Ness County Hospital

All Charges

Charge

Type

Setting

Price

ECG BACKPAD

Facility

$25.00

Hospital Charge Code	2709522
Hospital Revenue Code	270
Min. Negotiated Rate	$20.50
Max. Negotiated Rate	$24.25
Rate for Payer: Cash Price	$18.75
Rate for Payer: Health Partners Plans Commercial	$23.75
Rate for Payer: UnitedHealthcare Commercial	$24.25
Rate for Payer: WPPA Commercial	$20.50

ECG BACKPAD

Facility

$25.00

Hospital Charge Code	2709522
Hospital Revenue Code	270
Min. Negotiated Rate	$11.55
Max. Negotiated Rate	$24.25
Rate for Payer: Cash Price	$18.75
Rate for Payer: Celtic Commercial/Exchange	$11.55
Rate for Payer: Health Partners Plans Commercial	$23.75
Rate for Payer: UnitedHealthcare Commercial	$24.25
Rate for Payer: WPPA Commercial	$21.00

ECHO/LIMITED OR F/U NO DOPPLER

Facility

$872.00

Service Code	HCPCS 93308
Hospital Charge Code	3320029
Hospital Revenue Code	480
Min. Negotiated Rate	$402.86
Max. Negotiated Rate	$845.84
Rate for Payer: BCBS Commercial	$575.70
Rate for Payer: Cash Price	$654.00
Rate for Payer: Cash Price	$654.00
Rate for Payer: Celtic Commercial/Exchange	$402.86
Rate for Payer: Health Partners Plans Commercial	$828.40
Rate for Payer: UnitedHealthcare Commercial	$845.84
Rate for Payer: WPPA Commercial	$732.48

ECHO/LIMITED OR F/U NO DOPPLER

Facility

$872.00

Service Code	HCPCS 93308
Hospital Charge Code	3320029
Hospital Revenue Code	480
Min. Negotiated Rate	$715.04
Max. Negotiated Rate	$845.84
Rate for Payer: Cash Price	$654.00
Rate for Payer: Health Partners Plans Commercial	$828.40
Rate for Payer: UnitedHealthcare Commercial	$845.84
Rate for Payer: WPPA Commercial	$715.04

ECHO LIMITED W/ DEFINITY

Facility

$880.00

Service Code	HCPCS C8924
Hospital Charge Code	C892400
Hospital Revenue Code	480
Min. Negotiated Rate	$406.56
Max. Negotiated Rate	$853.60
Rate for Payer: BCBS Commercial	$579.74
Rate for Payer: Cash Price	$660.00
Rate for Payer: Cash Price	$660.00
Rate for Payer: Celtic Commercial/Exchange	$406.56
Rate for Payer: Health Partners Plans Commercial	$836.00
Rate for Payer: UnitedHealthcare Commercial	$853.60
Rate for Payer: WPPA Commercial	$739.20

ECHO LIMITED W/ DEFINITY

Facility

$880.00

Service Code	HCPCS C8924
Hospital Charge Code	C892400
Hospital Revenue Code	480
Min. Negotiated Rate	$721.60
Max. Negotiated Rate	$853.60
Rate for Payer: Cash Price	$660.00
Rate for Payer: Health Partners Plans Commercial	$836.00
Rate for Payer: UnitedHealthcare Commercial	$853.60
Rate for Payer: WPPA Commercial	$721.60

ECHO W/DEFINITY DOPPLER COMPL

Facility

$2,208.00

Service Code	HCPCS C8929
Hospital Charge Code	C892900
Hospital Revenue Code	480
Min. Negotiated Rate	$1,020.10
Max. Negotiated Rate	$2,141.76
Rate for Payer: BCBS Commercial	$1,532.17
Rate for Payer: Cash Price	$1,656.00
Rate for Payer: Cash Price	$1,656.00
Rate for Payer: Celtic Commercial/Exchange	$1,020.10
Rate for Payer: Health Partners Plans Commercial	$2,097.60
Rate for Payer: UnitedHealthcare Commercial	$2,141.76
Rate for Payer: WPPA Commercial	$1,854.72

ECHO W/DEFINITY DOPPLER COMPL

Facility

$2,208.00

Service Code	HCPCS C8929
Hospital Charge Code	C892900
Hospital Revenue Code	480
Min. Negotiated Rate	$1,810.56
Max. Negotiated Rate	$2,141.76
Rate for Payer: Cash Price	$1,656.00
Rate for Payer: Health Partners Plans Commercial	$2,097.60
Rate for Payer: UnitedHealthcare Commercial	$2,141.76
Rate for Payer: WPPA Commercial	$1,810.56

ECHO W/DOPPLER COMPLETE

Facility

$2,532.00

Service Code	HCPCS 93306
Hospital Charge Code	3320628
Hospital Revenue Code	483
Min. Negotiated Rate	$1,169.78
Max. Negotiated Rate	$2,456.04
Rate for Payer: BCBS Commercial	$1,532.17
Rate for Payer: Cash Price	$1,899.00
Rate for Payer: Cash Price	$1,899.00
Rate for Payer: Celtic Commercial/Exchange	$1,169.78
Rate for Payer: Health Partners Plans Commercial	$2,405.40
Rate for Payer: UnitedHealthcare Commercial	$2,456.04
Rate for Payer: WPPA Commercial	$2,126.88

ECHO W/DOPPLER COMPLETE

Facility

$2,532.00

Service Code	HCPCS 93306
Hospital Charge Code	3320628
Hospital Revenue Code	483
Min. Negotiated Rate	$2,076.24
Max. Negotiated Rate	$2,456.04
Rate for Payer: Cash Price	$1,899.00
Rate for Payer: Health Partners Plans Commercial	$2,405.40
Rate for Payer: UnitedHealthcare Commercial	$2,456.04
Rate for Payer: WPPA Commercial	$2,076.24

ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES

Facility

$171,304.75

Service Code	MSDRG 003
Min. Negotiated Rate	$171,304.75
Max. Negotiated Rate	$171,304.75
Rate for Payer: BCBS Commercial	$171,304.75

EFFEXOR XR 75 MG CAP (VENLAFAXINE)

Facility

$16.00

Service Code	NDC 68084070911
Hospital Charge Code	2502177
Hospital Revenue Code	250
Min. Negotiated Rate	$7.39
Max. Negotiated Rate	$15.52
Rate for Payer: Cash Price	$12.38
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

EFFEXOR XR 75 MG CAP (VENLAFAXINE)

Facility

$16.00

Service Code	NDC 68084070911
Hospital Charge Code	2502177
Hospital Revenue Code	250
Min. Negotiated Rate	$13.12
Max. Negotiated Rate	$15.52
Rate for Payer: Cash Price	$12.38
Rate for Payer: Health Partners Plans Commercial	$15.20
Rate for Payer: UnitedHealthcare Commercial	$15.52
Rate for Payer: WPPA Commercial	$13.12

EGD (DIAGNOSTIC)

Facility

$1,270.00

Service Code	HCPCS 43235
Hospital Charge Code	4323500
Hospital Revenue Code	761
Min. Negotiated Rate	$1,041.40
Max. Negotiated Rate	$1,231.90
Rate for Payer: Cash Price	$952.50
Rate for Payer: Health Partners Plans Commercial	$1,206.50
Rate for Payer: UnitedHealthcare Commercial	$1,231.90
Rate for Payer: WPPA Commercial	$1,041.40

EGD (DIAGNOSTIC)

Facility

$1,270.00

Service Code	HCPCS 43235
Hospital Charge Code	4323500
Hospital Revenue Code	761
Min. Negotiated Rate	$586.74
Max. Negotiated Rate	$1,231.90
Rate for Payer: BCBS Commercial	$1,171.95
Rate for Payer: Cash Price	$952.50
Rate for Payer: Cash Price	$952.50
Rate for Payer: Celtic Commercial/Exchange	$586.74
Rate for Payer: Health Partners Plans Commercial	$1,206.50
Rate for Payer: UnitedHealthcare Commercial	$1,231.90
Rate for Payer: WPPA Commercial	$1,066.80

EGG CRATE MATTRESS ADULT

Facility

$64.00

Hospital Charge Code	2700482
Hospital Revenue Code	270
Min. Negotiated Rate	$29.57
Max. Negotiated Rate	$62.08
Rate for Payer: Cash Price	$48.00
Rate for Payer: Celtic Commercial/Exchange	$29.57
Rate for Payer: Health Partners Plans Commercial	$60.80
Rate for Payer: UnitedHealthcare Commercial	$62.08
Rate for Payer: WPPA Commercial	$53.76

EGG CRATE MATTRESS ADULT

Facility

$64.00

Hospital Charge Code	2700482
Hospital Revenue Code	270
Min. Negotiated Rate	$52.48
Max. Negotiated Rate	$62.08
Rate for Payer: Cash Price	$48.00
Rate for Payer: Health Partners Plans Commercial	$60.80
Rate for Payer: UnitedHealthcare Commercial	$62.08
Rate for Payer: WPPA Commercial	$52.48

EHRLICHIA

Facility

$150.00

Service Code	HCPCS 86666
Hospital Charge Code	8666600
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

EHRLICHIA

Facility

$150.00

Service Code	HCPCS 86666
Hospital Charge Code	8666600
Hospital Revenue Code	301
Min. Negotiated Rate	$69.30
Max. Negotiated Rate	$145.50
Rate for Payer: BCBS Commercial	$112.11
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

EKG, 30 SEC. RHYTHM STRIP

Facility

$76.00

Service Code	HCPCS 93041
Hospital Charge Code	7200016
Hospital Revenue Code	730
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

EKG, 30 SEC. RHYTHM STRIP

Facility

$76.00

Service Code	HCPCS 93041
Hospital Charge Code	7200016
Hospital Revenue Code	730
Min. Negotiated Rate	$35.11
Max. Negotiated Rate	$73.72
Rate for Payer: BCBS Commercial	$73.10
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

EKG BACK PAD ELECTRODE ADULT

Facility

$30.00

Hospital Charge Code	2700177
Hospital Revenue Code	270
Min. Negotiated Rate	$24.60
Max. Negotiated Rate	$29.10
Rate for Payer: Cash Price	$22.88
Rate for Payer: Health Partners Plans Commercial	$28.50
Rate for Payer: UnitedHealthcare Commercial	$29.10
Rate for Payer: WPPA Commercial	$24.60

EKG BACK PAD ELECTRODE ADULT

Facility

$30.00

Hospital Charge Code	2700177
Hospital Revenue Code	270
Min. Negotiated Rate	$13.86
Max. Negotiated Rate	$29.10
Rate for Payer: Cash Price	$22.88
Rate for Payer: Celtic Commercial/Exchange	$13.86
Rate for Payer: Health Partners Plans Commercial	$28.50
Rate for Payer: UnitedHealthcare Commercial	$29.10
Rate for Payer: WPPA Commercial	$25.20

EKG PULSE O2

Facility

$31.00

Hospital Charge Code	2900298
Hospital Revenue Code	270
Min. Negotiated Rate	$14.32
Max. Negotiated Rate	$30.07
Rate for Payer: Cash Price	$23.25
Rate for Payer: Celtic Commercial/Exchange	$14.32
Rate for Payer: Health Partners Plans Commercial	$29.45
Rate for Payer: UnitedHealthcare Commercial	$30.07
Rate for Payer: WPPA Commercial	$26.04

EKG PULSE O2

Facility

$31.00

Hospital Charge Code	2900298
Hospital Revenue Code	270
Min. Negotiated Rate	$25.42
Max. Negotiated Rate	$30.07
Rate for Payer: Cash Price	$23.25
Rate for Payer: Health Partners Plans Commercial	$29.45
Rate for Payer: UnitedHealthcare Commercial	$30.07
Rate for Payer: WPPA Commercial	$25.42

Know your out-of-pocket cost for care.

All Charges