Ness County Hospital

All Charges

Charge

Type

Setting

Price

ADMIN IMMUNIZATION, < 19YRS

Facility

$76.00

Service Code	HCPCS 90460
Hospital Charge Code	9046000
Hospital Revenue Code	760
Min. Negotiated Rate	$62.32
Max. Negotiated Rate	$73.72
Rate for Payer: Cash Price	$57.00
Rate for Payer: Health Partners Plans Commercial	$72.20
Rate for Payer: UnitedHealthcare Commercial	$73.72
Rate for Payer: WPPA Commercial	$62.32

ADMIN IMMUNIZATION, < 19YRS

Facility

$76.00

Service Code	HCPCS 90460
Hospital Charge Code	9046000
Hospital Revenue Code	760
Min. Negotiated Rate	$24.15
Max. Negotiated Rate	$73.72
Rate for Payer: BCBS Commercial	$24.15
Rate for Payer: Cash Price	$57.00
Rate for Payer: Cash Price	$57.00
Rate for Payer: Celtic Commercial/Exchange	$35.11
Rate for Payer: Health Partners Plans Commercial	$72.20
Rate for Payer: UnitedHealthcare Commercial	$73.72
Rate for Payer: WPPA Commercial	$63.84

ADMIN MODERNA 2ND DOSE

Facility

$70.00

Service Code	HCPCS 0012A
Hospital Charge Code	0012A00
Hospital Revenue Code	761
Min. Negotiated Rate	$57.40
Max. Negotiated Rate	$67.90
Rate for Payer: Cash Price	$52.50
Rate for Payer: Health Partners Plans Commercial	$66.50
Rate for Payer: UnitedHealthcare Commercial	$67.90
Rate for Payer: WPPA Commercial	$57.40

ADMIN MODERNA 2ND DOSE

Facility

$70.00

Service Code	HCPCS 0012A
Hospital Charge Code	0012A00
Hospital Revenue Code	761
Min. Negotiated Rate	$32.34
Max. Negotiated Rate	$67.90
Rate for Payer: Cash Price	$52.50
Rate for Payer: Celtic Commercial/Exchange	$32.34
Rate for Payer: Health Partners Plans Commercial	$66.50
Rate for Payer: UnitedHealthcare Commercial	$67.90
Rate for Payer: WPPA Commercial	$58.80

ADMIN MODERNA BOOSTER

Facility

$70.00

Service Code	HCPCS 0064A
Hospital Charge Code	0064A00
Hospital Revenue Code	771
Min. Negotiated Rate	$57.40
Max. Negotiated Rate	$67.90
Rate for Payer: Cash Price	$52.50
Rate for Payer: Health Partners Plans Commercial	$66.50
Rate for Payer: UnitedHealthcare Commercial	$67.90
Rate for Payer: WPPA Commercial	$57.40

ADMIN MODERNA BOOSTER

Facility

$70.00

Service Code	HCPCS 0064A
Hospital Charge Code	0064A00
Hospital Revenue Code	771
Min. Negotiated Rate	$32.34
Max. Negotiated Rate	$67.90
Rate for Payer: Cash Price	$52.50
Rate for Payer: Celtic Commercial/Exchange	$32.34
Rate for Payer: Health Partners Plans Commercial	$66.50
Rate for Payer: UnitedHealthcare Commercial	$67.90
Rate for Payer: WPPA Commercial	$58.80

ADMIN MODERNA INITIAL DOSE

Facility

$70.00

Service Code	HCPCS 0011A
Hospital Charge Code	0011A00
Hospital Revenue Code	761
Min. Negotiated Rate	$57.40
Max. Negotiated Rate	$67.90
Rate for Payer: Cash Price	$52.50
Rate for Payer: Health Partners Plans Commercial	$66.50
Rate for Payer: UnitedHealthcare Commercial	$67.90
Rate for Payer: WPPA Commercial	$57.40

ADMIN MODERNA INITIAL DOSE

Facility

$70.00

Service Code	HCPCS 0011A
Hospital Charge Code	0011A00
Hospital Revenue Code	761
Min. Negotiated Rate	$32.34
Max. Negotiated Rate	$67.90
Rate for Payer: Cash Price	$52.50
Rate for Payer: Celtic Commercial/Exchange	$32.34
Rate for Payer: Health Partners Plans Commercial	$66.50
Rate for Payer: UnitedHealthcare Commercial	$67.90
Rate for Payer: WPPA Commercial	$58.80

ADMIN OF COVID VACCINE

Facility

$70.00

Service Code	HCPCS 90480
Hospital Charge Code	9048000
Hospital Revenue Code	771
Min. Negotiated Rate	$32.34
Max. Negotiated Rate	$67.90
Rate for Payer: BCBS Commercial	$51.90
Rate for Payer: Cash Price	$52.50
Rate for Payer: Cash Price	$52.50
Rate for Payer: Celtic Commercial/Exchange	$32.34
Rate for Payer: Health Partners Plans Commercial	$66.50
Rate for Payer: UnitedHealthcare Commercial	$67.90
Rate for Payer: WPPA Commercial	$58.80

ADMIN OF COVID VACCINE

Facility

$70.00

Service Code	HCPCS 90480
Hospital Charge Code	9048000
Hospital Revenue Code	771
Min. Negotiated Rate	$57.40
Max. Negotiated Rate	$67.90
Rate for Payer: Cash Price	$52.50
Rate for Payer: Health Partners Plans Commercial	$66.50
Rate for Payer: UnitedHealthcare Commercial	$67.90
Rate for Payer: WPPA Commercial	$57.40

ADM OF BEBTELOVIM

Facility

$351.00

Service Code	HCPCS M0222
Hospital Charge Code	M022200
Hospital Revenue Code	761
Min. Negotiated Rate	$162.16
Max. Negotiated Rate	$340.47
Rate for Payer: Cash Price	$263.25
Rate for Payer: Celtic Commercial/Exchange	$162.16
Rate for Payer: Health Partners Plans Commercial	$333.45
Rate for Payer: UnitedHealthcare Commercial	$340.47
Rate for Payer: WPPA Commercial	$294.84

ADM OF BEBTELOVIM

Facility

$351.00

Service Code	HCPCS M0222
Hospital Charge Code	M022200
Hospital Revenue Code	761
Min. Negotiated Rate	$287.82
Max. Negotiated Rate	$340.47
Rate for Payer: Cash Price	$263.25
Rate for Payer: Health Partners Plans Commercial	$333.45
Rate for Payer: UnitedHealthcare Commercial	$340.47
Rate for Payer: WPPA Commercial	$287.82

ADM OF FLU VACCINE

Facility

$79.00

Service Code	HCPCS G0008
Hospital Charge Code	4590008
Hospital Revenue Code	771
Min. Negotiated Rate	$64.78
Max. Negotiated Rate	$76.63
Rate for Payer: Cash Price	$59.25
Rate for Payer: Health Partners Plans Commercial	$75.05
Rate for Payer: UnitedHealthcare Commercial	$76.63
Rate for Payer: WPPA Commercial	$64.78

ADM OF FLU VACCINE

Facility

$79.00

Service Code	HCPCS G0008
Hospital Charge Code	4590008
Hospital Revenue Code	771
Min. Negotiated Rate	$8.08
Max. Negotiated Rate	$76.63
Rate for Payer: BCBS Commercial	$8.08
Rate for Payer: Cash Price	$59.25
Rate for Payer: Cash Price	$59.25
Rate for Payer: Celtic Commercial/Exchange	$36.50
Rate for Payer: Health Partners Plans Commercial	$75.05
Rate for Payer: UnitedHealthcare Commercial	$76.63
Rate for Payer: WPPA Commercial	$66.36

ADM OF PNEUMONIA VACCINE

Facility

$100.00

Service Code	HCPCS G0009
Hospital Charge Code	4590009
Hospital Revenue Code	771
Min. Negotiated Rate	$8.08
Max. Negotiated Rate	$97.00
Rate for Payer: BCBS Commercial	$8.08
Rate for Payer: Cash Price	$75.00
Rate for Payer: Cash Price	$75.00
Rate for Payer: Celtic Commercial/Exchange	$46.20
Rate for Payer: Health Partners Plans Commercial	$95.00
Rate for Payer: UnitedHealthcare Commercial	$97.00
Rate for Payer: WPPA Commercial	$84.00

ADM OF PNEUMONIA VACCINE

Facility

$100.00

Service Code	HCPCS G0009
Hospital Charge Code	4590009
Hospital Revenue Code	771
Min. Negotiated Rate	$82.00
Max. Negotiated Rate	$97.00
Rate for Payer: Cash Price	$75.00
Rate for Payer: Health Partners Plans Commercial	$95.00
Rate for Payer: UnitedHealthcare Commercial	$97.00
Rate for Payer: WPPA Commercial	$82.00

ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC

Facility

$25,460.78

Service Code	MSDRG 614
Min. Negotiated Rate	$25,460.78
Max. Negotiated Rate	$25,460.78
Rate for Payer: BCBS Commercial	$25,460.78

ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC

Facility

$16,045.24

Service Code	MSDRG 615
Min. Negotiated Rate	$16,045.24
Max. Negotiated Rate	$16,045.24
Rate for Payer: BCBS Commercial	$16,045.24

ADRENALIN 1:1000 - 1 MG/ML INJ. (EPINEPHRINE) VIAL

Facility

$52.00

Service Code	NDC 54288010310
Hospital Charge Code	2502623
Hospital Revenue Code	250
Min. Negotiated Rate	$24.02
Max. Negotiated Rate	$50.44
Rate for Payer: Cash Price	$39.38
Rate for Payer: Celtic Commercial/Exchange	$24.02
Rate for Payer: Health Partners Plans Commercial	$49.40
Rate for Payer: UnitedHealthcare Commercial	$50.44
Rate for Payer: WPPA Commercial	$43.68

ADRENALIN 1:1000 - 1 MG/ML INJ. (EPINEPHRINE) VIAL

Facility

$52.00

Service Code	NDC 54288010310
Hospital Charge Code	2502623
Hospital Revenue Code	250
Min. Negotiated Rate	$42.64
Max. Negotiated Rate	$50.44
Rate for Payer: Cash Price	$39.38
Rate for Payer: Health Partners Plans Commercial	$49.40
Rate for Payer: UnitedHealthcare Commercial	$50.44
Rate for Payer: WPPA Commercial	$42.64

ADRENOCORTICOTROPIC HORMONE

Facility

$253.00

Service Code	HCPCS 82024
Hospital Charge Code	8202400
Hospital Revenue Code	301
Min. Negotiated Rate	$207.46
Max. Negotiated Rate	$245.41
Rate for Payer: Cash Price	$189.75
Rate for Payer: Health Partners Plans Commercial	$240.35
Rate for Payer: UnitedHealthcare Commercial	$245.41
Rate for Payer: WPPA Commercial	$207.46

ADRENOCORTICOTROPIC HORMONE

Facility

$253.00

Service Code	HCPCS 82024
Hospital Charge Code	8202400
Hospital Revenue Code	301
Min. Negotiated Rate	$116.89
Max. Negotiated Rate	$245.41
Rate for Payer: BCBS Commercial	$118.38
Rate for Payer: Cash Price	$189.75
Rate for Payer: Cash Price	$189.75
Rate for Payer: Celtic Commercial/Exchange	$116.89
Rate for Payer: Health Partners Plans Commercial	$240.35
Rate for Payer: UnitedHealthcare Commercial	$245.41
Rate for Payer: WPPA Commercial	$212.52

ADULT AMBU COLLAR

Facility

$55.00

Hospital Charge Code	2701169
Hospital Revenue Code	270
Min. Negotiated Rate	$25.41
Max. Negotiated Rate	$53.35
Rate for Payer: Cash Price	$41.25
Rate for Payer: Celtic Commercial/Exchange	$25.41
Rate for Payer: Health Partners Plans Commercial	$52.25
Rate for Payer: UnitedHealthcare Commercial	$53.35
Rate for Payer: WPPA Commercial	$46.20

ADULT AMBU COLLAR

Facility

$55.00

Hospital Charge Code	2701169
Hospital Revenue Code	270
Min. Negotiated Rate	$45.10
Max. Negotiated Rate	$53.35
Rate for Payer: Cash Price	$41.25
Rate for Payer: Health Partners Plans Commercial	$52.25
Rate for Payer: UnitedHealthcare Commercial	$53.35
Rate for Payer: WPPA Commercial	$45.10

AEROBIC CULTURE

Facility

$62.00

Service Code	HCPCS 87070
Hospital Charge Code	8707001
Hospital Revenue Code	306
Min. Negotiated Rate	$50.84
Max. Negotiated Rate	$60.14
Rate for Payer: Cash Price	$46.50
Rate for Payer: Health Partners Plans Commercial	$58.90
Rate for Payer: UnitedHealthcare Commercial	$60.14
Rate for Payer: WPPA Commercial	$50.84

Know your out-of-pocket cost for care.

All Charges