Ness County Hospital

All Charges

Charge

Type

Setting

Price

CNTRL NASL HEMORR ANT SMPL ANY

Facility

$489.00

Service Code	HCPCS 30901
Hospital Charge Code	3090100
Hospital Revenue Code	761
Min. Negotiated Rate	$400.98
Max. Negotiated Rate	$474.33
Rate for Payer: Cash Price	$366.75
Rate for Payer: Health Partners Plans Commercial	$464.55
Rate for Payer: UnitedHealthcare Commercial	$474.33
Rate for Payer: WPPA Commercial	$400.98

CNTRL NASL HEMORR ANT SMPL ANY

Facility

$489.00

Service Code	HCPCS 30901
Hospital Charge Code	3090100
Hospital Revenue Code	761
Min. Negotiated Rate	$225.92
Max. Negotiated Rate	$488.84
Rate for Payer: BCBS Commercial	$488.84
Rate for Payer: Cash Price	$366.75
Rate for Payer: Cash Price	$366.75
Rate for Payer: Celtic Commercial/Exchange	$225.92
Rate for Payer: Health Partners Plans Commercial	$464.55
Rate for Payer: UnitedHealthcare Commercial	$474.33
Rate for Payer: WPPA Commercial	$410.76

CO2 DETECTOR

Facility

$40.00

Hospital Charge Code	2708777
Hospital Revenue Code	270
Min. Negotiated Rate	$18.48
Max. Negotiated Rate	$38.80
Rate for Payer: Cash Price	$30.38
Rate for Payer: Celtic Commercial/Exchange	$18.48
Rate for Payer: Health Partners Plans Commercial	$38.00
Rate for Payer: UnitedHealthcare Commercial	$38.80
Rate for Payer: WPPA Commercial	$33.60

CO2 DETECTOR

Facility

$40.00

Hospital Charge Code	2708777
Hospital Revenue Code	270
Min. Negotiated Rate	$32.80
Max. Negotiated Rate	$38.80
Rate for Payer: Cash Price	$30.38
Rate for Payer: Health Partners Plans Commercial	$38.00
Rate for Payer: UnitedHealthcare Commercial	$38.80
Rate for Payer: WPPA Commercial	$32.80

COAGULATION DISORDERS

Facility

$13,713.55

Service Code	MSDRG 813
Min. Negotiated Rate	$13,713.55
Max. Negotiated Rate	$13,713.55
Rate for Payer: BCBS Commercial	$13,713.55

COBAN 2"

Facility

$9.00

Hospital Charge Code	2707611LTC
Hospital Revenue Code	272
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$6.75
Rate for Payer: Celtic Commercial/Exchange	$4.16
Rate for Payer: Health Partners Plans Commercial	$8.55
Rate for Payer: UnitedHealthcare Commercial	$8.73
Rate for Payer: WPPA Commercial	$7.56

COBAN 2"

Facility

$9.00

Hospital Charge Code	2707611LTC
Hospital Revenue Code	272
Min. Negotiated Rate	$7.38
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$6.75
Rate for Payer: Health Partners Plans Commercial	$8.55
Rate for Payer: UnitedHealthcare Commercial	$8.73
Rate for Payer: WPPA Commercial	$7.38

COBAN 3" LTC

Facility

$9.00

Hospital Charge Code	2707789LTC
Hospital Revenue Code	270
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$6.75
Rate for Payer: Celtic Commercial/Exchange	$4.16
Rate for Payer: Health Partners Plans Commercial	$8.55
Rate for Payer: UnitedHealthcare Commercial	$8.73
Rate for Payer: WPPA Commercial	$7.56

COBAN 3" LTC

Facility

$9.00

Hospital Charge Code	2707789LTC
Hospital Revenue Code	270
Min. Negotiated Rate	$7.38
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$6.75
Rate for Payer: Health Partners Plans Commercial	$8.55
Rate for Payer: UnitedHealthcare Commercial	$8.73
Rate for Payer: WPPA Commercial	$7.38

COBAN 4"

Facility

$9.00

Hospital Charge Code	2707790LTC
Hospital Revenue Code	272
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$6.75
Rate for Payer: Celtic Commercial/Exchange	$4.16
Rate for Payer: Health Partners Plans Commercial	$8.55
Rate for Payer: UnitedHealthcare Commercial	$8.73
Rate for Payer: WPPA Commercial	$7.56

COBAN 4"

Facility

$6.00

Hospital Charge Code	2707790
Hospital Revenue Code	272
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

COBAN 4"

Facility

$9.00

Hospital Charge Code	2707790LTC
Hospital Revenue Code	272
Min. Negotiated Rate	$7.38
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$6.75
Rate for Payer: Health Partners Plans Commercial	$8.55
Rate for Payer: UnitedHealthcare Commercial	$8.73
Rate for Payer: WPPA Commercial	$7.38

COBAN 4"

Facility

$6.00

Hospital Charge Code	2707790
Hospital Revenue Code	272
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

COBAN COLOR 3"

Facility

$9.00

Hospital Charge Code	2722601
Hospital Revenue Code	272
Min. Negotiated Rate	$7.38
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$6.75
Rate for Payer: Health Partners Plans Commercial	$8.55
Rate for Payer: UnitedHealthcare Commercial	$8.73
Rate for Payer: WPPA Commercial	$7.38

COBAN COLOR 3"

Facility

$9.00

Hospital Charge Code	2722601
Hospital Revenue Code	272
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$6.75
Rate for Payer: Celtic Commercial/Exchange	$4.16
Rate for Payer: Health Partners Plans Commercial	$8.55
Rate for Payer: UnitedHealthcare Commercial	$8.73
Rate for Payer: WPPA Commercial	$7.56

COCAINE

Facility

$162.00

Service Code	HCPCS 80353
Hospital Charge Code	8035300
Hospital Revenue Code	300
Min. Negotiated Rate	$132.84
Max. Negotiated Rate	$157.14
Rate for Payer: Cash Price	$121.50
Rate for Payer: Health Partners Plans Commercial	$153.90
Rate for Payer: UnitedHealthcare Commercial	$157.14
Rate for Payer: WPPA Commercial	$132.84

COCAINE

Facility

$162.00

Service Code	HCPCS 80353
Hospital Charge Code	8035300
Hospital Revenue Code	300
Min. Negotiated Rate	$35.00
Max. Negotiated Rate	$157.14
Rate for Payer: BCBS Commercial	$35.00
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cash Price	$121.50
Rate for Payer: Celtic Commercial/Exchange	$74.84
Rate for Payer: Health Partners Plans Commercial	$153.90
Rate for Payer: UnitedHealthcare Commercial	$157.14
Rate for Payer: WPPA Commercial	$136.08

COCKUP SPLINT

Facility

$36.00

Hospital Charge Code	2701002
Hospital Revenue Code	270
Min. Negotiated Rate	$29.52
Max. Negotiated Rate	$34.92
Rate for Payer: Cash Price	$27.38
Rate for Payer: Health Partners Plans Commercial	$34.20
Rate for Payer: UnitedHealthcare Commercial	$34.92
Rate for Payer: WPPA Commercial	$29.52

COCKUP SPLINT

Facility

$36.00

Hospital Charge Code	2701002
Hospital Revenue Code	270
Min. Negotiated Rate	$16.63
Max. Negotiated Rate	$34.92
Rate for Payer: Cash Price	$27.38
Rate for Payer: Celtic Commercial/Exchange	$16.63
Rate for Payer: Health Partners Plans Commercial	$34.20
Rate for Payer: UnitedHealthcare Commercial	$34.92
Rate for Payer: WPPA Commercial	$30.24

COFLEX 2 LAYER KIT

Facility

$29.00

Hospital Charge Code	2709478
Hospital Revenue Code	270
Min. Negotiated Rate	$23.78
Max. Negotiated Rate	$28.13
Rate for Payer: Cash Price	$21.75
Rate for Payer: Health Partners Plans Commercial	$27.55
Rate for Payer: UnitedHealthcare Commercial	$28.13
Rate for Payer: WPPA Commercial	$23.78

COFLEX 2 LAYER KIT

Facility

$29.00

Hospital Charge Code	2709478
Hospital Revenue Code	270
Min. Negotiated Rate	$13.40
Max. Negotiated Rate	$28.13
Rate for Payer: Cash Price	$21.75
Rate for Payer: Celtic Commercial/Exchange	$13.40
Rate for Payer: Health Partners Plans Commercial	$27.55
Rate for Payer: UnitedHealthcare Commercial	$28.13
Rate for Payer: WPPA Commercial	$24.36

COGENTIN 2 MG/2ML INJ. (BENZTROPINE)

Facility

$1,460.00

Service Code	NDC 00143972905
Hospital Charge Code	2501575
Hospital Revenue Code	250
Min. Negotiated Rate	$1,197.20
Max. Negotiated Rate	$1,416.20
Rate for Payer: Cash Price	$1,095.22
Rate for Payer: Health Partners Plans Commercial	$1,387.00
Rate for Payer: UnitedHealthcare Commercial	$1,416.20
Rate for Payer: WPPA Commercial	$1,197.20

COGENTIN 2 MG/2ML INJ. (BENZTROPINE)

Facility

$1,460.00

Service Code	NDC 00143972905
Hospital Charge Code	2501575
Hospital Revenue Code	250
Min. Negotiated Rate	$674.52
Max. Negotiated Rate	$1,416.20
Rate for Payer: Cash Price	$1,095.22
Rate for Payer: Celtic Commercial/Exchange	$674.52
Rate for Payer: Health Partners Plans Commercial	$1,387.00
Rate for Payer: UnitedHealthcare Commercial	$1,416.20
Rate for Payer: WPPA Commercial	$1,226.40

COLACE 100 MG CAP (DOCUSATE SODIUM)

Facility

$1.00

Service Code	NDC 00904718361
Hospital Charge Code	2501583
Hospital Revenue Code	250
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.75
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

COLACE 100 MG CAP (DOCUSATE SODIUM)

Facility

$1.00

Service Code	NDC 00904718361
Hospital Charge Code	2501583
Hospital Revenue Code	250
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.75
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