Ness County Hospital

All Charges

Charge

Type

Setting

Price

DEHYDROEPIANDROSTERONE,(DHEA)

Facility

$161.00

Service Code	HCPCS 82626
Hospital Charge Code	8262600
Hospital Revenue Code	301
Min. Negotiated Rate	$74.38
Max. Negotiated Rate	$156.17
Rate for Payer: BCBS Commercial	$91.51
Rate for Payer: Cash Price	$120.75
Rate for Payer: Cash Price	$120.75
Rate for Payer: Celtic Commercial/Exchange	$74.38
Rate for Payer: Health Partners Plans Commercial	$152.95
Rate for Payer: UnitedHealthcare Commercial	$156.17
Rate for Payer: WPPA Commercial	$135.24

DEHYDROEPIANDROSTERONE,(DHEA)

Facility

$161.00

Service Code	HCPCS 82626
Hospital Charge Code	8262600
Hospital Revenue Code	301
Min. Negotiated Rate	$132.02
Max. Negotiated Rate	$156.17
Rate for Payer: Cash Price	$120.75
Rate for Payer: Health Partners Plans Commercial	$152.95
Rate for Payer: UnitedHealthcare Commercial	$156.17
Rate for Payer: WPPA Commercial	$132.02

DEHYDROEPIANDROSTERONE SULFATE

Facility

$161.00

Service Code	HCPCS 82627
Hospital Charge Code	8262700
Hospital Revenue Code	301
Min. Negotiated Rate	$74.38
Max. Negotiated Rate	$156.17
Rate for Payer: BCBS Commercial	$80.41
Rate for Payer: Cash Price	$120.75
Rate for Payer: Cash Price	$120.75
Rate for Payer: Celtic Commercial/Exchange	$74.38
Rate for Payer: Health Partners Plans Commercial	$152.95
Rate for Payer: UnitedHealthcare Commercial	$156.17
Rate for Payer: WPPA Commercial	$135.24

DEHYDROEPIANDROSTERONE SULFATE

Facility

$161.00

Service Code	HCPCS 82627
Hospital Charge Code	8262700
Hospital Revenue Code	301
Min. Negotiated Rate	$132.02
Max. Negotiated Rate	$156.17
Rate for Payer: Cash Price	$120.75
Rate for Payer: Health Partners Plans Commercial	$152.95
Rate for Payer: UnitedHealthcare Commercial	$156.17
Rate for Payer: WPPA Commercial	$132.02

DEMADEX 20 MG TAB (TORSEMIDE)

Facility

$3.00

Service Code	NDC 50268075611
Hospital Charge Code	2515633
Hospital Revenue Code	250
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.29
Rate for Payer: Health Partners Plans Commercial	$2.85
Rate for Payer: UnitedHealthcare Commercial	$2.91
Rate for Payer: WPPA Commercial	$2.46

DEMADEX 20 MG TAB (TORSEMIDE)

Facility

$3.00

Service Code	NDC 50268075611
Hospital Charge Code	2515633
Hospital Revenue Code	250
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.29
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

Demerol 50 mg/ml vial (meperidine)

Facility

$8.00

Service Code	NDC 00409117803
Hospital Charge Code	2519825
Hospital Revenue Code	250
Min. Negotiated Rate	$3.70
Max. Negotiated Rate	$7.76
Rate for Payer: Cash Price	$6.49
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

Demerol 50 mg/ml vial (meperidine)

Facility

$8.00

Service Code	NDC 00409117803
Hospital Charge Code	2519825
Hospital Revenue Code	250
Min. Negotiated Rate	$6.56
Max. Negotiated Rate	$7.76
Rate for Payer: Cash Price	$6.49
Rate for Payer: Health Partners Plans Commercial	$7.60
Rate for Payer: UnitedHealthcare Commercial	$7.76
Rate for Payer: WPPA Commercial	$6.56

Demerol (meperidine) 100 MG/ ML INJ.

Facility

$20.00

Service Code	NDC 00641605425
Hospital Charge Code	2507382
Hospital Revenue Code	250
Min. Negotiated Rate	$16.40
Max. Negotiated Rate	$19.40
Rate for Payer: Cash Price	$15.56
Rate for Payer: Health Partners Plans Commercial	$19.00
Rate for Payer: UnitedHealthcare Commercial	$19.40
Rate for Payer: WPPA Commercial	$16.40

Demerol (meperidine) 100 MG/ ML INJ.

Facility

$20.00

Service Code	NDC 00641605425
Hospital Charge Code	2507382
Hospital Revenue Code	250
Min. Negotiated Rate	$9.24
Max. Negotiated Rate	$19.40
Rate for Payer: Cash Price	$15.56
Rate for Payer: Celtic Commercial/Exchange	$9.24
Rate for Payer: Health Partners Plans Commercial	$19.00
Rate for Payer: UnitedHealthcare Commercial	$19.40
Rate for Payer: WPPA Commercial	$16.80

Demerol (meperidine) 25 MG/ ML INJ.

Facility

$21.00

Service Code	NDC 00409117603
Hospital Charge Code	2504322
Hospital Revenue Code	250
Min. Negotiated Rate	$17.22
Max. Negotiated Rate	$20.37
Rate for Payer: Cash Price	$16.24
Rate for Payer: Health Partners Plans Commercial	$19.95
Rate for Payer: UnitedHealthcare Commercial	$20.37
Rate for Payer: WPPA Commercial	$17.22

Demerol (meperidine) 25 MG/ ML INJ.

Facility

$21.00

Service Code	NDC 00409117603
Hospital Charge Code	2504322
Hospital Revenue Code	250
Min. Negotiated Rate	$9.70
Max. Negotiated Rate	$20.37
Rate for Payer: Cash Price	$16.24
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

Demerol (meperidine) 75 MG/ ML INJ.

Facility

$20.00

Service Code	NDC 00409117930
Hospital Charge Code	2514412
Hospital Revenue Code	250
Min. Negotiated Rate	$16.40
Max. Negotiated Rate	$19.40
Rate for Payer: Cash Price	$15.56
Rate for Payer: Health Partners Plans Commercial	$19.00
Rate for Payer: UnitedHealthcare Commercial	$19.40
Rate for Payer: WPPA Commercial	$16.40

Demerol (meperidine) 75 MG/ ML INJ.

Facility

$20.00

Service Code	NDC 00409117930
Hospital Charge Code	2514412
Hospital Revenue Code	250
Min. Negotiated Rate	$9.24
Max. Negotiated Rate	$19.40
Rate for Payer: Cash Price	$15.56
Rate for Payer: Celtic Commercial/Exchange	$9.24
Rate for Payer: Health Partners Plans Commercial	$19.00
Rate for Payer: UnitedHealthcare Commercial	$19.40
Rate for Payer: WPPA Commercial	$16.80

DEM/EVAL PT ASL GEN NEB INHAL/

Facility

$212.00

Service Code	HCPCS 94664
Hospital Charge Code	9466400
Hospital Revenue Code	450
Min. Negotiated Rate	$97.94
Max. Negotiated Rate	$211.17
Rate for Payer: UnitedHealthcare Commercial	$205.64
Rate for Payer: BCBS Commercial	$211.17
Rate for Payer: Cash Price	$159.00
Rate for Payer: Cash Price	$159.00
Rate for Payer: Celtic Commercial/Exchange	$97.94
Rate for Payer: Health Partners Plans Commercial	$201.40
Rate for Payer: WPPA Commercial	$178.08

DEM/EVAL PT ASL GEN NEB INHAL/

Facility

$212.00

Service Code	HCPCS 94664
Hospital Charge Code	9466400
Hospital Revenue Code	450
Min. Negotiated Rate	$173.84
Max. Negotiated Rate	$205.64
Rate for Payer: Cash Price	$159.00
Rate for Payer: Health Partners Plans Commercial	$201.40
Rate for Payer: UnitedHealthcare Commercial	$205.64
Rate for Payer: WPPA Commercial	$173.84

DEMO/EVAL USE OF INHALER

Facility

$300.00

Service Code	HCPCS 94664
Hospital Charge Code	9466416
Hospital Revenue Code	410
Min. Negotiated Rate	$246.00
Max. Negotiated Rate	$291.00
Rate for Payer: Cash Price	$225.00
Rate for Payer: Health Partners Plans Commercial	$285.00
Rate for Payer: UnitedHealthcare Commercial	$291.00
Rate for Payer: WPPA Commercial	$246.00

DEMO/EVAL USE OF INHALER

Facility

$300.00

Service Code	HCPCS 94664
Hospital Charge Code	9466416
Hospital Revenue Code	410
Min. Negotiated Rate	$138.60
Max. Negotiated Rate	$291.00
Rate for Payer: BCBS Commercial	$211.17
Rate for Payer: Cash Price	$225.00
Rate for Payer: Cash Price	$225.00
Rate for Payer: Celtic Commercial/Exchange	$138.60
Rate for Payer: Health Partners Plans Commercial	$285.00
Rate for Payer: UnitedHealthcare Commercial	$291.00
Rate for Payer: WPPA Commercial	$252.00

DENTAL AND ORAL DISEASES WITH CC

Facility

$8,071.40

Service Code	MSDRG 158
Min. Negotiated Rate	$8,071.40
Max. Negotiated Rate	$8,071.40
Rate for Payer: BCBS Commercial	$8,071.40

DENTAL AND ORAL DISEASES WITH MCC

Facility

$14,132.59

Service Code	MSDRG 157
Min. Negotiated Rate	$14,132.59
Max. Negotiated Rate	$14,132.59
Rate for Payer: BCBS Commercial	$14,132.59

DENTAL AND ORAL DISEASES WITHOUT CC/MCC

Facility

$5,885.34

Service Code	MSDRG 159
Min. Negotiated Rate	$5,885.34
Max. Negotiated Rate	$5,885.34
Rate for Payer: BCBS Commercial	$5,885.34

DEOXYCORTISOL, 11-

Facility

$150.00

Service Code	HCPCS 82634
Hospital Charge Code	8263400
Hospital Revenue Code	301
Min. Negotiated Rate	$69.30
Max. Negotiated Rate	$145.50
Rate for Payer: BCBS Commercial	$88.99
Rate for Payer: Cash Price	$112.50
Rate for Payer: Cash Price	$112.50
Rate for Payer: Celtic Commercial/Exchange	$69.30
Rate for Payer: Health Partners Plans Commercial	$142.50
Rate for Payer: UnitedHealthcare Commercial	$145.50
Rate for Payer: WPPA Commercial	$126.00

DEOXYCORTISOL, 11-

Facility

$150.00

Service Code	HCPCS 82634
Hospital Charge Code	8263400
Hospital Revenue Code	301
Min. Negotiated Rate	$123.00
Max. Negotiated Rate	$145.50
Rate for Payer: Cash Price	$112.50
Rate for Payer: Health Partners Plans Commercial	$142.50
Rate for Payer: UnitedHealthcare Commercial	$145.50
Rate for Payer: WPPA Commercial	$123.00

DEOXYRIBONUCLEASE, ANTIBODY

Facility

$87.00

Service Code	HCPCS 86215
Hospital Charge Code	8621500
Hospital Revenue Code	302
Min. Negotiated Rate	$40.19
Max. Negotiated Rate	$84.39
Rate for Payer: BCBS Commercial	$63.07
Rate for Payer: Cash Price	$65.25
Rate for Payer: Cash Price	$65.25
Rate for Payer: Celtic Commercial/Exchange	$40.19
Rate for Payer: Health Partners Plans Commercial	$82.65
Rate for Payer: UnitedHealthcare Commercial	$84.39
Rate for Payer: WPPA Commercial	$73.08

DEOXYRIBONUCLEASE, ANTIBODY

Facility

$87.00

Service Code	HCPCS 86215
Hospital Charge Code	8621500
Hospital Revenue Code	302
Min. Negotiated Rate	$71.34
Max. Negotiated Rate	$84.39
Rate for Payer: Cash Price	$65.25
Rate for Payer: Health Partners Plans Commercial	$82.65
Rate for Payer: UnitedHealthcare Commercial	$84.39
Rate for Payer: WPPA Commercial	$71.34

Know your out-of-pocket cost for care.

All Charges