Ness County Hospital

All Charges

Charge

Type

Setting

Price

COTTON BALLS PACK

Facility

$4.00

Hospital Charge Code	2720191
Hospital Revenue Code	272
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$3.00
Rate for Payer: Celtic Commercial/Exchange	$1.85
Rate for Payer: Health Partners Plans Commercial	$3.80
Rate for Payer: UnitedHealthcare Commercial	$3.88
Rate for Payer: WPPA Commercial	$3.36

COTTON BALLS PACK

Facility

$4.00

Hospital Charge Code	2720191
Hospital Revenue Code	272
Min. Negotiated Rate	$3.28
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$3.00
Rate for Payer: Health Partners Plans Commercial	$3.80
Rate for Payer: UnitedHealthcare Commercial	$3.88
Rate for Payer: WPPA Commercial	$3.28

COUMADIN 1 MG TAB (WARFARIN SODIUM) (JANOTVEN)

Facility

$6.00

Service Code	NDC 00832121189
Hospital Charge Code	2514818
Hospital Revenue Code	250
Min. Negotiated Rate	$4.92
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$4.65
Rate for Payer: Health Partners Plans Commercial	$5.70
Rate for Payer: UnitedHealthcare Commercial	$5.82
Rate for Payer: WPPA Commercial	$4.92

COUMADIN 1 MG TAB (WARFARIN SODIUM) (JANOTVEN)

Facility

$6.00

Service Code	NDC 00832121189
Hospital Charge Code	2514818
Hospital Revenue Code	250
Min. Negotiated Rate	$2.77
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$4.65
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

COUMADIN 2.5 MG TAB (WARFARIN SODIUM) (JANTOVEN)

Facility

$3.00

Service Code	NDC 65162076310
Hospital Charge Code	2514859
Hospital Revenue Code	250
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.92
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

COUMADIN 2.5 MG TAB (WARFARIN SODIUM) (JANTOVEN)

Facility

$3.00

Service Code	NDC 65162076310
Hospital Charge Code	2514859
Hospital Revenue Code	250
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.92
Rate for Payer: Health Partners Plans Commercial	$2.85
Rate for Payer: UnitedHealthcare Commercial	$2.91
Rate for Payer: WPPA Commercial	$2.46

COUMADIN 2 MG TAB (WARFARIN SODIUM) (JANTOVEN)

Facility

$3.00

Service Code	NDC 00832121289
Hospital Charge Code	2501740
Hospital Revenue Code	250
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.70
Rate for Payer: Health Partners Plans Commercial	$2.85
Rate for Payer: UnitedHealthcare Commercial	$2.91
Rate for Payer: WPPA Commercial	$2.46

COUMADIN 2 MG TAB (WARFARIN SODIUM) (JANTOVEN)

Facility

$3.00

Service Code	NDC 00832121289
Hospital Charge Code	2501740
Hospital Revenue Code	250
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.70
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

COUMADIN 5 MG TAB (WARFARIN SODIUM) (JANTOVEN)

Facility

$3.00

Service Code	NDC 62584099411
Hospital Charge Code	2514867
Hospital Revenue Code	250
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.78
Rate for Payer: Health Partners Plans Commercial	$2.85
Rate for Payer: UnitedHealthcare Commercial	$2.91
Rate for Payer: WPPA Commercial	$2.46

COUMADIN 5 MG TAB (WARFARIN SODIUM) (JANTOVEN)

Facility

$3.00

Service Code	NDC 62584099411
Hospital Charge Code	2514867
Hospital Revenue Code	250
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.78
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

COVID 19 ANTIBODY, IGG IMMUN

Facility

$180.00

Service Code	HCPCS 86769
Hospital Charge Code	8676900
Hospital Revenue Code	302
Min. Negotiated Rate	$22.69
Max. Negotiated Rate	$174.60
Rate for Payer: BCBS Commercial	$22.69
Rate for Payer: Cash Price	$135.00
Rate for Payer: Cash Price	$135.00
Rate for Payer: Celtic Commercial/Exchange	$83.16
Rate for Payer: Health Partners Plans Commercial	$171.00
Rate for Payer: UnitedHealthcare Commercial	$174.60
Rate for Payer: WPPA Commercial	$151.20

COVID 19 ANTIBODY, IGG IMMUN

Facility

$180.00

Service Code	HCPCS 86769
Hospital Charge Code	8676900
Hospital Revenue Code	302
Min. Negotiated Rate	$147.60
Max. Negotiated Rate	$174.60
Rate for Payer: Cash Price	$135.00
Rate for Payer: Health Partners Plans Commercial	$171.00
Rate for Payer: UnitedHealthcare Commercial	$174.60
Rate for Payer: WPPA Commercial	$147.60

COXIELLA BURNETII (Q FEVER)

Facility

$13.00

Service Code	HCPCS 86638
Hospital Charge Code	8663800
Hospital Revenue Code	302
Min. Negotiated Rate	$10.66
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$9.75
Rate for Payer: Health Partners Plans Commercial	$12.35
Rate for Payer: UnitedHealthcare Commercial	$12.61
Rate for Payer: WPPA Commercial	$10.66

COXIELLA BURNETII (Q FEVER)

Facility

$13.00

Service Code	HCPCS 86638
Hospital Charge Code	8663800
Hospital Revenue Code	302
Min. Negotiated Rate	$6.01
Max. Negotiated Rate	$12.61
Rate for Payer: BCBS Commercial	$9.97
Rate for Payer: Cash Price	$9.75
Rate for Payer: Cash Price	$9.75
Rate for Payer: Celtic Commercial/Exchange	$6.01
Rate for Payer: Health Partners Plans Commercial	$12.35
Rate for Payer: UnitedHealthcare Commercial	$12.61
Rate for Payer: WPPA Commercial	$10.92

COZAAR 25 MG TAB (LOSARTAN)

Facility

$5.00

Service Code	NDC 68084034611
Hospital Charge Code	2518884
Hospital Revenue Code	250
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$3.82
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

COZAAR 25 MG TAB (LOSARTAN)

Facility

$5.00

Service Code	NDC 68084034611
Hospital Charge Code	2518884
Hospital Revenue Code	250
Min. Negotiated Rate	$4.10
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$3.82
Rate for Payer: Health Partners Plans Commercial	$4.75
Rate for Payer: UnitedHealthcare Commercial	$4.85
Rate for Payer: WPPA Commercial	$4.10

CPAP KIT W/HEADGEAR

Facility

$463.00

Hospital Charge Code	2703571
Hospital Revenue Code	270
Min. Negotiated Rate	$379.66
Max. Negotiated Rate	$449.11
Rate for Payer: Cash Price	$347.25
Rate for Payer: Health Partners Plans Commercial	$439.85
Rate for Payer: UnitedHealthcare Commercial	$449.11
Rate for Payer: WPPA Commercial	$379.66

CPAP KIT W/HEADGEAR

Facility

$463.00

Hospital Charge Code	2703571
Hospital Revenue Code	270
Min. Negotiated Rate	$213.91
Max. Negotiated Rate	$449.11
Rate for Payer: Cash Price	$347.25
Rate for Payer: Celtic Commercial/Exchange	$213.91
Rate for Payer: Health Partners Plans Commercial	$439.85
Rate for Payer: UnitedHealthcare Commercial	$449.11
Rate for Payer: WPPA Commercial	$388.92

C-PEPTIDE

Facility

$82.00

Service Code	HCPCS 84681
Hospital Charge Code	8468100
Hospital Revenue Code	301
Min. Negotiated Rate	$67.24
Max. Negotiated Rate	$79.54
Rate for Payer: Cash Price	$61.50
Rate for Payer: Health Partners Plans Commercial	$77.90
Rate for Payer: UnitedHealthcare Commercial	$79.54
Rate for Payer: WPPA Commercial	$67.24

C-PEPTIDE

Facility

$82.00

Service Code	HCPCS 84681
Hospital Charge Code	8468100
Hospital Revenue Code	301
Min. Negotiated Rate	$37.88
Max. Negotiated Rate	$79.54
Rate for Payer: BCBS Commercial	$66.63
Rate for Payer: Cash Price	$61.50
Rate for Payer: Cash Price	$61.50
Rate for Payer: Celtic Commercial/Exchange	$37.88
Rate for Payer: Health Partners Plans Commercial	$77.90
Rate for Payer: UnitedHealthcare Commercial	$79.54
Rate for Payer: WPPA Commercial	$68.88

CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC

Facility

$13,027.06

Service Code	MSDRG 073
Min. Negotiated Rate	$13,027.06
Max. Negotiated Rate	$13,027.06
Rate for Payer: BCBS Commercial	$13,027.06

CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC

Facility

$9,044.13

Service Code	MSDRG 074
Min. Negotiated Rate	$9,044.13
Max. Negotiated Rate	$9,044.13
Rate for Payer: BCBS Commercial	$9,044.13

CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC

Facility

$27,176.80

Service Code	MSDRG 026
Min. Negotiated Rate	$27,176.80
Max. Negotiated Rate	$27,176.80
Rate for Payer: BCBS Commercial	$27,176.80

CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC

Facility

$39,916.71

Service Code	MSDRG 025
Min. Negotiated Rate	$39,916.71
Max. Negotiated Rate	$39,916.71
Rate for Payer: BCBS Commercial	$39,916.71

CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC

Facility

$22,315.69

Service Code	MSDRG 027
Min. Negotiated Rate	$22,315.69
Max. Negotiated Rate	$22,315.69
Rate for Payer: BCBS Commercial	$22,315.69

Know your out-of-pocket cost for care.

All Charges