Ness County Hospital

All Charges

Charge

Type

Setting

Price

ESOPHAGOSCOPY, FLEX, TRANSNASAL

Facility

$964.00

Service Code	HCPCS 43197
Hospital Charge Code	4319700
Hospital Revenue Code	761
Min. Negotiated Rate	$445.37
Max. Negotiated Rate	$935.08
Rate for Payer: BCBS Commercial	$914.05
Rate for Payer: Cash Price	$723.00
Rate for Payer: Cash Price	$723.00
Rate for Payer: Celtic Commercial/Exchange	$445.37
Rate for Payer: Health Partners Plans Commercial	$915.80
Rate for Payer: UnitedHealthcare Commercial	$935.08
Rate for Payer: WPPA Commercial	$809.76

EST PATIENT,WND MGMT,<=10 CM

Facility

$74.00

Service Code	HCPCS 99211 GP
Hospital Charge Code	9921109
Hospital Revenue Code	421
Min. Negotiated Rate	$60.68
Max. Negotiated Rate	$71.78
Rate for Payer: Cash Price	$55.88
Rate for Payer: Health Partners Plans Commercial	$70.30
Rate for Payer: UnitedHealthcare Commercial	$71.78
Rate for Payer: WPPA Commercial	$60.68

EST PATIENT,WND MGMT,<=10 CM

Facility

$74.00

Service Code	HCPCS 99211 GP
Hospital Charge Code	9921109
Hospital Revenue Code	421
Min. Negotiated Rate	$34.19
Max. Negotiated Rate	$71.78
Rate for Payer: BCBS Commercial	$42.50
Rate for Payer: Cash Price	$55.88
Rate for Payer: Cash Price	$55.88
Rate for Payer: Celtic Commercial/Exchange	$34.19
Rate for Payer: Health Partners Plans Commercial	$70.30
Rate for Payer: UnitedHealthcare Commercial	$71.78
Rate for Payer: WPPA Commercial	$62.16

EST PATIENT,WND MGMT, 11-25 CM

Facility

$93.00

Service Code	HCPCS 99212 GP
Hospital Charge Code	9921209
Hospital Revenue Code	421
Min. Negotiated Rate	$76.26
Max. Negotiated Rate	$90.21
Rate for Payer: Cash Price	$69.94
Rate for Payer: Health Partners Plans Commercial	$88.35
Rate for Payer: UnitedHealthcare Commercial	$90.21
Rate for Payer: WPPA Commercial	$76.26

EST PATIENT,WND MGMT, 11-25 CM

Facility

$93.00

Service Code	HCPCS 99212 GP
Hospital Charge Code	9921209
Hospital Revenue Code	421
Min. Negotiated Rate	$42.97
Max. Negotiated Rate	$90.21
Rate for Payer: BCBS Commercial	$85.38
Rate for Payer: Cash Price	$69.94
Rate for Payer: Cash Price	$69.94
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

EST PATIENT,WND MGMT,26-50 CM

Facility

$134.00

Service Code	HCPCS 99213 GP
Hospital Charge Code	9921309
Hospital Revenue Code	421
Min. Negotiated Rate	$61.91
Max. Negotiated Rate	$133.49
Rate for Payer: BCBS Commercial	$133.49
Rate for Payer: Cash Price	$100.50
Rate for Payer: Cash Price	$100.50
Rate for Payer: Celtic Commercial/Exchange	$61.91
Rate for Payer: Health Partners Plans Commercial	$127.30
Rate for Payer: UnitedHealthcare Commercial	$129.98
Rate for Payer: WPPA Commercial	$112.56

EST PATIENT,WND MGMT,26-50 CM

Facility

$134.00

Service Code	HCPCS 99213 GP
Hospital Charge Code	9921309
Hospital Revenue Code	421
Min. Negotiated Rate	$109.88
Max. Negotiated Rate	$129.98
Rate for Payer: Cash Price	$100.50
Rate for Payer: Health Partners Plans Commercial	$127.30
Rate for Payer: UnitedHealthcare Commercial	$129.98
Rate for Payer: WPPA Commercial	$109.88

EST PATIENT,WND MGMT, 51-75 CM

Facility

$189.00

Service Code	HCPCS 99214 GP
Hospital Charge Code	9921409
Hospital Revenue Code	421
Min. Negotiated Rate	$87.32
Max. Negotiated Rate	$188.57
Rate for Payer: BCBS Commercial	$188.57
Rate for Payer: Cash Price	$141.75
Rate for Payer: Cash Price	$141.75
Rate for Payer: Celtic Commercial/Exchange	$87.32
Rate for Payer: Health Partners Plans Commercial	$179.55
Rate for Payer: UnitedHealthcare Commercial	$183.33
Rate for Payer: WPPA Commercial	$158.76

EST PATIENT,WND MGMT, 51-75 CM

Facility

$189.00

Service Code	HCPCS 99214 GP
Hospital Charge Code	9921409
Hospital Revenue Code	421
Min. Negotiated Rate	$154.98
Max. Negotiated Rate	$183.33
Rate for Payer: Cash Price	$141.75
Rate for Payer: Health Partners Plans Commercial	$179.55
Rate for Payer: UnitedHealthcare Commercial	$183.33
Rate for Payer: WPPA Commercial	$154.98

EST PATIENT,WND MGMT, >=76 CM

Facility

$267.00

Service Code	HCPCS 99215 GP
Hospital Charge Code	9921509
Hospital Revenue Code	421
Min. Negotiated Rate	$218.94
Max. Negotiated Rate	$258.99
Rate for Payer: Cash Price	$200.25
Rate for Payer: Health Partners Plans Commercial	$253.65
Rate for Payer: UnitedHealthcare Commercial	$258.99
Rate for Payer: WPPA Commercial	$218.94

EST PATIENT,WND MGMT, >=76 CM

Facility

$267.00

Service Code	HCPCS 99215 GP
Hospital Charge Code	9921509
Hospital Revenue Code	421
Min. Negotiated Rate	$123.35
Max. Negotiated Rate	$266.24
Rate for Payer: BCBS Commercial	$266.24
Rate for Payer: Cash Price	$200.25
Rate for Payer: Cash Price	$200.25
Rate for Payer: Celtic Commercial/Exchange	$123.35
Rate for Payer: Health Partners Plans Commercial	$253.65
Rate for Payer: UnitedHealthcare Commercial	$258.99
Rate for Payer: WPPA Commercial	$224.28

ESTRADIOL

Facility

$232.00

Service Code	HCPCS 82670
Hospital Charge Code	8267000
Hospital Revenue Code	301
Min. Negotiated Rate	$107.18
Max. Negotiated Rate	$225.04
Rate for Payer: BCBS Commercial	$125.19
Rate for Payer: Cash Price	$174.00
Rate for Payer: Cash Price	$174.00
Rate for Payer: Celtic Commercial/Exchange	$107.18
Rate for Payer: Health Partners Plans Commercial	$220.40
Rate for Payer: UnitedHealthcare Commercial	$225.04
Rate for Payer: WPPA Commercial	$194.88

ESTRADIOL

Facility

$232.00

Service Code	HCPCS 82670
Hospital Charge Code	8267000
Hospital Revenue Code	301
Min. Negotiated Rate	$190.24
Max. Negotiated Rate	$225.04
Rate for Payer: Cash Price	$174.00
Rate for Payer: Health Partners Plans Commercial	$220.40
Rate for Payer: UnitedHealthcare Commercial	$225.04
Rate for Payer: WPPA Commercial	$190.24

ESTRADIOL 1 MG TAB

Facility

$2.00

Service Code	NDC 42806008801
Hospital Charge Code	2515559
Hospital Revenue Code	250
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.58
Rate for Payer: Health Partners Plans Commercial	$1.90
Rate for Payer: UnitedHealthcare Commercial	$1.94
Rate for Payer: WPPA Commercial	$1.64

ESTRADIOL 1 MG TAB

Facility

$2.00

Service Code	NDC 42806008801
Hospital Charge Code	2515559
Hospital Revenue Code	250
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.58
Rate for Payer: Celtic Commercial/Exchange	$0.92
Rate for Payer: Health Partners Plans Commercial	$1.90
Rate for Payer: UnitedHealthcare Commercial	$1.94
Rate for Payer: WPPA Commercial	$1.68

ESTRIOL

Facility

$97.00

Service Code	HCPCS 82677
Hospital Charge Code	8267700
Hospital Revenue Code	301
Min. Negotiated Rate	$79.54
Max. Negotiated Rate	$94.09
Rate for Payer: Cash Price	$72.75
Rate for Payer: Health Partners Plans Commercial	$92.15
Rate for Payer: UnitedHealthcare Commercial	$94.09
Rate for Payer: WPPA Commercial	$79.54

ESTRIOL

Facility

$97.00

Service Code	HCPCS 82677
Hospital Charge Code	8267700
Hospital Revenue Code	301
Min. Negotiated Rate	$44.81
Max. Negotiated Rate	$94.09
Rate for Payer: BCBS Commercial	$69.53
Rate for Payer: Cash Price	$72.75
Rate for Payer: Cash Price	$72.75
Rate for Payer: Celtic Commercial/Exchange	$44.81
Rate for Payer: Health Partners Plans Commercial	$92.15
Rate for Payer: UnitedHealthcare Commercial	$94.09
Rate for Payer: WPPA Commercial	$81.48

ESTROGEN FRACTIONATED

Facility

$146.00

Service Code	HCPCS 82671
Hospital Charge Code	8267101
Hospital Revenue Code	309
Min. Negotiated Rate	$67.45
Max. Negotiated Rate	$141.62
Rate for Payer: BCBS Commercial	$119.04
Rate for Payer: Cash Price	$109.50
Rate for Payer: Cash Price	$109.50
Rate for Payer: Celtic Commercial/Exchange	$67.45
Rate for Payer: Health Partners Plans Commercial	$138.70
Rate for Payer: UnitedHealthcare Commercial	$141.62
Rate for Payer: WPPA Commercial	$122.64

ESTROGEN FRACTIONATED

Facility

$146.00

Service Code	HCPCS 82671
Hospital Charge Code	8267101
Hospital Revenue Code	309
Min. Negotiated Rate	$119.72
Max. Negotiated Rate	$141.62
Rate for Payer: Cash Price	$109.50
Rate for Payer: Health Partners Plans Commercial	$138.70
Rate for Payer: UnitedHealthcare Commercial	$141.62
Rate for Payer: WPPA Commercial	$119.72

ESTROGENS TOTAL

Facility

$205.00

Service Code	HCPCS 82672
Hospital Charge Code	8267200
Hospital Revenue Code	301
Min. Negotiated Rate	$168.10
Max. Negotiated Rate	$198.85
Rate for Payer: Cash Price	$153.75
Rate for Payer: Health Partners Plans Commercial	$194.75
Rate for Payer: UnitedHealthcare Commercial	$198.85
Rate for Payer: WPPA Commercial	$168.10

ESTROGENS TOTAL

Facility

$205.00

Service Code	HCPCS 82672
Hospital Charge Code	8267200
Hospital Revenue Code	301
Min. Negotiated Rate	$84.51
Max. Negotiated Rate	$198.85
Rate for Payer: BCBS Commercial	$84.51
Rate for Payer: Cash Price	$153.75
Rate for Payer: Cash Price	$153.75
Rate for Payer: Celtic Commercial/Exchange	$94.71
Rate for Payer: Health Partners Plans Commercial	$194.75
Rate for Payer: UnitedHealthcare Commercial	$198.85
Rate for Payer: WPPA Commercial	$172.20

ESTRONE

Facility

$85.00

Service Code	HCPCS 82679
Hospital Charge Code	8267900
Hospital Revenue Code	301
Min. Negotiated Rate	$69.70
Max. Negotiated Rate	$82.45
Rate for Payer: Cash Price	$63.75
Rate for Payer: Health Partners Plans Commercial	$80.75
Rate for Payer: UnitedHealthcare Commercial	$82.45
Rate for Payer: WPPA Commercial	$69.70

ESTRONE

Facility

$85.00

Service Code	HCPCS 82679
Hospital Charge Code	8267900
Hospital Revenue Code	301
Min. Negotiated Rate	$39.27
Max. Negotiated Rate	$82.45
Rate for Payer: BCBS Commercial	$62.10
Rate for Payer: Cash Price	$63.75
Rate for Payer: Cash Price	$63.75
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

ETHILON SUTURE 662G

Facility

$13.00

Hospital Charge Code	2702488
Hospital Revenue Code	270
Min. Negotiated Rate	$10.66
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$9.75
Rate for Payer: Health Partners Plans Commercial	$12.35
Rate for Payer: UnitedHealthcare Commercial	$12.61
Rate for Payer: WPPA Commercial	$10.66

ETHILON SUTURE 662G

Facility

$13.00

Hospital Charge Code	2702488
Hospital Revenue Code	270
Min. Negotiated Rate	$6.01
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$9.75
Rate for Payer: Celtic Commercial/Exchange	$6.01
Rate for Payer: Health Partners Plans Commercial	$12.35
Rate for Payer: UnitedHealthcare Commercial	$12.61
Rate for Payer: WPPA Commercial	$10.92

Know your out-of-pocket cost for care.

All Charges