Ness County Hospital

All Charges

Charge

Type

Setting

Price

ACIDOPHILUS CAP (LACTOBACILLUS/PROBIOTIC)

Facility

$1.00

Service Code	NDC 77333000415
Hospital Charge Code	2516532
Hospital Revenue Code	250
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$1.20
Rate for Payer: Health Partners Plans Commercial	$0.95
Rate for Payer: UnitedHealthcare Commercial	$0.97
Rate for Payer: WPPA Commercial	$0.82

ACIDOPHILUS CAP (LACTOBACILLUS/PROBIOTIC)

Facility

$1.00

Service Code	NDC 77333000415
Hospital Charge Code	2516532
Hospital Revenue Code	250
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$1.20
Rate for Payer: Celtic Commercial/Exchange	$0.46
Rate for Payer: Health Partners Plans Commercial	$0.95
Rate for Payer: UnitedHealthcare Commercial	$0.97
Rate for Payer: WPPA Commercial	$0.84

AC JOINTS BIL W OR W/O WGT

Facility

$190.00

Service Code	HCPCS 73050
Hospital Charge Code	3280030
Hospital Revenue Code	320
Min. Negotiated Rate	$155.80
Max. Negotiated Rate	$184.30
Rate for Payer: Cash Price	$142.50
Rate for Payer: Health Partners Plans Commercial	$180.50
Rate for Payer: UnitedHealthcare Commercial	$184.30
Rate for Payer: WPPA Commercial	$155.80

AC JOINTS BIL W OR W/O WGT

Facility

$190.00

Service Code	HCPCS 73050
Hospital Charge Code	3280030
Hospital Revenue Code	320
Min. Negotiated Rate	$87.78
Max. Negotiated Rate	$184.30
Rate for Payer: BCBS Commercial	$146.81
Rate for Payer: Cash Price	$142.50
Rate for Payer: Cash Price	$142.50
Rate for Payer: Celtic Commercial/Exchange	$87.78
Rate for Payer: Health Partners Plans Commercial	$180.50
Rate for Payer: UnitedHealthcare Commercial	$184.30
Rate for Payer: WPPA Commercial	$159.60

ACNE SURGERY

Facility

$250.00

Service Code	HCPCS 10040
Hospital Charge Code	1004000
Hospital Revenue Code	761
Min. Negotiated Rate	$115.50
Max. Negotiated Rate	$248.38
Rate for Payer: BCBS Commercial	$248.38
Rate for Payer: Cash Price	$187.50
Rate for Payer: Cash Price	$187.50
Rate for Payer: Celtic Commercial/Exchange	$115.50
Rate for Payer: Health Partners Plans Commercial	$237.50
Rate for Payer: UnitedHealthcare Commercial	$242.50
Rate for Payer: WPPA Commercial	$210.00

ACNE SURGERY

Facility

$250.00

Service Code	HCPCS 10040
Hospital Charge Code	1004000
Hospital Revenue Code	761
Min. Negotiated Rate	$205.00
Max. Negotiated Rate	$242.50
Rate for Payer: Cash Price	$187.50
Rate for Payer: Health Partners Plans Commercial	$237.50
Rate for Payer: UnitedHealthcare Commercial	$242.50
Rate for Payer: WPPA Commercial	$205.00

Activase 100 mg IV (alteplase)

Facility

$31,681.00

Service Code	NDC 50242008527
Hospital Charge Code	2519155
Hospital Revenue Code	250
Min. Negotiated Rate	$14,636.62
Max. Negotiated Rate	$30,730.57
Rate for Payer: Cash Price	$23,761.35
Rate for Payer: Celtic Commercial/Exchange	$14,636.62
Rate for Payer: Health Partners Plans Commercial	$30,096.95
Rate for Payer: UnitedHealthcare Commercial	$30,730.57
Rate for Payer: WPPA Commercial	$26,612.04

Activase 100 mg IV (alteplase)

Facility

$31,681.00

Service Code	NDC 50242008527
Hospital Charge Code	2519155
Hospital Revenue Code	250
Min. Negotiated Rate	$25,978.42
Max. Negotiated Rate	$30,730.57
Rate for Payer: Cash Price	$23,761.35
Rate for Payer: Health Partners Plans Commercial	$30,096.95
Rate for Payer: UnitedHealthcare Commercial	$30,730.57
Rate for Payer: WPPA Commercial	$25,978.42

ACTIVATED PROTEIN C (APC)

Facility

$312.00

Service Code	HCPCS 85307
Hospital Charge Code	8530700
Hospital Revenue Code	305
Min. Negotiated Rate	$144.14
Max. Negotiated Rate	$302.64
Rate for Payer: BCBS Commercial	$249.21
Rate for Payer: Cash Price	$234.00
Rate for Payer: Cash Price	$234.00
Rate for Payer: Celtic Commercial/Exchange	$144.14
Rate for Payer: Health Partners Plans Commercial	$296.40
Rate for Payer: UnitedHealthcare Commercial	$302.64
Rate for Payer: WPPA Commercial	$262.08

ACTIVATED PROTEIN C (APC)

Facility

$312.00

Service Code	HCPCS 85307
Hospital Charge Code	8530700
Hospital Revenue Code	305
Min. Negotiated Rate	$255.84
Max. Negotiated Rate	$302.64
Rate for Payer: Cash Price	$234.00
Rate for Payer: Health Partners Plans Commercial	$296.40
Rate for Payer: UnitedHealthcare Commercial	$302.64
Rate for Payer: WPPA Commercial	$255.84

ACTONEL 35 MG TAB (RISEDRONATE SODIUM)

Facility

$185.00

Service Code	NDC 33342010937
Hospital Charge Code	2510584
Hospital Revenue Code	250
Min. Negotiated Rate	$151.70
Max. Negotiated Rate	$179.45
Rate for Payer: Cash Price	$139.43
Rate for Payer: Health Partners Plans Commercial	$175.75
Rate for Payer: UnitedHealthcare Commercial	$179.45
Rate for Payer: WPPA Commercial	$151.70

ACTONEL 35 MG TAB (RISEDRONATE SODIUM)

Facility

$185.00

Service Code	NDC 33342010937
Hospital Charge Code	2510584
Hospital Revenue Code	250
Min. Negotiated Rate	$85.47
Max. Negotiated Rate	$179.45
Rate for Payer: Cash Price	$139.43
Rate for Payer: Celtic Commercial/Exchange	$85.47
Rate for Payer: Health Partners Plans Commercial	$175.75
Rate for Payer: UnitedHealthcare Commercial	$179.45
Rate for Payer: WPPA Commercial	$155.40

ACTOS (PIOGLITAZONE) 15 GM oral tablet

Facility

$46.00

Service Code	NDC 60687039111
Hospital Charge Code	2516144
Hospital Revenue Code	250
Min. Negotiated Rate	$37.72
Max. Negotiated Rate	$44.62
Rate for Payer: Cash Price	$34.61
Rate for Payer: Health Partners Plans Commercial	$43.70
Rate for Payer: UnitedHealthcare Commercial	$44.62
Rate for Payer: WPPA Commercial	$37.72

ACTOS (PIOGLITAZONE) 15 GM oral tablet

Facility

$46.00

Service Code	NDC 60687039111
Hospital Charge Code	2516144
Hospital Revenue Code	250
Min. Negotiated Rate	$21.25
Max. Negotiated Rate	$44.62
Rate for Payer: Cash Price	$34.61
Rate for Payer: Celtic Commercial/Exchange	$21.25
Rate for Payer: Health Partners Plans Commercial	$43.70
Rate for Payer: UnitedHealthcare Commercial	$44.62
Rate for Payer: WPPA Commercial	$38.64

ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION

Facility

$9,311.74

Service Code	MSDRG 880
Min. Negotiated Rate	$9,311.74
Max. Negotiated Rate	$9,311.74
Rate for Payer: BCBS Commercial	$9,311.74

ACUTE AND SUBACUTE ENDOCARDITIS WITH CC

Facility

$14,587.77

Service Code	MSDRG 289
Min. Negotiated Rate	$14,587.77
Max. Negotiated Rate	$14,587.77
Rate for Payer: BCBS Commercial	$14,587.77

ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC

Facility

$23,834.28

Service Code	MSDRG 288
Min. Negotiated Rate	$23,834.28
Max. Negotiated Rate	$23,834.28
Rate for Payer: BCBS Commercial	$23,834.28

ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC

Facility

$9,989.56

Service Code	MSDRG 290
Min. Negotiated Rate	$9,989.56
Max. Negotiated Rate	$9,989.56
Rate for Payer: BCBS Commercial	$9,989.56

ACUTE HEPATITIS PANEL

Facility

$209.00

Service Code	HCPCS 80074
Hospital Charge Code	8007400
Hospital Revenue Code	301
Min. Negotiated Rate	$171.38
Max. Negotiated Rate	$202.73
Rate for Payer: Cash Price	$156.75
Rate for Payer: Health Partners Plans Commercial	$198.55
Rate for Payer: UnitedHealthcare Commercial	$202.73
Rate for Payer: WPPA Commercial	$171.38

ACUTE HEPATITIS PANEL

Facility

$209.00

Service Code	HCPCS 80074
Hospital Charge Code	8007400
Hospital Revenue Code	301
Min. Negotiated Rate	$96.56
Max. Negotiated Rate	$202.73
Rate for Payer: BCBS Commercial	$137.99
Rate for Payer: Cash Price	$156.75
Rate for Payer: Cash Price	$156.75
Rate for Payer: Celtic Commercial/Exchange	$96.56
Rate for Payer: Health Partners Plans Commercial	$198.55
Rate for Payer: UnitedHealthcare Commercial	$202.73
Rate for Payer: WPPA Commercial	$175.56

ACUTE LEUKEMIA WITH CC

Facility

$21,632.54

Service Code	MSDRG 835
Min. Negotiated Rate	$21,632.54
Max. Negotiated Rate	$21,632.54
Rate for Payer: BCBS Commercial	$21,632.54

ACUTE LEUKEMIA WITH MCC

Facility

$54,899.59

Service Code	MSDRG 834
Min. Negotiated Rate	$54,899.59
Max. Negotiated Rate	$54,899.59
Rate for Payer: BCBS Commercial	$54,899.59

ACUTE LEUKEMIA WITH OTHER PROCEDURES

Facility

$96,514.95

Service Code	MSDRG 850
Min. Negotiated Rate	$96,514.95
Max. Negotiated Rate	$96,514.95
Rate for Payer: BCBS Commercial	$96,514.95

ACUTE LEUKEMIA WITHOUT CC/MCC

Facility

$12,253.25

Service Code	MSDRG 836
Min. Negotiated Rate	$12,253.25
Max. Negotiated Rate	$12,253.25
Rate for Payer: BCBS Commercial	$12,253.25

ACUTE MAJOR EYE INFECTIONS WITH CC/MCC

Facility

$8,601.85

Service Code	MSDRG 121
Min. Negotiated Rate	$8,601.85
Max. Negotiated Rate	$8,601.85
Rate for Payer: BCBS Commercial	$8,601.85

Know your out-of-pocket cost for care.

All Charges