchange	$65.14
Rate for Payer: Health Partners Plans Commercial	$133.95
Rate for Payer: UnitedHealthcare Commercial	$136.77
Rate for Payer: WPPA Commercial	$118.44

CIRCUIT DISP 22MM PASSIVE

Facility

$50.00

Hospital Charge Code	4100300
Hospital Revenue Code	272
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

CIRCUIT DISP 22MM PASSIVE

Facility

$50.00

Hospital Charge Code	4100300
Hospital Revenue Code	272
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

CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC

Facility

$19,154.59

Service Code	MSDRG 286
Min. Negotiated Rate	$19,154.59
Max. Negotiated Rate	$19,154.59
Rate for Payer: BCBS Commercial	$19,154.59

CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC

Facility

$10,337.02

Service Code	MSDRG 287
Min. Negotiated Rate	$10,337.02
Max. Negotiated Rate	$10,337.02
Rate for Payer: BCBS Commercial	$10,337.02

CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC

Facility

$10,342.92

Service Code	MSDRG 433
Min. Negotiated Rate	$10,342.92
Max. Negotiated Rate	$10,342.92
Rate for Payer: BCBS Commercial	$10,342.92

CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC

Facility

$16,863.73

Service Code	MSDRG 432
Min. Negotiated Rate	$16,863.73
Max. Negotiated Rate	$16,863.73
Rate for Payer: BCBS Commercial	$16,863.73

CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC

Facility

$6,721.12

Service Code	MSDRG 434
Min. Negotiated Rate	$6,721.12
Max. Negotiated Rate	$6,721.12
Rate for Payer: BCBS Commercial	$6,721.12

CITRACAL-VIT D3 MAXIMUM 315 MG/6.25 MCG (250 IU) (CALCIUM CITRATE+D) TAB

Facility

$3.00

Service Code	NDC 77333011325
Hospital Charge Code	2514222
Hospital Revenue Code	250
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.55
Rate for Payer: Health Partners Plans Commercial	$2.85
Rate for Payer: UnitedHealthcare Commercial	$2.91
Rate for Payer: WPPA Commercial	$2.46

CITRACAL-VIT D3 MAXIMUM 315 MG/6.25 MCG (250 IU) (CALCIUM CITRATE+D) TAB

Facility

$3.00

Service Code	NDC 77333011325
Hospital Charge Code	2514222
Hospital Revenue Code	250
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.55
Rate for Payer: Celtic Commercial/Exchange	$1.39
Rate for Payer: Health Partners Plans Commercial	$2.85
Rate for Payer: UnitedHealthcare Commercial	$2.91
Rate for Payer: WPPA Commercial	$2.52

CITRATE

Facility

$211.00

Service Code	HCPCS 82507
Hospital Charge Code	8250700
Hospital Revenue Code	301
Min. Negotiated Rate	$97.48
Max. Negotiated Rate	$204.67
Rate for Payer: BCBS Commercial	$99.90
Rate for Payer: Cash Price	$158.25
Rate for Payer: Cash Price	$158.25
Rate for Payer: Celtic Commercial/Exchange	$97.48
Rate for Payer: Health Partners Plans Commercial	$200.45
Rate for Payer: UnitedHealthcare Commercial	$204.67
Rate for Payer: WPPA Commercial	$177.24

CITRATE

Facility

$211.00

Service Code	HCPCS 82507
Hospital Charge Code	8250700
Hospital Revenue Code	301
Min. Negotiated Rate	$173.02
Max. Negotiated Rate	$204.67
Rate for Payer: Cash Price	$158.25
Rate for Payer: Health Partners Plans Commercial	$200.45
Rate for Payer: UnitedHealthcare Commercial	$204.67
Rate for Payer: WPPA Commercial	$173.02

CLARITIN 10 MG TAB (LORATADINE)

Facility

$5.00

Service Code	NDC 68084024811
Hospital Charge Code	2505170
Hospital Revenue Code	250
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$4.05
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

CLARITIN 10 MG TAB (LORATADINE)

Facility

$5.00

Service Code	NDC 68084024811
Hospital Charge Code	2505170
Hospital Revenue Code	250
Min. Negotiated Rate	$4.10
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$4.05
Rate for Payer: Health Partners Plans Commercial	$4.75
Rate for Payer: UnitedHealthcare Commercial	$4.85
Rate for Payer: WPPA Commercial	$4.10

CLAVE CONNECTOR

Facility

$35.00

Hospital Charge Code	2580561
Hospital Revenue Code	270
Min. Negotiated Rate	$28.70
Max. Negotiated Rate	$33.95
Rate for Payer: Cash Price	$26.25
Rate for Payer: Health Partners Plans Commercial	$33.25
Rate for Payer: UnitedHealthcare Commercial	$33.95
Rate for Payer: WPPA Commercial	$28.70

CLAVE CONNECTOR

Facility

$35.00

Hospital Charge Code	2580561
Hospital Revenue Code	270
Min. Negotiated Rate	$16.17
Max. Negotiated Rate	$33.95
Rate for Payer: Cash Price	$26.25
Rate for Payer: Celtic Commercial/Exchange	$16.17
Rate for Payer: Health Partners Plans Commercial	$33.25
Rate for Payer: UnitedHealthcare Commercial	$33.95
Rate for Payer: WPPA Commercial	$29.40

CLAVE EXTENSION SET

Facility

$45.00

Hospital Charge Code	2580677
Hospital Revenue Code	270
Min. Negotiated Rate	$20.79
Max. Negotiated Rate	$43.65
Rate for Payer: Cash Price	$33.75
Rate for Payer: Celtic Commercial/Exchange	$20.79
Rate for Payer: Health Partners Plans Commercial	$42.75
Rate for Payer: UnitedHealthcare Commercial	$43.65
Rate for Payer: WPPA Commercial	$37.80

CLAVE EXTENSION SET

Facility

$45.00

Hospital Charge Code	2580677
Hospital Revenue Code	270
Min. Negotiated Rate	$36.90
Max. Negotiated Rate	$43.65
Rate for Payer: Cash Price	$33.75
Rate for Payer: Health Partners Plans Commercial	$42.75
Rate for Payer: UnitedHealthcare Commercial	$43.65
Rate for Payer: WPPA Commercial	$36.90

CLAVICLE LT

Facility

$192.00

Service Code	HCPCS 73000 LT
Hospital Charge Code	3280029
Hospital Revenue Code	320
Min. Negotiated Rate	$157.44
Max. Negotiated Rate	$186.24
Rate for Payer: Cash Price	$144.00
Rate for Payer: Health Partners Plans Commercial	$182.40
Rate for Payer: UnitedHealthcare Commercial	$186.24
Rate for Payer: WPPA Commercial	$157.44

CLAVICLE LT

Facility

$192.00

Service Code	HCPCS 73000 LT
Hospital Charge Code	3280029
Hospital Revenue Code	320
Min. Negotiated Rate	$88.70
Max. Negotiated Rate	$186.24
Rate for Payer: BCBS Commercial	$114.29
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cash Price	$144.00
Rate for Payer: Celtic Commercial/Exchange	$88.70
Rate for Payer: Health Partners Plans Commercial	$182.40
Rate for Payer: UnitedHealthcare Commercial	$186.24
Rate for Payer: WPPA Commercial	$161.28

CLAVICLE RT

Facility

$192.00

Service Code	HCPCS 73000 RT
Hospital Charge Code	3280028
Hospital Revenue Code	320
Min. Negotiated Rate	$157.44
Max. Negotiated Rate	$186.24
Rate for Payer: Cash Price	$144.00
Rate for Payer: Health Partners Plans Commercial	$182.40
Rate for Payer: UnitedHealthcare Commercial	$186.24
Rate for Payer: WPPA Commercial	$157.44

CLAVICLE RT

Facility

$192.00

Service Code	HCPCS 73000 RT
Hospital Charge Code	3280028
Hospital Revenue Code	320
Min. Negotiated Rate	$88.70
Max. Negotiated Rate	$186.24
Rate for Payer: BCBS Commercial	$114.29
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cash Price	$144.00
Rate for Payer: Celtic Commercial/Exchange	$88.70
Rate for Payer: Health Partners Plans Commercial	$182.40
Rate for Payer: UnitedHealthcare Commercial	$186.24
Rate for Payer: WPPA Commercial	$161.28

CLAVICLE STRAP

Facility

$39.00

Hospital Charge Code	2701209
Hospital Revenue Code	270
Min. Negotiated Rate	$31.98
Max. Negotiated Rate	$37.83
Rate for Payer: Cash Price	$29.62
Rate for Payer: Health Partners Plans Commercial	$37.05
Rate for Payer: UnitedHealthcare Commercial	$37.83
Rate for Payer: WPPA Commercial	$31.98

Know your out-of-pocket cost for care.

All Charges