Ness County Hospital

All Charges

Charge

Type

Setting

Price

ENDOMYSIAL ANTIBODY (IGA)SCREE

Facility

$93.00

Service Code	HCPCS 86255
Hospital Charge Code	8625503
Hospital Revenue Code	302
Min. Negotiated Rate	$42.97
Max. Negotiated Rate	$90.21
Rate for Payer: BCBS Commercial	$49.98
Rate for Payer: Cash Price	$69.75
Rate for Payer: Cash Price	$69.75
Rate for Payer: Celtic Commercial/Exchange	$42.97
Rate for Payer: Health Partners Plans Commercial	$88.35
Rate for Payer: UnitedHealthcare Commercial	$90.21
Rate for Payer: WPPA Commercial	$78.12

ENDOMYSIAL IGA AB

Facility

$111.00

Service Code	HCPCS 86231
Hospital Charge Code	8623100
Hospital Revenue Code	300
Min. Negotiated Rate	$91.02
Max. Negotiated Rate	$107.67
Rate for Payer: Cash Price	$83.25
Rate for Payer: Health Partners Plans Commercial	$105.45
Rate for Payer: UnitedHealthcare Commercial	$107.67
Rate for Payer: WPPA Commercial	$91.02

ENDOMYSIAL IGA AB

Facility

$111.00

Service Code	HCPCS 86231
Hospital Charge Code	8623100
Hospital Revenue Code	300
Min. Negotiated Rate	$22.67
Max. Negotiated Rate	$107.67
Rate for Payer: BCBS Commercial	$22.67
Rate for Payer: Cash Price	$83.25
Rate for Payer: Cash Price	$83.25
Rate for Payer: Celtic Commercial/Exchange	$51.28
Rate for Payer: Health Partners Plans Commercial	$105.45
Rate for Payer: UnitedHealthcare Commercial	$107.67
Rate for Payer: WPPA Commercial	$93.24

ENDOSCOPIC MARKER

Facility

$60.00

Hospital Charge Code	2705671
Hospital Revenue Code	270
Min. Negotiated Rate	$27.72
Max. Negotiated Rate	$58.20
Rate for Payer: Cash Price	$45.00
Rate for Payer: Celtic Commercial/Exchange	$27.72
Rate for Payer: Health Partners Plans Commercial	$57.00
Rate for Payer: UnitedHealthcare Commercial	$58.20
Rate for Payer: WPPA Commercial	$50.40

ENDOSCOPIC MARKER

Facility

$60.00

Hospital Charge Code	2705671
Hospital Revenue Code	270
Min. Negotiated Rate	$49.20
Max. Negotiated Rate	$58.20
Rate for Payer: Cash Price	$45.00
Rate for Payer: Health Partners Plans Commercial	$57.00
Rate for Payer: UnitedHealthcare Commercial	$58.20
Rate for Payer: WPPA Commercial	$49.20

ENDO SCOPY BRUSH

Facility

$10.00

Hospital Charge Code	2725897
Hospital Revenue Code	270
Min. Negotiated Rate	$8.20
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$7.88
Rate for Payer: Health Partners Plans Commercial	$9.50
Rate for Payer: UnitedHealthcare Commercial	$9.70
Rate for Payer: WPPA Commercial	$8.20

ENDO SCOPY BRUSH

Facility

$10.00

Hospital Charge Code	2725897
Hospital Revenue Code	270
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$7.88
Rate for Payer: Celtic Commercial/Exchange	$4.62
Rate for Payer: Health Partners Plans Commercial	$9.50
Rate for Payer: UnitedHealthcare Commercial	$9.70
Rate for Payer: WPPA Commercial	$8.40

ENDO-TRACH STYLET

Facility

$24.00

Hospital Charge Code	2721850
Hospital Revenue Code	272
Min. Negotiated Rate	$19.68
Max. Negotiated Rate	$23.28
Rate for Payer: Cash Price	$18.00
Rate for Payer: Health Partners Plans Commercial	$22.80
Rate for Payer: UnitedHealthcare Commercial	$23.28
Rate for Payer: WPPA Commercial	$19.68

ENDO-TRACH STYLET

Facility

$24.00

Hospital Charge Code	2721850
Hospital Revenue Code	272
Min. Negotiated Rate	$11.09
Max. Negotiated Rate	$23.28
Rate for Payer: Cash Price	$18.00
Rate for Payer: Celtic Commercial/Exchange	$11.09
Rate for Payer: Health Partners Plans Commercial	$22.80
Rate for Payer: UnitedHealthcare Commercial	$23.28
Rate for Payer: WPPA Commercial	$20.16

ENDOTRACH STYLET 10FR

Facility

$24.00

Hospital Charge Code	2721710
Hospital Revenue Code	272
Min. Negotiated Rate	$19.68
Max. Negotiated Rate	$23.28
Rate for Payer: Cash Price	$18.00
Rate for Payer: Health Partners Plans Commercial	$22.80
Rate for Payer: UnitedHealthcare Commercial	$23.28
Rate for Payer: WPPA Commercial	$19.68

ENDOTRACH STYLET 10FR

Facility

$24.00

Hospital Charge Code	2721710
Hospital Revenue Code	272
Min. Negotiated Rate	$11.09
Max. Negotiated Rate	$23.28
Rate for Payer: Cash Price	$18.00
Rate for Payer: Celtic Commercial/Exchange	$11.09
Rate for Payer: Health Partners Plans Commercial	$22.80
Rate for Payer: UnitedHealthcare Commercial	$23.28
Rate for Payer: WPPA Commercial	$20.16

ENDO-TRACH TUBE

Facility

$30.00

Hospital Charge Code	2721736
Hospital Revenue Code	272
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

ENDO-TRACH TUBE

Facility

$30.00

Hospital Charge Code	2721736
Hospital Revenue Code	272
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

ENDOTRACH TUBE 3.5MM W/O CUFF

Facility

$26.00

Hospital Charge Code	2721701
Hospital Revenue Code	270
Min. Negotiated Rate	$21.32
Max. Negotiated Rate	$25.22
Rate for Payer: Cash Price	$19.50
Rate for Payer: Health Partners Plans Commercial	$24.70
Rate for Payer: UnitedHealthcare Commercial	$25.22
Rate for Payer: WPPA Commercial	$21.32

ENDOTRACH TUBE 3.5MM W/O CUFF

Facility

$26.00

Hospital Charge Code	2721701
Hospital Revenue Code	270
Min. Negotiated Rate	$12.01
Max. Negotiated Rate	$25.22
Rate for Payer: Cash Price	$19.50
Rate for Payer: Celtic Commercial/Exchange	$12.01
Rate for Payer: Health Partners Plans Commercial	$24.70
Rate for Payer: UnitedHealthcare Commercial	$25.22
Rate for Payer: WPPA Commercial	$21.84

ENDOTRACH TUBE 3.OMM W/O CUFF

Facility

$26.00

Hospital Charge Code	2721700
Hospital Revenue Code	270
Min. Negotiated Rate	$12.01
Max. Negotiated Rate	$25.22
Rate for Payer: Cash Price	$19.50
Rate for Payer: Celtic Commercial/Exchange	$12.01
Rate for Payer: Health Partners Plans Commercial	$24.70
Rate for Payer: UnitedHealthcare Commercial	$25.22
Rate for Payer: WPPA Commercial	$21.84

ENDOTRACH TUBE 3.OMM W/O CUFF

Facility

$26.00

Hospital Charge Code	2721700
Hospital Revenue Code	270
Min. Negotiated Rate	$21.32
Max. Negotiated Rate	$25.22
Rate for Payer: Cash Price	$19.50
Rate for Payer: Health Partners Plans Commercial	$24.70
Rate for Payer: UnitedHealthcare Commercial	$25.22
Rate for Payer: WPPA Commercial	$21.32

ENDOTRACH TUBE 4.0MM CUFF LOW

Facility

$12.00

Hospital Charge Code	2721698
Hospital Revenue Code	272
Min. Negotiated Rate	$9.84
Max. Negotiated Rate	$11.64
Rate for Payer: Cash Price	$9.00
Rate for Payer: Health Partners Plans Commercial	$11.40
Rate for Payer: UnitedHealthcare Commercial	$11.64
Rate for Payer: WPPA Commercial	$9.84

ENDOTRACH TUBE 4.0MM CUFF LOW

Facility

$12.00

Hospital Charge Code	2721698
Hospital Revenue Code	272
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$11.64
Rate for Payer: Cash Price	$9.00
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

ENDOTRACH TUBE 4.5MM CUFFED

Facility

$26.00

Hospital Charge Code	2721702
Hospital Revenue Code	270
Min. Negotiated Rate	$21.32
Max. Negotiated Rate	$25.22
Rate for Payer: Cash Price	$19.50
Rate for Payer: Health Partners Plans Commercial	$24.70
Rate for Payer: UnitedHealthcare Commercial	$25.22
Rate for Payer: WPPA Commercial	$21.32

ENDOTRACH TUBE 4.5MM CUFFED

Facility

$26.00

Hospital Charge Code	2721702
Hospital Revenue Code	270
Min. Negotiated Rate	$12.01
Max. Negotiated Rate	$25.22
Rate for Payer: Cash Price	$19.50
Rate for Payer: Celtic Commercial/Exchange	$12.01
Rate for Payer: Health Partners Plans Commercial	$24.70
Rate for Payer: UnitedHealthcare Commercial	$25.22
Rate for Payer: WPPA Commercial	$21.84

ENDOTRACH TUBE 5.0MM CUFF LOW

Facility

$12.00

Hospital Charge Code	2721699
Hospital Revenue Code	272
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$11.64
Rate for Payer: Cash Price	$9.00
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

ENDOTRACH TUBE 5.0MM CUFF LOW

Facility

$12.00

Hospital Charge Code	2721699
Hospital Revenue Code	272
Min. Negotiated Rate	$9.84
Max. Negotiated Rate	$11.64
Rate for Payer: Cash Price	$9.00
Rate for Payer: Health Partners Plans Commercial	$11.40
Rate for Payer: UnitedHealthcare Commercial	$11.64
Rate for Payer: WPPA Commercial	$9.84

ENDOTRACH TUBE 5.0MM W/O CUFF

Facility

$26.00

Hospital Charge Code	2721703
Hospital Revenue Code	270
Min. Negotiated Rate	$21.32
Max. Negotiated Rate	$25.22
Rate for Payer: Cash Price	$19.50
Rate for Payer: Health Partners Plans Commercial	$24.70
Rate for Payer: UnitedHealthcare Commercial	$25.22
Rate for Payer: WPPA Commercial	$21.32

ENDOTRACH TUBE 5.0MM W/O CUFF

Facility

$26.00

Hospital Charge Code	2721703
Hospital Revenue Code	270
Min. Negotiated Rate	$12.01
Max. Negotiated Rate	$25.22
Rate for Payer: Cash Price	$19.50
Rate for Payer: Celtic Commercial/Exchange	$12.01
Rate for Payer: Health Partners Plans Commercial	$24.70
Rate for Payer: UnitedHealthcare Commercial	$25.22
Rate for Payer: WPPA Commercial	$21.84

Know your out-of-pocket cost for care.

All Charges