Ness County Hospital

All Charges

Charge

Type

Setting

Price

CONE IRRIGATOR KIT

Facility

$14.00

Hospital Charge Code	2700954
Hospital Revenue Code	272
Min. Negotiated Rate	$11.48
Max. Negotiated Rate	$13.58
Rate for Payer: Cash Price	$10.50
Rate for Payer: Health Partners Plans Commercial	$13.30
Rate for Payer: UnitedHealthcare Commercial	$13.58
Rate for Payer: WPPA Commercial	$11.48

CONE IRRIGATOR KIT

Facility

$14.00

Hospital Charge Code	2700954
Hospital Revenue Code	272
Min. Negotiated Rate	$6.47
Max. Negotiated Rate	$13.58
Rate for Payer: Cash Price	$10.50
Rate for Payer: Celtic Commercial/Exchange	$6.47
Rate for Payer: Health Partners Plans Commercial	$13.30
Rate for Payer: UnitedHealthcare Commercial	$13.58
Rate for Payer: WPPA Commercial	$11.76

CONFORM 2"

Facility

$9.00

Hospital Charge Code	2720671
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

CONFORM 2"

Facility

$9.00

Hospital Charge Code	2720671
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

CONFORM 3"

Facility

$9.00

Hospital Charge Code	2720673
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

CONFORM 3"

Facility

$9.00

Hospital Charge Code	2720673
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

CONFORM 3" LTC

Facility

$9.00

Hospital Charge Code	2720673LTC
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

CONFORM 3" LTC

Facility

$9.00

Hospital Charge Code	2720673LTC
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

CONFORM 4"

Facility

$9.00

Hospital Charge Code	2720672
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

CONFORM 4"

Facility

$9.00

Hospital Charge Code	2720672
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

CONFORM 4" LTC

Facility

$9.00

Hospital Charge Code	2720672LTC
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

CONFORM 4" LTC

Facility

$9.00

Hospital Charge Code	2720672LTC
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

CONFORM DRESSING

Facility

$9.00

Hospital Charge Code	2720670
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

CONFORM DRESSING

Facility

$9.00

Hospital Charge Code	2720670
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

CONNECTIVE TISSUE DISORDERS WITH CC

Facility

$10,721.61

Service Code	MSDRG 546
Min. Negotiated Rate	$10,721.61
Max. Negotiated Rate	$10,721.61
Rate for Payer: BCBS Commercial	$10,721.61

CONNECTIVE TISSUE DISORDERS WITH MCC

Facility

$20,107.46

Service Code	MSDRG 545
Min. Negotiated Rate	$20,107.46
Max. Negotiated Rate	$20,107.46
Rate for Payer: BCBS Commercial	$20,107.46

CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC

Facility

$7,398.61

Service Code	MSDRG 547
Min. Negotiated Rate	$7,398.61
Max. Negotiated Rate	$7,398.61
Rate for Payer: BCBS Commercial	$7,398.61

CONTRAST BATH PER 15 MIN

Facility

$81.00

Service Code	HCPCS 97034 GP
Hospital Charge Code	4200895
Hospital Revenue Code	420
Min. Negotiated Rate	$66.42
Max. Negotiated Rate	$78.57
Rate for Payer: Cash Price	$60.75
Rate for Payer: Health Partners Plans Commercial	$76.95
Rate for Payer: UnitedHealthcare Commercial	$78.57
Rate for Payer: WPPA Commercial	$66.42

CONTRAST BATH PER 15 MIN

Facility

$81.00

Service Code	HCPCS 97034 GP
Hospital Charge Code	4200895
Hospital Revenue Code	420
Min. Negotiated Rate	$30.30
Max. Negotiated Rate	$78.57
Rate for Payer: BCBS Commercial	$30.30
Rate for Payer: Cash Price	$60.75
Rate for Payer: Cash Price	$60.75
Rate for Payer: Celtic Commercial/Exchange	$37.42
Rate for Payer: Health Partners Plans Commercial	$76.95
Rate for Payer: UnitedHealthcare Commercial	$78.57
Rate for Payer: WPPA Commercial	$68.04

COPPER

Facility

$80.00

Service Code	HCPCS 82525
Hospital Charge Code	8252500
Hospital Revenue Code	301
Min. Negotiated Rate	$26.90
Max. Negotiated Rate	$77.60
Rate for Payer: BCBS Commercial	$26.90
Rate for Payer: Cash Price	$60.00
Rate for Payer: Cash Price	$60.00
Rate for Payer: Celtic Commercial/Exchange	$36.96
Rate for Payer: Health Partners Plans Commercial	$76.00
Rate for Payer: UnitedHealthcare Commercial	$77.60
Rate for Payer: WPPA Commercial	$67.20

COPPER

Facility

$80.00

Service Code	HCPCS 82525
Hospital Charge Code	8252500
Hospital Revenue Code	301
Min. Negotiated Rate	$65.60
Max. Negotiated Rate	$77.60
Rate for Payer: Cash Price	$60.00
Rate for Payer: Health Partners Plans Commercial	$76.00
Rate for Payer: UnitedHealthcare Commercial	$77.60
Rate for Payer: WPPA Commercial	$65.60

CORDARONE 100 MG TAB (AMIODARONE) (PACERONE)

Facility

$50.00

Service Code	NDC 00245014489
Hospital Charge Code	2519098
Hospital Revenue Code	250
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$48.50
Rate for Payer: Cash Price	$37.61
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

CORDARONE 100 MG TAB (AMIODARONE) (PACERONE)

Facility

$50.00

Service Code	NDC 00245014489
Hospital Charge Code	2519098
Hospital Revenue Code	250
Min. Negotiated Rate	$41.00
Max. Negotiated Rate	$48.50
Rate for Payer: Cash Price	$37.61
Rate for Payer: Health Partners Plans Commercial	$47.50
Rate for Payer: UnitedHealthcare Commercial	$48.50
Rate for Payer: WPPA Commercial	$41.00

CORD-CLAMP

Facility

$7.00

Hospital Charge Code	2709758
Hospital Revenue Code	272
Min. Negotiated Rate	$3.23
Max. Negotiated Rate	$6.79
Rate for Payer: Cash Price	$5.25
Rate for Payer: Celtic Commercial/Exchange	$3.23
Rate for Payer: Health Partners Plans Commercial	$6.65
Rate for Payer: UnitedHealthcare Commercial	$6.79
Rate for Payer: WPPA Commercial	$5.88

CORD-CLAMP

Facility

$7.00

Hospital Charge Code	2709758
Hospital Revenue Code	272
Min. Negotiated Rate	$5.74
Max. Negotiated Rate	$6.79
Rate for Payer: Cash Price	$5.25
Rate for Payer: Health Partners Plans Commercial	$6.65
Rate for Payer: UnitedHealthcare Commercial	$6.79
Rate for Payer: WPPA Commercial	$5.74

Know your out-of-pocket cost for care.

All Charges