Ness County Hospital

All Charges

Charge

Type

Setting

Price

EPIDERM AUTOGRFT,F/H/FT 100SQC

Facility

$2,450.00

Service Code	HCPCS 15115
Hospital Charge Code	1511523
Hospital Revenue Code	761
Min. Negotiated Rate	$2,009.00
Max. Negotiated Rate	$2,376.50
Rate for Payer: Cash Price	$1,837.50
Rate for Payer: Health Partners Plans Commercial	$2,327.50
Rate for Payer: UnitedHealthcare Commercial	$2,376.50
Rate for Payer: WPPA Commercial	$2,009.00

EPIDERM AUTOGRFT,T/A/L 100SQCM

Facility

$2,450.00

Service Code	HCPCS 15110
Hospital Charge Code	1511023
Hospital Revenue Code	761
Min. Negotiated Rate	$2,009.00
Max. Negotiated Rate	$2,376.50
Rate for Payer: Cash Price	$1,837.50
Rate for Payer: Health Partners Plans Commercial	$2,327.50
Rate for Payer: UnitedHealthcare Commercial	$2,376.50
Rate for Payer: WPPA Commercial	$2,009.00

EPIDERM AUTOGRFT,T/A/L 100SQCM

Facility

$2,450.00

Service Code	HCPCS 15110
Hospital Charge Code	1511023
Hospital Revenue Code	761
Min. Negotiated Rate	$1,131.90
Max. Negotiated Rate	$2,376.50
Rate for Payer: Cash Price	$1,837.50
Rate for Payer: Celtic Commercial/Exchange	$1,131.90
Rate for Payer: Health Partners Plans Commercial	$2,327.50
Rate for Payer: UnitedHealthcare Commercial	$2,376.50
Rate for Payer: WPPA Commercial	$2,058.00

EPI MAX EPISTAXIS PACK

Facility

$400.00

Hospital Charge Code	2700311
Hospital Revenue Code	272
Min. Negotiated Rate	$328.00
Max. Negotiated Rate	$388.00
Rate for Payer: Cash Price	$300.00
Rate for Payer: Health Partners Plans Commercial	$380.00
Rate for Payer: UnitedHealthcare Commercial	$388.00
Rate for Payer: WPPA Commercial	$328.00

EPI MAX EPISTAXIS PACK

Facility

$400.00

Hospital Charge Code	2700311
Hospital Revenue Code	272
Min. Negotiated Rate	$184.80
Max. Negotiated Rate	$388.00
Rate for Payer: Cash Price	$300.00
Rate for Payer: Celtic Commercial/Exchange	$184.80
Rate for Payer: Health Partners Plans Commercial	$380.00
Rate for Payer: UnitedHealthcare Commercial	$388.00
Rate for Payer: WPPA Commercial	$336.00

EPINEPHRINE 1:10,000 - 1 MG/10 ML LEUR-JET SYR.

Facility

$85.00

Service Code	NDC 76329331601
Hospital Charge Code	2502607
Hospital Revenue Code	250
Min. Negotiated Rate	$39.27
Max. Negotiated Rate	$82.45
Rate for Payer: Cash Price	$63.90
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

EPINEPHRINE 1:10,000 - 1 MG/10 ML LEUR-JET SYR.

Facility

$85.00

Service Code	NDC 76329331601
Hospital Charge Code	2502607
Hospital Revenue Code	250
Min. Negotiated Rate	$69.70
Max. Negotiated Rate	$82.45
Rate for Payer: Cash Price	$63.90
Rate for Payer: Health Partners Plans Commercial	$80.75
Rate for Payer: UnitedHealthcare Commercial	$82.45
Rate for Payer: WPPA Commercial	$69.70

EPIPEN 0.3 MG INJ. (EPINEPHRINE) AUTO-INJECTOR

Facility

$1,125.00

Service Code	NDC 49502010202
Hospital Charge Code	2516623
Hospital Revenue Code	250
Min. Negotiated Rate	$922.50
Max. Negotiated Rate	$1,091.25
Rate for Payer: Cash Price	$843.75
Rate for Payer: Health Partners Plans Commercial	$1,068.75
Rate for Payer: UnitedHealthcare Commercial	$1,091.25
Rate for Payer: WPPA Commercial	$922.50

EPIPEN 0.3 MG INJ. (EPINEPHRINE) AUTO-INJECTOR

Facility

$1,125.00

Service Code	NDC 49502010202
Hospital Charge Code	2516623
Hospital Revenue Code	250
Min. Negotiated Rate	$519.75
Max. Negotiated Rate	$1,091.25
Rate for Payer: Cash Price	$843.75
Rate for Payer: Celtic Commercial/Exchange	$519.75
Rate for Payer: Health Partners Plans Commercial	$1,068.75
Rate for Payer: UnitedHealthcare Commercial	$1,091.25
Rate for Payer: WPPA Commercial	$945.00

EPISTAXIS WITH MCC

Facility

$10,368.93

Service Code	MSDRG 150
Min. Negotiated Rate	$10,368.93
Max. Negotiated Rate	$10,368.93
Rate for Payer: BCBS Commercial	$10,368.93

EPISTAXIS WITHOUT MCC

Facility

$6,553.66

Service Code	MSDRG 151
Min. Negotiated Rate	$6,553.66
Max. Negotiated Rate	$6,553.66
Rate for Payer: BCBS Commercial	$6,553.66

ER-ADM 2/MORE SGL/COMB VAC/TOX

Facility

$73.00

Service Code	HCPCS 90472
Hospital Charge Code	4590600
Hospital Revenue Code	450
Min. Negotiated Rate	$8.08
Max. Negotiated Rate	$70.81
Rate for Payer: BCBS Commercial	$8.08
Rate for Payer: Cash Price	$54.75
Rate for Payer: Cash Price	$54.75
Rate for Payer: Celtic Commercial/Exchange	$33.73
Rate for Payer: Health Partners Plans Commercial	$69.35
Rate for Payer: UnitedHealthcare Commercial	$70.81
Rate for Payer: WPPA Commercial	$61.32

ER-ADM 2/MORE SGL/COMB VAC/TOX

Facility

$73.00

Service Code	HCPCS 90472
Hospital Charge Code	4590600
Hospital Revenue Code	450
Min. Negotiated Rate	$59.86
Max. Negotiated Rate	$70.81
Rate for Payer: Cash Price	$54.75
Rate for Payer: Health Partners Plans Commercial	$69.35
Rate for Payer: UnitedHealthcare Commercial	$70.81
Rate for Payer: WPPA Commercial	$59.86

ER CHEMICAL CAUTERY OF TISSUE

Facility

$418.00

Service Code	HCPCS 17250
Hospital Charge Code	1725000
Hospital Revenue Code	761
Min. Negotiated Rate	$342.76
Max. Negotiated Rate	$405.46
Rate for Payer: Cash Price	$313.50
Rate for Payer: Health Partners Plans Commercial	$397.10
Rate for Payer: UnitedHealthcare Commercial	$405.46
Rate for Payer: WPPA Commercial	$342.76

ER CHEMICAL CAUTERY OF TISSUE

Facility

$418.00

Service Code	HCPCS 17250
Hospital Charge Code	1725000
Hospital Revenue Code	761
Min. Negotiated Rate	$193.12
Max. Negotiated Rate	$405.46
Rate for Payer: BCBS Commercial	$388.85
Rate for Payer: Cash Price	$313.50
Rate for Payer: Cash Price	$313.50
Rate for Payer: Celtic Commercial/Exchange	$193.12
Rate for Payer: Health Partners Plans Commercial	$397.10
Rate for Payer: UnitedHealthcare Commercial	$405.46
Rate for Payer: WPPA Commercial	$351.12

ER CRITICAL CARE 1ST 30-74 MIN

Facility

$2,059.00

Service Code	HCPCS 99291
Hospital Charge Code	4500091
Hospital Revenue Code	450
Min. Negotiated Rate	$1,688.38
Max. Negotiated Rate	$1,997.23
Rate for Payer: Cash Price	$1,544.25
Rate for Payer: Health Partners Plans Commercial	$1,956.05
Rate for Payer: UnitedHealthcare Commercial	$1,997.23
Rate for Payer: WPPA Commercial	$1,688.38

ER CRITICAL CARE 1ST 30-74 MIN

Facility

$2,059.00

Service Code	HCPCS 99291
Hospital Charge Code	4500091
Hospital Revenue Code	450
Min. Negotiated Rate	$951.26
Max. Negotiated Rate	$1,997.23
Rate for Payer: BCBS Commercial	$1,021.79
Rate for Payer: Cash Price	$1,544.25
Rate for Payer: Cash Price	$1,544.25
Rate for Payer: Celtic Commercial/Exchange	$951.26
Rate for Payer: Health Partners Plans Commercial	$1,956.05
Rate for Payer: UnitedHealthcare Commercial	$1,997.23
Rate for Payer: WPPA Commercial	$1,729.56

ER-CRITICAL CARE-EA ADDTL 30"

Facility

$1,375.00

Service Code	HCPCS 99292 25
Hospital Charge Code	9929200
Hospital Revenue Code	450
Min. Negotiated Rate	$303.29
Max. Negotiated Rate	$1,333.75
Rate for Payer: BCBS Commercial	$303.29
Rate for Payer: Cash Price	$1,031.25
Rate for Payer: Cash Price	$1,031.25
Rate for Payer: Celtic Commercial/Exchange	$635.25
Rate for Payer: Health Partners Plans Commercial	$1,306.25
Rate for Payer: UnitedHealthcare Commercial	$1,333.75
Rate for Payer: WPPA Commercial	$1,155.00

ER-CRITICAL CARE-EA ADDTL 30"

Facility

$1,375.00

Service Code	HCPCS 99292 25
Hospital Charge Code	9929200
Hospital Revenue Code	450
Min. Negotiated Rate	$1,127.50
Max. Negotiated Rate	$1,333.75
Rate for Payer: Cash Price	$1,031.25
Rate for Payer: Health Partners Plans Commercial	$1,306.25
Rate for Payer: UnitedHealthcare Commercial	$1,333.75
Rate for Payer: WPPA Commercial	$1,127.50

ER PHYS-CLOSED TX FMORAL FRACT

Facility

$474.00

Service Code	HCPCS 27508
Hospital Charge Code	2750801
Hospital Revenue Code	981
Min. Negotiated Rate	$388.68
Max. Negotiated Rate	$459.78
Rate for Payer: Cash Price	$355.50
Rate for Payer: Health Partners Plans Commercial	$450.30
Rate for Payer: UnitedHealthcare Commercial	$459.78
Rate for Payer: WPPA Commercial	$388.68

ER PHYS-CLOSED TX FMORAL FRACT

Facility

$474.00

Service Code	HCPCS 27508
Hospital Charge Code	2750801
Hospital Revenue Code	981
Min. Negotiated Rate	$218.99
Max. Negotiated Rate	$1,454.40
Rate for Payer: BCBS Commercial	$1,454.40
Rate for Payer: Cash Price	$355.50
Rate for Payer: Cash Price	$355.50
Rate for Payer: Celtic Commercial/Exchange	$218.99
Rate for Payer: Health Partners Plans Commercial	$450.30
Rate for Payer: UnitedHealthcare Commercial	$459.78
Rate for Payer: WPPA Commercial	$398.16

ER PHYS-COMP, HIGH COMPLEXITY

Facility

$280.00

Service Code	HCPCS 99285 GF
Hospital Charge Code	9810144
Hospital Revenue Code	981
Min. Negotiated Rate	$229.60
Max. Negotiated Rate	$271.60
Rate for Payer: Cash Price	$210.00
Rate for Payer: Health Partners Plans Commercial	$266.00
Rate for Payer: UnitedHealthcare Commercial	$271.60
Rate for Payer: WPPA Commercial	$229.60

ER PHYS-COMP, HIGH COMPLEXITY

Facility

$280.00

Service Code	HCPCS 99285 GF
Hospital Charge Code	9810144
Hospital Revenue Code	981
Min. Negotiated Rate	$129.36
Max. Negotiated Rate	$1,080.54
Rate for Payer: BCBS Commercial	$1,080.54
Rate for Payer: Cash Price	$210.00
Rate for Payer: Cash Price	$210.00
Rate for Payer: Celtic Commercial/Exchange	$129.36
Rate for Payer: Health Partners Plans Commercial	$266.00
Rate for Payer: UnitedHealthcare Commercial	$271.60
Rate for Payer: WPPA Commercial	$235.20

ER PHYS-CPR

Facility

$425.00

Service Code	HCPCS 92950 GF
Hospital Charge Code	9819295
Hospital Revenue Code	981
Min. Negotiated Rate	$196.35
Max. Negotiated Rate	$412.25
Rate for Payer: BCBS Commercial	$309.49
Rate for Payer: Cash Price	$318.75
Rate for Payer: Cash Price	$318.75
Rate for Payer: Celtic Commercial/Exchange	$196.35
Rate for Payer: Health Partners Plans Commercial	$403.75
Rate for Payer: UnitedHealthcare Commercial	$412.25
Rate for Payer: WPPA Commercial	$357.00

ER PHYS-CPR

Facility

$425.00

Service Code	HCPCS 92950 GF
Hospital Charge Code	9819295
Hospital Revenue Code	981
Min. Negotiated Rate	$348.50
Max. Negotiated Rate	$412.25
Rate for Payer: Cash Price	$318.75
Rate for Payer: Health Partners Plans Commercial	$403.75
Rate for Payer: UnitedHealthcare Commercial	$412.25
Rate for Payer: WPPA Commercial	$348.50

Know your out-of-pocket cost for care.

All Charges