Ness County Hospital

All Charges

Charge

Type

Setting

Price

Desitin Ointment 2 oz. (zinc oxide-cod liver oil)

Facility

$11.00

Service Code	NDC 00501340003
Hospital Charge Code	2502045
Hospital Revenue Code	250
Min. Negotiated Rate	$9.02
Max. Negotiated Rate	$10.67
Rate for Payer: Cash Price	$8.32
Rate for Payer: Health Partners Plans Commercial	$10.45
Rate for Payer: UnitedHealthcare Commercial	$10.67
Rate for Payer: WPPA Commercial	$9.02

Desitin Ointment 2 oz. (zinc oxide-cod liver oil)

Facility

$11.00

Service Code	NDC 00501340003
Hospital Charge Code	2502045
Hospital Revenue Code	250
Min. Negotiated Rate	$5.08
Max. Negotiated Rate	$10.67
Rate for Payer: Cash Price	$8.32
Rate for Payer: Celtic Commercial/Exchange	$5.08
Rate for Payer: Health Partners Plans Commercial	$10.45
Rate for Payer: UnitedHealthcare Commercial	$10.67
Rate for Payer: WPPA Commercial	$9.24

DESTROY MALIG LESIONS2.1-3.0CM

Facility

$430.00

Service Code	HCPCS 17283
Hospital Charge Code	1728300
Hospital Revenue Code	450
Min. Negotiated Rate	$198.66
Max. Negotiated Rate	$417.10
Rate for Payer: Cash Price	$322.50
Rate for Payer: Celtic Commercial/Exchange	$198.66
Rate for Payer: Health Partners Plans Commercial	$408.50
Rate for Payer: UnitedHealthcare Commercial	$417.10
Rate for Payer: WPPA Commercial	$361.20

DESTROY MALIG LESIONS2.1-3.0CM

Facility

$430.00

Service Code	HCPCS 17283
Hospital Charge Code	1728300
Hospital Revenue Code	450
Min. Negotiated Rate	$352.60
Max. Negotiated Rate	$417.10
Rate for Payer: Cash Price	$322.50
Rate for Payer: Health Partners Plans Commercial	$408.50
Rate for Payer: UnitedHealthcare Commercial	$417.10
Rate for Payer: WPPA Commercial	$352.60

DESTRUCT INTERNAL HEMORRHOIDS

Facility

$1,500.00

Service Code	HCPCS 46930
Hospital Charge Code	4693000
Hospital Revenue Code	761
Min. Negotiated Rate	$693.00
Max. Negotiated Rate	$2,023.03
Rate for Payer: BCBS Commercial	$2,023.03
Rate for Payer: Cash Price	$1,125.00
Rate for Payer: Cash Price	$1,125.00
Rate for Payer: Celtic Commercial/Exchange	$693.00
Rate for Payer: Health Partners Plans Commercial	$1,425.00
Rate for Payer: UnitedHealthcare Commercial	$1,455.00
Rate for Payer: WPPA Commercial	$1,260.00

DESTRUCT INTERNAL HEMORRHOIDS

Facility

$1,500.00

Service Code	HCPCS 46930
Hospital Charge Code	4693000
Hospital Revenue Code	761
Min. Negotiated Rate	$1,230.00
Max. Negotiated Rate	$1,455.00
Rate for Payer: Cash Price	$1,125.00
Rate for Payer: Health Partners Plans Commercial	$1,425.00
Rate for Payer: UnitedHealthcare Commercial	$1,455.00
Rate for Payer: WPPA Commercial	$1,230.00

DESTRUCTION-WARTS,MOLLS,MILIA

Facility

$340.00

Service Code	HCPCS 17110
Hospital Charge Code	1711000
Hospital Revenue Code	761
Min. Negotiated Rate	$157.08
Max. Negotiated Rate	$329.80
Rate for Payer: BCBS Commercial	$248.38
Rate for Payer: Cash Price	$255.00
Rate for Payer: Cash Price	$255.00
Rate for Payer: Celtic Commercial/Exchange	$157.08
Rate for Payer: Health Partners Plans Commercial	$323.00
Rate for Payer: UnitedHealthcare Commercial	$329.80
Rate for Payer: WPPA Commercial	$285.60

DESTRUCTION-WARTS,MOLLS,MILIA

Facility

$340.00

Service Code	HCPCS 17110
Hospital Charge Code	1711000
Hospital Revenue Code	761
Min. Negotiated Rate	$278.80
Max. Negotiated Rate	$329.80
Rate for Payer: Cash Price	$255.00
Rate for Payer: Health Partners Plans Commercial	$323.00
Rate for Payer: UnitedHealthcare Commercial	$329.80
Rate for Payer: WPPA Commercial	$278.80

DESTRUCT PREMALG LESION

Facility

$250.00

Service Code	HCPCS 17000
Hospital Charge Code	1700000
Hospital Revenue Code	761
Min. Negotiated Rate	$115.50
Max. Negotiated Rate	$248.38
Rate for Payer: BCBS Commercial	$248.38
Rate for Payer: Cash Price	$187.50
Rate for Payer: Cash Price	$187.50
Rate for Payer: Celtic Commercial/Exchange	$115.50
Rate for Payer: Health Partners Plans Commercial	$237.50
Rate for Payer: UnitedHealthcare Commercial	$242.50
Rate for Payer: WPPA Commercial	$210.00

DESTRUCT PREMALG LESION

Facility

$250.00

Service Code	HCPCS 17000
Hospital Charge Code	1700000
Hospital Revenue Code	761
Min. Negotiated Rate	$205.00
Max. Negotiated Rate	$242.50
Rate for Payer: Cash Price	$187.50
Rate for Payer: Health Partners Plans Commercial	$237.50
Rate for Payer: UnitedHealthcare Commercial	$242.50
Rate for Payer: WPPA Commercial	$205.00

DESTRUCT PREMALG LESION 2-14

Facility

$275.00

Service Code	HCPCS 17003
Hospital Charge Code	1700300
Hospital Revenue Code	761
Min. Negotiated Rate	$127.05
Max. Negotiated Rate	$266.75
Rate for Payer: Cash Price	$206.25
Rate for Payer: Celtic Commercial/Exchange	$127.05
Rate for Payer: Health Partners Plans Commercial	$261.25
Rate for Payer: UnitedHealthcare Commercial	$266.75
Rate for Payer: WPPA Commercial	$231.00

DESTRUCT PREMALG LESION 2-14

Facility

$275.00

Service Code	HCPCS 17003
Hospital Charge Code	1700300
Hospital Revenue Code	761
Min. Negotiated Rate	$225.50
Max. Negotiated Rate	$266.75
Rate for Payer: Cash Price	$206.25
Rate for Payer: Health Partners Plans Commercial	$261.25
Rate for Payer: UnitedHealthcare Commercial	$266.75
Rate for Payer: WPPA Commercial	$225.50

DETROL 1 MG TAB (TOLTERODINE TARTRATE)

Facility

$9.00

Service Code	NDC 00093001006
Hospital Charge Code	2519106
Hospital Revenue Code	250
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$7.46
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

DETROL 1 MG TAB (TOLTERODINE TARTRATE)

Facility

$9.00

Service Code	NDC 00093001006
Hospital Charge Code	2519106
Hospital Revenue Code	250
Min. Negotiated Rate	$7.38
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$7.46
Rate for Payer: Health Partners Plans Commercial	$8.55
Rate for Payer: UnitedHealthcare Commercial	$8.73
Rate for Payer: WPPA Commercial	$7.38

DETROL LA 2 MG CAP (TOLTERODINE TARTRATE ER)

Facility

$40.00

Service Code	NDC 60687031911
Hospital Charge Code	2513067
Hospital Revenue Code	250
Min. Negotiated Rate	$18.48
Max. Negotiated Rate	$38.80
Rate for Payer: Cash Price	$30.49
Rate for Payer: Celtic Commercial/Exchange	$18.48
Rate for Payer: Health Partners Plans Commercial	$38.00
Rate for Payer: UnitedHealthcare Commercial	$38.80
Rate for Payer: WPPA Commercial	$33.60

DETROL LA 2 MG CAP (TOLTERODINE TARTRATE ER)

Facility

$40.00

Service Code	NDC 60687031911
Hospital Charge Code	2513067
Hospital Revenue Code	250
Min. Negotiated Rate	$32.80
Max. Negotiated Rate	$38.80
Rate for Payer: Cash Price	$30.49
Rate for Payer: Health Partners Plans Commercial	$38.00
Rate for Payer: UnitedHealthcare Commercial	$38.80
Rate for Payer: WPPA Commercial	$32.80

DEXA BONE DENSITY AXIAL

Facility

$473.00

Service Code	HCPCS 77080
Hospital Charge Code	7708000
Hospital Revenue Code	320
Min. Negotiated Rate	$387.86
Max. Negotiated Rate	$458.81
Rate for Payer: Cash Price	$354.75
Rate for Payer: Health Partners Plans Commercial	$449.35
Rate for Payer: UnitedHealthcare Commercial	$458.81
Rate for Payer: WPPA Commercial	$387.86

DEXA BONE DENSITY AXIAL

Facility

$473.00

Service Code	HCPCS 77080
Hospital Charge Code	7708000
Hospital Revenue Code	320
Min. Negotiated Rate	$197.96
Max. Negotiated Rate	$458.81
Rate for Payer: BCBS Commercial	$197.96
Rate for Payer: Cash Price	$354.75
Rate for Payer: Cash Price	$354.75
Rate for Payer: Celtic Commercial/Exchange	$218.53
Rate for Payer: Health Partners Plans Commercial	$449.35
Rate for Payer: UnitedHealthcare Commercial	$458.81
Rate for Payer: WPPA Commercial	$397.32

DEXTROSE 25 GM 50ML VIAL

Facility

$12.00

Service Code	NDC 00409664802
Hospital Charge Code	2511285
Hospital Revenue Code	250
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$11.64
Rate for Payer: Cash Price	$9.23
Rate for Payer: Celtic Commercial/Exchange	$5.54
Rate for Payer: Health Partners Plans Commercial	$11.40
Rate for Payer: UnitedHealthcare Commercial	$11.64
Rate for Payer: WPPA Commercial	$10.08

DEXTROSE 25 GM 50ML VIAL

Facility

$12.00

Service Code	NDC 00409664802
Hospital Charge Code	2511285
Hospital Revenue Code	250
Min. Negotiated Rate	$9.84
Max. Negotiated Rate	$11.64
Rate for Payer: Cash Price	$9.23
Rate for Payer: Health Partners Plans Commercial	$11.40
Rate for Payer: UnitedHealthcare Commercial	$11.64
Rate for Payer: WPPA Commercial	$9.84

DEXTROSE 50% - 50 ml syringe - 25 GM

Facility

$115.00

Service Code	NDC 00409751716
Hospital Charge Code	2502102
Hospital Revenue Code	250
Min. Negotiated Rate	$53.13
Max. Negotiated Rate	$111.55
Rate for Payer: Cash Price	$86.66
Rate for Payer: Celtic Commercial/Exchange	$53.13
Rate for Payer: Health Partners Plans Commercial	$109.25
Rate for Payer: UnitedHealthcare Commercial	$111.55
Rate for Payer: WPPA Commercial	$96.60

DEXTROSE 50% - 50 ml syringe - 25 GM

Facility

$115.00

Service Code	NDC 00409751716
Hospital Charge Code	2502102
Hospital Revenue Code	250
Min. Negotiated Rate	$94.30
Max. Negotiated Rate	$111.55
Rate for Payer: Cash Price	$86.66
Rate for Payer: Health Partners Plans Commercial	$109.25
Rate for Payer: UnitedHealthcare Commercial	$111.55
Rate for Payer: WPPA Commercial	$94.30

Dextrose 5% 100 ml IV

Facility

$50.00

Service Code	NDC 00990792337
Hospital Charge Code	2580090
Hospital Revenue Code	258
Min. Negotiated Rate	$41.00
Max. Negotiated Rate	$48.50
Rate for Payer: Cash Price	$37.50
Rate for Payer: Health Partners Plans Commercial	$47.50
Rate for Payer: UnitedHealthcare Commercial	$48.50
Rate for Payer: WPPA Commercial	$41.00

Dextrose 5% 100 ml IV

Facility

$50.00

Service Code	NDC 00990792337
Hospital Charge Code	2580090
Hospital Revenue Code	258
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$48.50
Rate for Payer: Cash Price	$37.50
Rate for Payer: Celtic Commercial/Exchange	$23.10
Rate for Payer: Health Partners Plans Commercial	$47.50
Rate for Payer: UnitedHealthcare Commercial	$48.50
Rate for Payer: WPPA Commercial	$42.00

DEXTROSE 5% (D5W) ADV 250 ML

Facility

$52.00

Service Code	NDC 00409710002
Hospital Charge Code	2516912
Hospital Revenue Code	258
Min. Negotiated Rate	$42.64
Max. Negotiated Rate	$50.44
Rate for Payer: Cash Price	$39.00
Rate for Payer: Health Partners Plans Commercial	$49.40
Rate for Payer: UnitedHealthcare Commercial	$50.44
Rate for Payer: WPPA Commercial	$42.64

Know your out-of-pocket cost for care.

All Charges