Ness County Hospital

All Charges

Charge

Type

Setting

Price

DEBRIDE OF EXTENSIV ECZEMATOUS

Facility

$581.00

Service Code	HCPCS 11000
Hospital Charge Code	1100000
Hospital Revenue Code	761
Min. Negotiated Rate	$268.42
Max. Negotiated Rate	$563.57
Rate for Payer: BCBS Commercial	$278.76
Rate for Payer: Cash Price	$435.75
Rate for Payer: Cash Price	$435.75
Rate for Payer: Celtic Commercial/Exchange	$268.42
Rate for Payer: Health Partners Plans Commercial	$551.95
Rate for Payer: UnitedHealthcare Commercial	$563.57
Rate for Payer: WPPA Commercial	$488.04

DEBRIDE SKIN-EA ADDTL 20 SQCM

Facility

$478.00

Service Code	HCPCS 11045
Hospital Charge Code	1104523
Hospital Revenue Code	761
Min. Negotiated Rate	$391.96
Max. Negotiated Rate	$463.66
Rate for Payer: Cash Price	$358.50
Rate for Payer: Health Partners Plans Commercial	$454.10
Rate for Payer: UnitedHealthcare Commercial	$463.66
Rate for Payer: WPPA Commercial	$391.96

DEBRIDE SKIN-EA ADDTL 20 SQCM

Facility

$478.00

Service Code	HCPCS 11045
Hospital Charge Code	1104523
Hospital Revenue Code	761
Min. Negotiated Rate	$220.84
Max. Negotiated Rate	$463.66
Rate for Payer: BCBS Commercial	$278.76
Rate for Payer: Cash Price	$358.50
Rate for Payer: Cash Price	$358.50
Rate for Payer: Celtic Commercial/Exchange	$220.84
Rate for Payer: Health Partners Plans Commercial	$454.10
Rate for Payer: UnitedHealthcare Commercial	$463.66
Rate for Payer: WPPA Commercial	$401.52

DEBRIDE SKIN-SQ TIS,1ST 20SQCM

Facility

$654.00

Service Code	HCPCS 11042
Hospital Charge Code	1104223
Hospital Revenue Code	761
Min. Negotiated Rate	$536.28
Max. Negotiated Rate	$634.38
Rate for Payer: Cash Price	$490.50
Rate for Payer: Health Partners Plans Commercial	$621.30
Rate for Payer: UnitedHealthcare Commercial	$634.38
Rate for Payer: WPPA Commercial	$536.28

DEBRIDE SKIN-SQ TIS,1ST 20SQCM

Facility

$654.00

Service Code	HCPCS 11042
Hospital Charge Code	1104223
Hospital Revenue Code	761
Min. Negotiated Rate	$302.15
Max. Negotiated Rate	$634.38
Rate for Payer: BCBS Commercial	$451.17
Rate for Payer: Cash Price	$490.50
Rate for Payer: Cash Price	$490.50
Rate for Payer: Celtic Commercial/Exchange	$302.15
Rate for Payer: Health Partners Plans Commercial	$621.30
Rate for Payer: UnitedHealthcare Commercial	$634.38
Rate for Payer: WPPA Commercial	$549.36

DEBRIDE SKIN,SUB TISSUE/MUSCLE

Facility

$701.00

Service Code	HCPCS 11043
Hospital Charge Code	1104300
Hospital Revenue Code	761
Min. Negotiated Rate	$323.86
Max. Negotiated Rate	$700.21
Rate for Payer: BCBS Commercial	$700.21
Rate for Payer: Cash Price	$525.75
Rate for Payer: Cash Price	$525.75
Rate for Payer: Celtic Commercial/Exchange	$323.86
Rate for Payer: Health Partners Plans Commercial	$665.95
Rate for Payer: UnitedHealthcare Commercial	$679.97
Rate for Payer: WPPA Commercial	$588.84

DEBRIDE SKIN,SUB TISSUE/MUSCLE

Facility

$701.00

Service Code	HCPCS 11043
Hospital Charge Code	1104300
Hospital Revenue Code	761
Min. Negotiated Rate	$574.82
Max. Negotiated Rate	$679.97
Rate for Payer: Cash Price	$525.75
Rate for Payer: Health Partners Plans Commercial	$665.95
Rate for Payer: UnitedHealthcare Commercial	$679.97
Rate for Payer: WPPA Commercial	$574.82

DEBRIDE-SQ TIS,MUSL 1ST 20SQCM

Facility

$701.00

Service Code	HCPCS 11043
Hospital Charge Code	1104323
Hospital Revenue Code	761
Min. Negotiated Rate	$323.86
Max. Negotiated Rate	$700.21
Rate for Payer: BCBS Commercial	$700.21
Rate for Payer: Cash Price	$525.75
Rate for Payer: Cash Price	$525.75
Rate for Payer: Celtic Commercial/Exchange	$323.86
Rate for Payer: Health Partners Plans Commercial	$665.95
Rate for Payer: UnitedHealthcare Commercial	$679.97
Rate for Payer: WPPA Commercial	$588.84

DEBRIDE-SQ TIS,MUSL 1ST 20SQCM

Facility

$701.00

Service Code	HCPCS 11043
Hospital Charge Code	1104323
Hospital Revenue Code	761
Min. Negotiated Rate	$574.82
Max. Negotiated Rate	$679.97
Rate for Payer: Cash Price	$525.75
Rate for Payer: Health Partners Plans Commercial	$665.95
Rate for Payer: UnitedHealthcare Commercial	$679.97
Rate for Payer: WPPA Commercial	$574.82

DEBRIDE TIS/MSL EA ADTL 20SQCM

Facility

$400.00

Service Code	HCPCS 11046
Hospital Charge Code	1104623
Hospital Revenue Code	761
Min. Negotiated Rate	$184.80
Max. Negotiated Rate	$388.00
Rate for Payer: BCBS Commercial	$278.76
Rate for Payer: Cash Price	$300.00
Rate for Payer: Cash Price	$300.00
Rate for Payer: Celtic Commercial/Exchange	$184.80
Rate for Payer: Health Partners Plans Commercial	$380.00
Rate for Payer: UnitedHealthcare Commercial	$388.00
Rate for Payer: WPPA Commercial	$336.00

DEBRIDE TIS/MSL EA ADTL 20SQCM

Facility

$400.00

Service Code	HCPCS 11046
Hospital Charge Code	1104623
Hospital Revenue Code	761
Min. Negotiated Rate	$328.00
Max. Negotiated Rate	$388.00
Rate for Payer: Cash Price	$300.00
Rate for Payer: Health Partners Plans Commercial	$380.00
Rate for Payer: UnitedHealthcare Commercial	$388.00
Rate for Payer: WPPA Commercial	$328.00

DEBROX OTIC DROPS (EARWAX REMOVAL AID)

Facility

$21.00

Service Code	NDC 46122055705
Hospital Charge Code	2501930
Hospital Revenue Code	250
Min. Negotiated Rate	$17.22
Max. Negotiated Rate	$20.37
Rate for Payer: Cash Price	$16.42
Rate for Payer: Health Partners Plans Commercial	$19.95
Rate for Payer: UnitedHealthcare Commercial	$20.37
Rate for Payer: WPPA Commercial	$17.22

DEBROX OTIC DROPS (EARWAX REMOVAL AID)

Facility

$21.00

Service Code	NDC 46122055705
Hospital Charge Code	2501930
Hospital Revenue Code	250
Min. Negotiated Rate	$9.70
Max. Negotiated Rate	$20.37
Rate for Payer: Cash Price	$16.42
Rate for Payer: Celtic Commercial/Exchange	$9.70
Rate for Payer: Health Partners Plans Commercial	$19.95
Rate for Payer: UnitedHealthcare Commercial	$20.37
Rate for Payer: WPPA Commercial	$17.64

DECADRON 0.5 MG/5 ML OS (DEXAMETHASONE)

Facility

$3.00

Service Code	NDC 00054317757
Hospital Charge Code	2519239
Hospital Revenue Code	250
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.44
Rate for Payer: Health Partners Plans Commercial	$2.85
Rate for Payer: UnitedHealthcare Commercial	$2.91
Rate for Payer: WPPA Commercial	$2.46

DECADRON 0.5 MG/5 ML OS (DEXAMETHASONE)

Facility

$3.00

Service Code	NDC 00054317757
Hospital Charge Code	2519239
Hospital Revenue Code	250
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.44
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

DECADRON 4 MG/ML INJ. (DEXAMETHASONE SODIUM PHOSPHATE)

Facility

$39.00

Service Code	NDC 67457041900
Hospital Charge Code	2508265
Hospital Revenue Code	250
Min. Negotiated Rate	$18.02
Max. Negotiated Rate	$37.83
Rate for Payer: Cash Price	$29.25
Rate for Payer: Celtic Commercial/Exchange	$18.02
Rate for Payer: Health Partners Plans Commercial	$37.05
Rate for Payer: UnitedHealthcare Commercial	$37.83
Rate for Payer: WPPA Commercial	$32.76

DECADRON 4 MG/ML INJ. (DEXAMETHASONE SODIUM PHOSPHATE)

Facility

$39.00

Service Code	NDC 67457041900
Hospital Charge Code	2508265
Hospital Revenue Code	250
Min. Negotiated Rate	$31.98
Max. Negotiated Rate	$37.83
Rate for Payer: Cash Price	$29.25
Rate for Payer: Health Partners Plans Commercial	$37.05
Rate for Payer: UnitedHealthcare Commercial	$37.83
Rate for Payer: WPPA Commercial	$31.98

DECADRON 4 MG TAB (DEXAMETHASONE)

Facility

$16.00

Service Code	NDC 00054817525
Hospital Charge Code	2501955
Hospital Revenue Code	250
Min. Negotiated Rate	$7.39
Max. Negotiated Rate	$15.52
Rate for Payer: Cash Price	$12.15
Rate for Payer: Celtic Commercial/Exchange	$7.39
Rate for Payer: Health Partners Plans Commercial	$15.20
Rate for Payer: UnitedHealthcare Commercial	$15.52
Rate for Payer: WPPA Commercial	$13.44

DECADRON 4 MG TAB (DEXAMETHASONE)

Facility

$16.00

Service Code	NDC 00054817525
Hospital Charge Code	2501955
Hospital Revenue Code	250
Min. Negotiated Rate	$13.12
Max. Negotiated Rate	$15.52
Rate for Payer: Cash Price	$12.15
Rate for Payer: Health Partners Plans Commercial	$15.20
Rate for Payer: UnitedHealthcare Commercial	$15.52
Rate for Payer: WPPA Commercial	$13.12

DECADRON OPTHALMIC SOLUTION 0.1% (DEXAMETHASONE SODIUM PHOSPHATE)

Facility

$271.00

Service Code	NDC 24208072002
Hospital Charge Code	2501971
Hospital Revenue Code	250
Min. Negotiated Rate	$222.22
Max. Negotiated Rate	$262.87
Rate for Payer: Cash Price	$203.62
Rate for Payer: Health Partners Plans Commercial	$257.45
Rate for Payer: UnitedHealthcare Commercial	$262.87
Rate for Payer: WPPA Commercial	$222.22

DECADRON OPTHALMIC SOLUTION 0.1% (DEXAMETHASONE SODIUM PHOSPHATE)

Facility

$271.00

Service Code	NDC 24208072002
Hospital Charge Code	2501971
Hospital Revenue Code	250
Min. Negotiated Rate	$125.20
Max. Negotiated Rate	$262.87
Rate for Payer: Cash Price	$203.62
Rate for Payer: Celtic Commercial/Exchange	$125.20
Rate for Payer: Health Partners Plans Commercial	$257.45
Rate for Payer: UnitedHealthcare Commercial	$262.87
Rate for Payer: WPPA Commercial	$227.64

DEFINITIVE DRUG TESTING PROC

Facility

$85.00

Service Code	HCPCS 80359
Hospital Charge Code	8035900
Hospital Revenue Code	300
Min. Negotiated Rate	$23.88
Max. Negotiated Rate	$82.45
Rate for Payer: BCBS Commercial	$23.88
Rate for Payer: Cash Price	$63.75
Rate for Payer: Cash Price	$63.75
Rate for Payer: Celtic Commercial/Exchange	$39.27
Rate for Payer: Health Partners Plans Commercial	$80.75
Rate for Payer: UnitedHealthcare Commercial	$82.45
Rate for Payer: WPPA Commercial	$71.40

DEFINITIVE DRUG TESTING PROC

Facility

$85.00

Service Code	HCPCS 80359
Hospital Charge Code	8035900
Hospital Revenue Code	300
Min. Negotiated Rate	$69.70
Max. Negotiated Rate	$82.45
Rate for Payer: Cash Price	$63.75
Rate for Payer: Health Partners Plans Commercial	$80.75
Rate for Payer: UnitedHealthcare Commercial	$82.45
Rate for Payer: WPPA Commercial	$69.70

DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC

Facility

$19,683.60

Service Code	MSDRG 056
Min. Negotiated Rate	$19,683.60
Max. Negotiated Rate	$19,683.60
Rate for Payer: BCBS Commercial	$19,683.60

DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC

Facility

$11,364.72

Service Code	MSDRG 057
Min. Negotiated Rate	$11,364.72
Max. Negotiated Rate	$11,364.72
Rate for Payer: BCBS Commercial	$11,364.72

Know your out-of-pocket cost for care.

All Charges