Ness County Hospital

All Charges

Charge

Type

Setting

Price

ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC

Facility

$5,843.90

Service Code	MSDRG 122
Min. Negotiated Rate	$5,843.90
Max. Negotiated Rate	$5,843.90
Rate for Payer: BCBS Commercial	$5,843.90

ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC

Facility

$9,914.17

Service Code	MSDRG 281
Min. Negotiated Rate	$9,914.17
Max. Negotiated Rate	$9,914.17
Rate for Payer: BCBS Commercial	$9,914.17

ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC

Facility

$16,060.99

Service Code	MSDRG 280
Min. Negotiated Rate	$16,060.99
Max. Negotiated Rate	$16,060.99
Rate for Payer: BCBS Commercial	$16,060.99

ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC

Facility

$7,857.68

Service Code	MSDRG 282
Min. Negotiated Rate	$7,857.68
Max. Negotiated Rate	$7,857.68
Rate for Payer: BCBS Commercial	$7,857.68

ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC

Facility

$6,053.36

Service Code	MSDRG 284
Min. Negotiated Rate	$6,053.36
Max. Negotiated Rate	$6,053.36
Rate for Payer: BCBS Commercial	$6,053.36

ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC

Facility

$16,719.37

Service Code	MSDRG 283
Min. Negotiated Rate	$16,719.37
Max. Negotiated Rate	$16,719.37
Rate for Payer: BCBS Commercial	$16,719.37

ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CC/MCC

Facility

$4,435.60

Service Code	MSDRG 285
Min. Negotiated Rate	$4,435.60
Max. Negotiated Rate	$4,435.60
Rate for Payer: BCBS Commercial	$4,435.60

Adacel (Tdap) 0.5 ml inj. (Adolescent & Adult)

Facility

$179.00

Service Code	NDC 49281040015
Hospital Charge Code	2516276
Hospital Revenue Code	250
Min. Negotiated Rate	$82.70
Max. Negotiated Rate	$173.63
Rate for Payer: Cash Price	$134.32
Rate for Payer: Celtic Commercial/Exchange	$82.70
Rate for Payer: Health Partners Plans Commercial	$170.05
Rate for Payer: UnitedHealthcare Commercial	$173.63
Rate for Payer: WPPA Commercial	$150.36

Adacel (Tdap) 0.5 ml inj. (Adolescent & Adult)

Facility

$179.00

Service Code	NDC 49281040015
Hospital Charge Code	2516276
Hospital Revenue Code	250
Min. Negotiated Rate	$146.78
Max. Negotiated Rate	$173.63
Rate for Payer: Cash Price	$134.32
Rate for Payer: Health Partners Plans Commercial	$170.05
Rate for Payer: UnitedHealthcare Commercial	$173.63
Rate for Payer: WPPA Commercial	$146.78

ADAPTIC DRESSING

Facility

$9.00

Hospital Charge Code	2720860
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

ADAPTIC DRESSING

Facility

$9.00

Hospital Charge Code	2720860
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

ADAPT SKIN BARRIER OSTOMY PAST

Facility

$7.00

Hospital Charge Code	2720375
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

ADAPT SKIN BARRIER OSTOMY PAST

Facility

$7.00

Hospital Charge Code	2720375
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

ADD-A-FOLEY TRAY

Facility

$60.00

Hospital Charge Code	2720224
Hospital Revenue Code	272
Min. Negotiated Rate	$27.72
Max. Negotiated Rate	$58.20
Rate for Payer: Cash Price	$45.00
Rate for Payer: Celtic Commercial/Exchange	$27.72
Rate for Payer: Health Partners Plans Commercial	$57.00
Rate for Payer: UnitedHealthcare Commercial	$58.20
Rate for Payer: WPPA Commercial	$50.40

ADD-A-FOLEY TRAY

Facility

$60.00

Hospital Charge Code	2720224LTC
Hospital Revenue Code	272
Min. Negotiated Rate	$27.72
Max. Negotiated Rate	$58.20
Rate for Payer: Cash Price	$45.00
Rate for Payer: Celtic Commercial/Exchange	$27.72
Rate for Payer: Health Partners Plans Commercial	$57.00
Rate for Payer: UnitedHealthcare Commercial	$58.20
Rate for Payer: WPPA Commercial	$50.40

ADD-A-FOLEY TRAY

Facility

$60.00

Hospital Charge Code	2720224LTC
Hospital Revenue Code	272
Min. Negotiated Rate	$49.20
Max. Negotiated Rate	$58.20
Rate for Payer: Cash Price	$45.00
Rate for Payer: Health Partners Plans Commercial	$57.00
Rate for Payer: UnitedHealthcare Commercial	$58.20
Rate for Payer: WPPA Commercial	$49.20

ADD-A-FOLEY TRAY

Facility

$60.00

Hospital Charge Code	2720224
Hospital Revenue Code	272
Min. Negotiated Rate	$49.20
Max. Negotiated Rate	$58.20
Rate for Payer: Cash Price	$45.00
Rate for Payer: Health Partners Plans Commercial	$57.00
Rate for Payer: UnitedHealthcare Commercial	$58.20
Rate for Payer: WPPA Commercial	$49.20

ADDTL SEQ INFUSION UP TO 1 HR

Facility

$193.00

Service Code	HCPCS 96367
Hospital Charge Code	9636700
Hospital Revenue Code	761
Min. Negotiated Rate	$89.17
Max. Negotiated Rate	$187.21
Rate for Payer: BCBS Commercial	$133.32
Rate for Payer: Cash Price	$144.75
Rate for Payer: Cash Price	$144.75
Rate for Payer: Celtic Commercial/Exchange	$89.17
Rate for Payer: Health Partners Plans Commercial	$183.35
Rate for Payer: UnitedHealthcare Commercial	$187.21
Rate for Payer: WPPA Commercial	$162.12

ADDTL SEQ INFUSION UP TO 1 HR

Facility

$193.00

Service Code	HCPCS 96367
Hospital Charge Code	9636700
Hospital Revenue Code	761
Min. Negotiated Rate	$158.26
Max. Negotiated Rate	$187.21
Rate for Payer: Cash Price	$144.75
Rate for Payer: Health Partners Plans Commercial	$183.35
Rate for Payer: UnitedHealthcare Commercial	$187.21
Rate for Payer: WPPA Commercial	$158.26

ADENOCARD 6mg/2ml injection (ADENOSINE)

Facility

$122.00

Service Code	NDC 67457085502
Hospital Charge Code	2511418
Hospital Revenue Code	250
Min. Negotiated Rate	$100.04
Max. Negotiated Rate	$118.34
Rate for Payer: Cash Price	$92.10
Rate for Payer: Health Partners Plans Commercial	$115.90
Rate for Payer: UnitedHealthcare Commercial	$118.34
Rate for Payer: WPPA Commercial	$100.04

ADENOCARD 6mg/2ml injection (ADENOSINE)

Facility

$122.00

Service Code	NDC 67457085502
Hospital Charge Code	2511418
Hospital Revenue Code	250
Min. Negotiated Rate	$56.36
Max. Negotiated Rate	$118.34
Rate for Payer: Cash Price	$92.10
Rate for Payer: Celtic Commercial/Exchange	$56.36
Rate for Payer: Health Partners Plans Commercial	$115.90
Rate for Payer: UnitedHealthcare Commercial	$118.34
Rate for Payer: WPPA Commercial	$102.48

ADHESIVE HYDROCELLUAR FM DRESS

Facility

$18.00

Hospital Charge Code	2720068
Hospital Revenue Code	270
Min. Negotiated Rate	$14.76
Max. Negotiated Rate	$17.46
Rate for Payer: Cash Price	$13.88
Rate for Payer: Health Partners Plans Commercial	$17.10
Rate for Payer: UnitedHealthcare Commercial	$17.46
Rate for Payer: WPPA Commercial	$14.76

ADHESIVE HYDROCELLUAR FM DRESS

Facility

$18.00

Hospital Charge Code	2720068
Hospital Revenue Code	270
Min. Negotiated Rate	$8.32
Max. Negotiated Rate	$17.46
Rate for Payer: Cash Price	$13.88
Rate for Payer: Celtic Commercial/Exchange	$8.32
Rate for Payer: Health Partners Plans Commercial	$17.10
Rate for Payer: UnitedHealthcare Commercial	$17.46
Rate for Payer: WPPA Commercial	$15.12

A&D MEDICATED OINT 1.5OZ.

Facility

$8.00

Service Code	NDC 11523131401
Hospital Charge Code	2500148
Hospital Revenue Code	250
Min. Negotiated Rate	$3.70
Max. Negotiated Rate	$7.76
Rate for Payer: Cash Price	$6.00
Rate for Payer: Celtic Commercial/Exchange	$3.70
Rate for Payer: Health Partners Plans Commercial	$7.60
Rate for Payer: UnitedHealthcare Commercial	$7.76
Rate for Payer: WPPA Commercial	$6.72

A&D MEDICATED OINT 1.5OZ.

Facility

$8.00

Service Code	NDC 11523131401
Hospital Charge Code	2500148
Hospital Revenue Code	250
Min. Negotiated Rate	$6.56
Max. Negotiated Rate	$7.76
Rate for Payer: Cash Price	$6.00
Rate for Payer: Health Partners Plans Commercial	$7.60
Rate for Payer: UnitedHealthcare Commercial	$7.76
Rate for Payer: WPPA Commercial	$6.56

Know your out-of-pocket cost for care.

All Charges