Ness County Hospital

All Charges

Charge

Type

Setting

Price

ER PHYS-CRIT CARE-EA ADDTL 30"

Facility

$285.00

Service Code	HCPCS 99292 GF
Hospital Charge Code	9810179
Hospital Revenue Code	981
Min. Negotiated Rate	$131.67
Max. Negotiated Rate	$303.29
Rate for Payer: BCBS Commercial	$303.29
Rate for Payer: Cash Price	$213.75
Rate for Payer: Cash Price	$213.75
Rate for Payer: Celtic Commercial/Exchange	$131.67
Rate for Payer: Health Partners Plans Commercial	$270.75
Rate for Payer: UnitedHealthcare Commercial	$276.45
Rate for Payer: WPPA Commercial	$239.40

ER PHYS-CRIT CARE-EA ADDTL 30"

Facility

$285.00

Service Code	HCPCS 99292 GF
Hospital Charge Code	9810179
Hospital Revenue Code	981
Min. Negotiated Rate	$233.70
Max. Negotiated Rate	$276.45
Rate for Payer: Cash Price	$213.75
Rate for Payer: Health Partners Plans Commercial	$270.75
Rate for Payer: UnitedHealthcare Commercial	$276.45
Rate for Payer: WPPA Commercial	$233.70

ER PHYS-CRITICAL CARE 30-74MIN

Facility

$425.00

Service Code	HCPCS 99291 GF
Hospital Charge Code	9810151
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

ER PHYS-CRITICAL CARE 30-74MIN

Facility

$425.00

Service Code	HCPCS 99291 GF
Hospital Charge Code	9810151
Hospital Revenue Code	981
Min. Negotiated Rate	$196.35
Max. Negotiated Rate	$1,021.79
Rate for Payer: BCBS Commercial	$1,021.79
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-DETAILED,MODERATE COMP

Facility

$210.00

Service Code	HCPCS 99284 GF
Hospital Charge Code	9810136
Hospital Revenue Code	981
Min. Negotiated Rate	$97.02
Max. Negotiated Rate	$695.24
Rate for Payer: UnitedHealthcare Commercial	$203.70
Rate for Payer: BCBS Commercial	$695.24
Rate for Payer: Cash Price	$157.50
Rate for Payer: Cash Price	$157.50
Rate for Payer: Celtic Commercial/Exchange	$97.02
Rate for Payer: Health Partners Plans Commercial	$199.50
Rate for Payer: WPPA Commercial	$176.40

ER PHYS-DETAILED,MODERATE COMP

Facility

$210.00

Service Code	HCPCS 99284 GF
Hospital Charge Code	9810136
Hospital Revenue Code	981
Min. Negotiated Rate	$172.20
Max. Negotiated Rate	$203.70
Rate for Payer: Cash Price	$157.50
Rate for Payer: Health Partners Plans Commercial	$199.50
Rate for Payer: UnitedHealthcare Commercial	$203.70
Rate for Payer: WPPA Commercial	$172.20

ER PHYS-EXPANDED,LOW COMPLEXIT

Facility

$100.00

Service Code	HCPCS 99282 GF
Hospital Charge Code	4500047
Hospital Revenue Code	981
Min. Negotiated Rate	$46.20
Max. Negotiated Rate	$265.31
Rate for Payer: BCBS Commercial	$265.31
Rate for Payer: Cash Price	$75.00
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

ER PHYS-EXPANDED,LOW COMPLEXIT

Facility

$100.00

Service Code	HCPCS 99282 GF
Hospital Charge Code	4500047
Hospital Revenue Code	981
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

ER PHYS-EXPANDED, MODERATE COM

Facility

$150.00

Service Code	HCPCS 99283 GF
Hospital Charge Code	9810128
Hospital Revenue Code	981
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

ER PHYS-EXPANDED, MODERATE COM

Facility

$150.00

Service Code	HCPCS 99283 GF
Hospital Charge Code	9810128
Hospital Revenue Code	981
Min. Negotiated Rate	$69.30
Max. Negotiated Rate	$407.79
Rate for Payer: BCBS Commercial	$407.79
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

ER PHYS-PROB FOCUS,STRAIGHTFOR

Facility

$50.00

Service Code	HCPCS 99281 GF
Hospital Charge Code	4500039
Hospital Revenue Code	981
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$170.31
Rate for Payer: BCBS Commercial	$170.31
Rate for Payer: Cash Price	$37.50
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

ER PHYS-PROB FOCUS,STRAIGHTFOR

Facility

$50.00

Service Code	HCPCS 99281 GF
Hospital Charge Code	4500039
Hospital Revenue Code	981
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

ER SUTURE SETS

Facility

$30.00

Hospital Charge Code	2701779
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

ER SUTURE SETS

Facility

$30.00

Hospital Charge Code	2701779
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

Erythrocin (erythromycin lactobionate) IV recon soln

Facility

$3,043.00

Service Code	NDC 00409647644
Hospital Charge Code	2510352
Hospital Revenue Code	250
Min. Negotiated Rate	$1,405.87
Max. Negotiated Rate	$2,951.71
Rate for Payer: Cash Price	$2,282.42
Rate for Payer: Celtic Commercial/Exchange	$1,405.87
Rate for Payer: Health Partners Plans Commercial	$2,890.85
Rate for Payer: UnitedHealthcare Commercial	$2,951.71
Rate for Payer: WPPA Commercial	$2,556.12

Erythrocin (erythromycin lactobionate) IV recon soln

Facility

$3,043.00

Service Code	NDC 00409647644
Hospital Charge Code	2510352
Hospital Revenue Code	250
Min. Negotiated Rate	$2,495.26
Max. Negotiated Rate	$2,951.71
Rate for Payer: Cash Price	$2,282.42
Rate for Payer: Health Partners Plans Commercial	$2,890.85
Rate for Payer: UnitedHealthcare Commercial	$2,951.71
Rate for Payer: WPPA Commercial	$2,495.26

Erythromycin Opht Ointment 3.5 GM Tube

Facility

$56.00

Service Code	NDC 00574402435
Hospital Charge Code	2503316
Hospital Revenue Code	250
Min. Negotiated Rate	$45.92
Max. Negotiated Rate	$54.32
Rate for Payer: Cash Price	$42.11
Rate for Payer: Health Partners Plans Commercial	$53.20
Rate for Payer: UnitedHealthcare Commercial	$54.32
Rate for Payer: WPPA Commercial	$45.92

Erythromycin Opht Ointment 3.5 GM Tube

Facility

$56.00

Service Code	NDC 00574402435
Hospital Charge Code	2503316
Hospital Revenue Code	250
Min. Negotiated Rate	$25.87
Max. Negotiated Rate	$54.32
Rate for Payer: Cash Price	$42.11
Rate for Payer: Celtic Commercial/Exchange	$25.87
Rate for Payer: Health Partners Plans Commercial	$53.20
Rate for Payer: UnitedHealthcare Commercial	$54.32
Rate for Payer: WPPA Commercial	$47.04

ERYTHROPOIETIN (EPO)

Facility

$151.00

Service Code	HCPCS 82668
Hospital Charge Code	8266800
Hospital Revenue Code	301
Min. Negotiated Rate	$69.76
Max. Negotiated Rate	$146.47
Rate for Payer: BCBS Commercial	$70.98
Rate for Payer: Cash Price	$113.25
Rate for Payer: Cash Price	$113.25
Rate for Payer: Celtic Commercial/Exchange	$69.76
Rate for Payer: Health Partners Plans Commercial	$143.45
Rate for Payer: UnitedHealthcare Commercial	$146.47
Rate for Payer: WPPA Commercial	$126.84

ERYTHROPOIETIN (EPO)

Facility

$151.00

Service Code	HCPCS 82668
Hospital Charge Code	8266800
Hospital Revenue Code	301
Min. Negotiated Rate	$123.82
Max. Negotiated Rate	$146.47
Rate for Payer: Cash Price	$113.25
Rate for Payer: Health Partners Plans Commercial	$143.45
Rate for Payer: UnitedHealthcare Commercial	$146.47
Rate for Payer: WPPA Commercial	$123.82

ESGIC TAB

Facility

$5.00

Hospital Charge Code	2502714
Hospital Revenue Code	250
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$4.39
Rate for Payer: Celtic Commercial/Exchange	$2.31
Rate for Payer: Health Partners Plans Commercial	$4.75
Rate for Payer: UnitedHealthcare Commercial	$4.85
Rate for Payer: WPPA Commercial	$4.20

ESGIC TAB

Facility

$5.00

Hospital Charge Code	2502714
Hospital Revenue Code	250
Min. Negotiated Rate	$4.10
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$4.39
Rate for Payer: Health Partners Plans Commercial	$4.75
Rate for Payer: UnitedHealthcare Commercial	$4.85
Rate for Payer: WPPA Commercial	$4.10

ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC

Facility

$11,087.28

Service Code	MSDRG 391
Min. Negotiated Rate	$11,087.28
Max. Negotiated Rate	$11,087.28
Rate for Payer: BCBS Commercial	$11,087.28

ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC

Facility

$7,364.91

Service Code	MSDRG 392
Min. Negotiated Rate	$7,364.91
Max. Negotiated Rate	$7,364.91
Rate for Payer: BCBS Commercial	$7,364.91

ESOPHAGOSCOPY, FLEX, TRANSNASAL

Facility

$964.00

Service Code	HCPCS 43197
Hospital Charge Code	4319700
Hospital Revenue Code	761
Min. Negotiated Rate	$790.48
Max. Negotiated Rate	$935.08
Rate for Payer: Cash Price	$723.00
Rate for Payer: Health Partners Plans Commercial	$915.80
Rate for Payer: UnitedHealthcare Commercial	$935.08
Rate for Payer: WPPA Commercial	$790.48

Know your out-of-pocket cost for care.

All Charges