Ness County Hospital

All Charges

Charge

Type

Setting

Price

COLOWRAP

Facility

$450.00

Hospital Charge Code	2708778
Hospital Revenue Code	270
Min. Negotiated Rate	$369.00
Max. Negotiated Rate	$436.50
Rate for Payer: Cash Price	$337.50
Rate for Payer: Health Partners Plans Commercial	$427.50
Rate for Payer: UnitedHealthcare Commercial	$436.50
Rate for Payer: WPPA Commercial	$369.00

COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITH MCC

Facility

$87,385.57

Service Code	MSDRG 429
Min. Negotiated Rate	$87,385.57
Max. Negotiated Rate	$87,385.57
Rate for Payer: BCBS Commercial	$87,385.57

COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITHOUT MCC

Facility

$57,315.08

Service Code	MSDRG 430
Min. Negotiated Rate	$57,315.08
Max. Negotiated Rate	$57,315.08
Rate for Payer: BCBS Commercial	$57,315.08

COMBITUBE KIT

Facility

$150.00

Hospital Charge Code	2505729
Hospital Revenue Code	270
Min. Negotiated Rate	$123.00
Max. Negotiated Rate	$145.50
Rate for Payer: Cash Price	$113.06
Rate for Payer: Health Partners Plans Commercial	$142.50
Rate for Payer: UnitedHealthcare Commercial	$145.50
Rate for Payer: WPPA Commercial	$123.00

COMBITUBE KIT

Facility

$150.00

Hospital Charge Code	2505729
Hospital Revenue Code	270
Min. Negotiated Rate	$69.30
Max. Negotiated Rate	$145.50
Rate for Payer: Cash Price	$113.06
Rate for Payer: Celtic Commercial/Exchange	$69.30
Rate for Payer: Health Partners Plans Commercial	$142.50
Rate for Payer: UnitedHealthcare Commercial	$145.50
Rate for Payer: WPPA Commercial	$126.00

COMBITUBE ROLLUP 41FR S-ADULT

Facility

$150.00

Hospital Charge Code	2505728
Hospital Revenue Code	272
Min. Negotiated Rate	$69.30
Max. Negotiated Rate	$145.50
Rate for Payer: Cash Price	$113.06
Rate for Payer: Celtic Commercial/Exchange	$69.30
Rate for Payer: Health Partners Plans Commercial	$142.50
Rate for Payer: UnitedHealthcare Commercial	$145.50
Rate for Payer: WPPA Commercial	$126.00

COMBITUBE ROLLUP 41FR S-ADULT

Facility

$150.00

Hospital Charge Code	2505728
Hospital Revenue Code	272
Min. Negotiated Rate	$123.00
Max. Negotiated Rate	$145.50
Rate for Payer: Cash Price	$113.06
Rate for Payer: Health Partners Plans Commercial	$142.50
Rate for Payer: UnitedHealthcare Commercial	$145.50
Rate for Payer: WPPA Commercial	$123.00

COMFEEL 4X4

Facility

$9.00

Hospital Charge Code	2709479
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

COMFEEL 4X4

Facility

$9.00

Hospital Charge Code	2709479
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

Comirnaty 2023-24 (12y up)(PF) (COVID vac23-24(12up)(raxt)(PF)) IM suspension

Facility

$414.00

Service Code	NDC 00069236201
Hospital Charge Code	2513133
Hospital Revenue Code	250
Min. Negotiated Rate	$339.48
Max. Negotiated Rate	$401.58
Rate for Payer: Cash Price	$310.50
Rate for Payer: Health Partners Plans Commercial	$393.30
Rate for Payer: UnitedHealthcare Commercial	$401.58
Rate for Payer: WPPA Commercial	$339.48

Comirnaty 2023-24 (12y up)(PF) (COVID vac23-24(12up)(raxt)(PF)) IM suspension

Facility

$414.00

Service Code	NDC 00069236201
Hospital Charge Code	2513133
Hospital Revenue Code	250
Min. Negotiated Rate	$191.27
Max. Negotiated Rate	$401.58
Rate for Payer: Cash Price	$310.50
Rate for Payer: Celtic Commercial/Exchange	$191.27
Rate for Payer: Health Partners Plans Commercial	$393.30
Rate for Payer: UnitedHealthcare Commercial	$401.58
Rate for Payer: WPPA Commercial	$347.76

COMMODE

Facility

$184.00

Hospital Charge Code	5710280
Hospital Revenue Code	271
Min. Negotiated Rate	$150.88
Max. Negotiated Rate	$178.48
Rate for Payer: Cash Price	$138.38
Rate for Payer: Health Partners Plans Commercial	$174.80
Rate for Payer: UnitedHealthcare Commercial	$178.48
Rate for Payer: WPPA Commercial	$150.88

COMMODE

Facility

$184.00

Hospital Charge Code	5710280
Hospital Revenue Code	271
Min. Negotiated Rate	$85.01
Max. Negotiated Rate	$178.48
Rate for Payer: Cash Price	$138.38
Rate for Payer: Celtic Commercial/Exchange	$85.01
Rate for Payer: Health Partners Plans Commercial	$174.80
Rate for Payer: UnitedHealthcare Commercial	$178.48
Rate for Payer: WPPA Commercial	$154.56

COMPATIBILITY TEST EA UNIT

Facility

$163.00

Service Code	HCPCS 86922
Hospital Charge Code	8692200
Hospital Revenue Code	309
Min. Negotiated Rate	$42.03
Max. Negotiated Rate	$158.11
Rate for Payer: BCBS Commercial	$42.03
Rate for Payer: Cash Price	$122.25
Rate for Payer: Cash Price	$122.25
Rate for Payer: Celtic Commercial/Exchange	$75.31
Rate for Payer: Health Partners Plans Commercial	$154.85
Rate for Payer: UnitedHealthcare Commercial	$158.11
Rate for Payer: WPPA Commercial	$136.92

COMPATIBILITY TEST EA UNIT

Facility

$163.00

Service Code	HCPCS 86920
Hospital Charge Code	8692000
Hospital Revenue Code	309
Min. Negotiated Rate	$46.33
Max. Negotiated Rate	$158.11
Rate for Payer: BCBS Commercial	$46.33
Rate for Payer: Cash Price	$122.25
Rate for Payer: Cash Price	$122.25
Rate for Payer: Celtic Commercial/Exchange	$75.31
Rate for Payer: Health Partners Plans Commercial	$154.85
Rate for Payer: UnitedHealthcare Commercial	$158.11
Rate for Payer: WPPA Commercial	$136.92

COMPATIBILITY TEST EA UNIT

Facility

$163.00

Service Code	HCPCS 86922
Hospital Charge Code	8692200
Hospital Revenue Code	309
Min. Negotiated Rate	$133.66
Max. Negotiated Rate	$158.11
Rate for Payer: Cash Price	$122.25
Rate for Payer: Health Partners Plans Commercial	$154.85
Rate for Payer: UnitedHealthcare Commercial	$158.11
Rate for Payer: WPPA Commercial	$133.66

COMPATIBILITY TEST EA UNIT

Facility

$158.00

Service Code	HCPCS 86921
Hospital Charge Code	8692100
Hospital Revenue Code	309
Min. Negotiated Rate	$129.56
Max. Negotiated Rate	$153.26
Rate for Payer: Cash Price	$118.50
Rate for Payer: Health Partners Plans Commercial	$150.10
Rate for Payer: UnitedHealthcare Commercial	$153.26
Rate for Payer: WPPA Commercial	$129.56

COMPATIBILITY TEST EA UNIT

Facility

$163.00

Service Code	HCPCS 86920
Hospital Charge Code	8692000
Hospital Revenue Code	309
Min. Negotiated Rate	$133.66
Max. Negotiated Rate	$158.11
Rate for Payer: Cash Price	$122.25
Rate for Payer: Health Partners Plans Commercial	$154.85
Rate for Payer: UnitedHealthcare Commercial	$158.11
Rate for Payer: WPPA Commercial	$133.66

COMPATIBILITY TEST EA UNIT

Facility

$158.00

Service Code	HCPCS 86921
Hospital Charge Code	8692100
Hospital Revenue Code	309
Min. Negotiated Rate	$66.21
Max. Negotiated Rate	$153.26
Rate for Payer: BCBS Commercial	$66.21
Rate for Payer: Cash Price	$118.50
Rate for Payer: Cash Price	$118.50
Rate for Payer: Celtic Commercial/Exchange	$73.00
Rate for Payer: Health Partners Plans Commercial	$150.10
Rate for Payer: UnitedHealthcare Commercial	$153.26
Rate for Payer: WPPA Commercial	$132.72

COMPAZINE 10 MG/2 ML INJ. (PROCHLORPERAZINE EDISYLATE)

Facility

$66.00

Service Code	NDC 23155049742
Hospital Charge Code	2501658
Hospital Revenue Code	250
Min. Negotiated Rate	$54.12
Max. Negotiated Rate	$64.02
Rate for Payer: Cash Price	$49.95
Rate for Payer: Health Partners Plans Commercial	$62.70
Rate for Payer: UnitedHealthcare Commercial	$64.02
Rate for Payer: WPPA Commercial	$54.12

COMPAZINE 10 MG/2 ML INJ. (PROCHLORPERAZINE EDISYLATE)

Facility

$66.00

Service Code	NDC 23155049742
Hospital Charge Code	2501658
Hospital Revenue Code	250
Min. Negotiated Rate	$30.49
Max. Negotiated Rate	$64.02
Rate for Payer: Cash Price	$49.95
Rate for Payer: Celtic Commercial/Exchange	$30.49
Rate for Payer: Health Partners Plans Commercial	$62.70
Rate for Payer: UnitedHealthcare Commercial	$64.02
Rate for Payer: WPPA Commercial	$55.44

COMPAZINE 5 MG TAB (PROCHLORPERAZINE MALEATE)

Facility

$5.00

Service Code	NDC 50268068415
Hospital Charge Code	2515773
Hospital Revenue Code	250
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$4.28
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

COMPAZINE 5 MG TAB (PROCHLORPERAZINE MALEATE)

Facility

$5.00

Service Code	NDC 50268068415
Hospital Charge Code	2515773
Hospital Revenue Code	250
Min. Negotiated Rate	$4.10
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$4.28
Rate for Payer: Health Partners Plans Commercial	$4.75
Rate for Payer: UnitedHealthcare Commercial	$4.85
Rate for Payer: WPPA Commercial	$4.10

COMPAZINE SUPP 25 MG (PROCHLORPERAZINE / COMPRO)

Facility

$37.00

Service Code	NDC 00574722612
Hospital Charge Code	2501682
Hospital Revenue Code	250
Min. Negotiated Rate	$30.34
Max. Negotiated Rate	$35.89
Rate for Payer: Cash Price	$28.35
Rate for Payer: Health Partners Plans Commercial	$35.15
Rate for Payer: UnitedHealthcare Commercial	$35.89
Rate for Payer: WPPA Commercial	$30.34

COMPAZINE SUPP 25 MG (PROCHLORPERAZINE / COMPRO)

Facility

$37.00

Service Code	NDC 00574722612
Hospital Charge Code	2501682
Hospital Revenue Code	250
Min. Negotiated Rate	$17.09
Max. Negotiated Rate	$35.89
Rate for Payer: Cash Price	$28.35
Rate for Payer: Celtic Commercial/Exchange	$17.09
Rate for Payer: Health Partners Plans Commercial	$35.15
Rate for Payer: UnitedHealthcare Commercial	$35.89
Rate for Payer: WPPA Commercial	$31.08

Know your out-of-pocket cost for care.

All Charges