Ness County Hospital

All Charges

Charge

Type

Setting

Price

DEOXYRIBONUCLEIC ACID DNA

Facility

$150.00

Service Code	HCPCS 86226
Hospital Charge Code	8622600
Hospital Revenue Code	302
Min. Negotiated Rate	$61.53
Max. Negotiated Rate	$145.50
Rate for Payer: BCBS Commercial	$61.53
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

DEOXYRIBONUCLEIC ACID DNA

Facility

$150.00

Service Code	HCPCS 86226
Hospital Charge Code	8622600
Hospital Revenue Code	302
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

DEPAKOTE 125 MG CAP (DIVALPROEX SODIUM DR)

Facility

$6.00

Service Code	NDC 68084031311
Hospital Charge Code	2519718
Hospital Revenue Code	250
Min. Negotiated Rate	$4.92
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$4.54
Rate for Payer: Health Partners Plans Commercial	$5.70
Rate for Payer: UnitedHealthcare Commercial	$5.82
Rate for Payer: WPPA Commercial	$4.92

DEPAKOTE 125 MG CAP (DIVALPROEX SODIUM DR)

Facility

$6.00

Service Code	NDC 68084031311
Hospital Charge Code	2519718
Hospital Revenue Code	250
Min. Negotiated Rate	$2.77
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$4.54
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

DEPENDS

Facility

$13.00

Hospital Charge Code	2706723
Hospital Revenue Code	270
Min. Negotiated Rate	$6.01
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$10.12
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

DEPENDS

Facility

$13.00

Hospital Charge Code	2706723
Hospital Revenue Code	270
Min. Negotiated Rate	$10.66
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$10.12
Rate for Payer: Health Partners Plans Commercial	$12.35
Rate for Payer: UnitedHealthcare Commercial	$12.61
Rate for Payer: WPPA Commercial	$10.66

DEPO-MEDROL 80 MG/ML INJ. (METHYLPREDNISOLONE ACETATE)

Facility

$100.00

Service Code	NDC 70121157401
Hospital Charge Code	2502029
Hospital Revenue Code	250
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

DEPO-MEDROL 80 MG/ML INJ. (METHYLPREDNISOLONE ACETATE)

Facility

$100.00

Service Code	NDC 70121157401
Hospital Charge Code	2502029
Hospital Revenue Code	250
Min. Negotiated Rate	$46.20
Max. Negotiated Rate	$97.00
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

DEPO-PROVERA 150 MG/ML (MEDROXYPROGESTERONE) IM USE ONLY

Facility

$442.00

Service Code	NDC 00548540000
Hospital Charge Code	2514297
Hospital Revenue Code	250
Min. Negotiated Rate	$362.44
Max. Negotiated Rate	$428.74
Rate for Payer: Cash Price	$332.22
Rate for Payer: Health Partners Plans Commercial	$419.90
Rate for Payer: UnitedHealthcare Commercial	$428.74
Rate for Payer: WPPA Commercial	$362.44

DEPO-PROVERA 150 MG/ML (MEDROXYPROGESTERONE) IM USE ONLY

Facility

$442.00

Service Code	NDC 00548540000
Hospital Charge Code	2514297
Hospital Revenue Code	250
Min. Negotiated Rate	$204.20
Max. Negotiated Rate	$428.74
Rate for Payer: Cash Price	$332.22
Rate for Payer: Celtic Commercial/Exchange	$204.20
Rate for Payer: Health Partners Plans Commercial	$419.90
Rate for Payer: UnitedHealthcare Commercial	$428.74
Rate for Payer: WPPA Commercial	$371.28

DEPO-TESTOSTERONE 200 MG/ML INJ. (TESTOSTERONE CYPIONATE)

Facility

$85.00

Service Code	NDC 00009008601
Hospital Charge Code	2517142
Hospital Revenue Code	250
Min. Negotiated Rate	$39.27
Max. Negotiated Rate	$82.45
Rate for Payer: Cash Price	$64.43
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

DEPO-TESTOSTERONE 200 MG/ML INJ. (TESTOSTERONE CYPIONATE)

Facility

$85.00

Service Code	NDC 00009008601
Hospital Charge Code	2517142
Hospital Revenue Code	250
Min. Negotiated Rate	$69.70
Max. Negotiated Rate	$82.45
Rate for Payer: Cash Price	$64.43
Rate for Payer: Health Partners Plans Commercial	$80.75
Rate for Payer: UnitedHealthcare Commercial	$82.45
Rate for Payer: WPPA Commercial	$69.70

DEPRESSIVE NEUROSES

Facility

$8,638.53

Service Code	MSDRG 881
Min. Negotiated Rate	$8,638.53
Max. Negotiated Rate	$8,638.53
Rate for Payer: BCBS Commercial	$8,638.53

DERMABOND

Facility

$55.00

Hospital Charge Code	2721008
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

DERMABOND

Facility

$110.00

Hospital Charge Code	2518279
Hospital Revenue Code	270
Min. Negotiated Rate	$90.20
Max. Negotiated Rate	$106.70
Rate for Payer: Cash Price	$82.99
Rate for Payer: Health Partners Plans Commercial	$104.50
Rate for Payer: UnitedHealthcare Commercial	$106.70
Rate for Payer: WPPA Commercial	$90.20

DERMABOND

Facility

$110.00

Hospital Charge Code	2518279
Hospital Revenue Code	270
Min. Negotiated Rate	$50.82
Max. Negotiated Rate	$106.70
Rate for Payer: Cash Price	$82.99
Rate for Payer: Celtic Commercial/Exchange	$50.82
Rate for Payer: Health Partners Plans Commercial	$104.50
Rate for Payer: UnitedHealthcare Commercial	$106.70
Rate for Payer: WPPA Commercial	$92.40

DERMABOND

Facility

$55.00

Hospital Charge Code	2721008
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

DERMACEA

Facility

$9.00

Hospital Charge Code	2725058
Hospital Revenue Code	270
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

DERMACEA

Facility

$9.00

Hospital Charge Code	2725058
Hospital Revenue Code	270
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

DERMACEA LTC

Facility

$9.00

Hospital Charge Code	2725058LTC
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

DERMACEA LTC

Facility

$9.00

Hospital Charge Code	2725058LTC
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

DERMAL CURETTE DISPOSABLE

Facility

$15.00

Hospital Charge Code	2721670
Hospital Revenue Code	272
Min. Negotiated Rate	$6.93
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$11.25
Rate for Payer: Celtic Commercial/Exchange	$6.93
Rate for Payer: Health Partners Plans Commercial	$14.25
Rate for Payer: UnitedHealthcare Commercial	$14.55
Rate for Payer: WPPA Commercial	$12.60

DERMAL CURETTE DISPOSABLE

Facility

$15.00

Hospital Charge Code	2721670
Hospital Revenue Code	272
Min. Negotiated Rate	$12.30
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$11.25
Rate for Payer: Health Partners Plans Commercial	$14.25
Rate for Payer: UnitedHealthcare Commercial	$14.55
Rate for Payer: WPPA Commercial	$12.30

DERMOPLAST SPRAY

Facility

$18.00

Service Code	NDC 00573085520
Hospital Charge Code	2502037
Hospital Revenue Code	250
Min. Negotiated Rate	$8.32
Max. Negotiated Rate	$17.46
Rate for Payer: Cash Price	$13.58
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

DERMOPLAST SPRAY

Facility

$18.00

Service Code	NDC 00573085520
Hospital Charge Code	2502037
Hospital Revenue Code	250
Min. Negotiated Rate	$14.76
Max. Negotiated Rate	$17.46
Rate for Payer: Cash Price	$13.58
Rate for Payer: Health Partners Plans Commercial	$17.10
Rate for Payer: UnitedHealthcare Commercial	$17.46
Rate for Payer: WPPA Commercial	$14.76

Know your out-of-pocket cost for care.

All Charges