Ness County Hospital

All Charges

Charge

Type

Setting

Price

ET TUBE HOLDER

Facility

$13.00

Hospital Charge Code	2700599
Hospital Revenue Code	270
Min. Negotiated Rate	$6.01
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$9.90
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

ET TUBE HOLDER

Facility

$13.00

Hospital Charge Code	2700599
Hospital Revenue Code	270
Min. Negotiated Rate	$10.66
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$9.90
Rate for Payer: Health Partners Plans Commercial	$12.35
Rate for Payer: UnitedHealthcare Commercial	$12.61
Rate for Payer: WPPA Commercial	$10.66

Eucerin 8 oz. lotion (thera-derm)

Facility

$19.00

Service Code	NDC 00904429909
Hospital Charge Code	2511665
Hospital Revenue Code	250
Min. Negotiated Rate	$8.78
Max. Negotiated Rate	$18.43
Rate for Payer: Cash Price	$14.92
Rate for Payer: Celtic Commercial/Exchange	$8.78
Rate for Payer: Health Partners Plans Commercial	$18.05
Rate for Payer: UnitedHealthcare Commercial	$18.43
Rate for Payer: WPPA Commercial	$15.96

Eucerin 8 oz. lotion (thera-derm)

Facility

$19.00

Service Code	NDC 00904429909
Hospital Charge Code	2511665
Hospital Revenue Code	250
Min. Negotiated Rate	$15.58
Max. Negotiated Rate	$18.43
Rate for Payer: Cash Price	$14.92
Rate for Payer: Health Partners Plans Commercial	$18.05
Rate for Payer: UnitedHealthcare Commercial	$18.43
Rate for Payer: WPPA Commercial	$15.58

EVACUATION SUBUNGUAL HEMATOMA

Facility

$125.00

Service Code	HCPCS 11740
Hospital Charge Code	1174000
Hospital Revenue Code	450
Min. Negotiated Rate	$57.75
Max. Negotiated Rate	$161.13
Rate for Payer: BCBS Commercial	$161.13
Rate for Payer: Cash Price	$93.75
Rate for Payer: Cash Price	$93.75
Rate for Payer: Celtic Commercial/Exchange	$57.75
Rate for Payer: Health Partners Plans Commercial	$118.75
Rate for Payer: UnitedHealthcare Commercial	$121.25
Rate for Payer: WPPA Commercial	$105.00

EVACUATION SUBUNGUAL HEMATOMA

Facility

$125.00

Service Code	HCPCS 11740
Hospital Charge Code	1174000
Hospital Revenue Code	450
Min. Negotiated Rate	$102.50
Max. Negotiated Rate	$121.25
Rate for Payer: Cash Price	$93.75
Rate for Payer: Health Partners Plans Commercial	$118.75
Rate for Payer: UnitedHealthcare Commercial	$121.25
Rate for Payer: WPPA Commercial	$102.50

EVAL ORAL/PHARYNGEAL SWALLOW

Facility

$350.00

Service Code	HCPCS 92610 GN
Hospital Charge Code	9261000
Hospital Revenue Code	444
Min. Negotiated Rate	$287.00
Max. Negotiated Rate	$339.50
Rate for Payer: Cash Price	$262.50
Rate for Payer: Health Partners Plans Commercial	$332.50
Rate for Payer: UnitedHealthcare Commercial	$339.50
Rate for Payer: WPPA Commercial	$287.00

EVAL ORAL/PHARYNGEAL SWALLOW

Facility

$350.00

Service Code	HCPCS 92610 GN
Hospital Charge Code	9261000
Hospital Revenue Code	444
Min. Negotiated Rate	$128.71
Max. Negotiated Rate	$339.50
Rate for Payer: BCBS Commercial	$128.71
Rate for Payer: Cash Price	$262.50
Rate for Payer: Cash Price	$262.50
Rate for Payer: Celtic Commercial/Exchange	$161.70
Rate for Payer: Health Partners Plans Commercial	$332.50
Rate for Payer: UnitedHealthcare Commercial	$339.50
Rate for Payer: WPPA Commercial	$294.00

Evenity (romosozumab-aqqg) subQ syringe

Facility

$6,697.00

Service Code	NDC 55513088002
Hospital Charge Code	2513307
Hospital Revenue Code	250
Min. Negotiated Rate	$5,491.54
Max. Negotiated Rate	$6,496.09
Rate for Payer: Cash Price	$5,023.10
Rate for Payer: Health Partners Plans Commercial	$6,362.15
Rate for Payer: UnitedHealthcare Commercial	$6,496.09
Rate for Payer: WPPA Commercial	$5,491.54

Evenity (romosozumab-aqqg) subQ syringe

Facility

$6,697.00

Service Code	NDC 55513088002
Hospital Charge Code	2513307
Hospital Revenue Code	250
Min. Negotiated Rate	$3,094.01
Max. Negotiated Rate	$6,496.09
Rate for Payer: Cash Price	$5,023.10
Rate for Payer: Celtic Commercial/Exchange	$3,094.01
Rate for Payer: Health Partners Plans Commercial	$6,362.15
Rate for Payer: UnitedHealthcare Commercial	$6,496.09
Rate for Payer: WPPA Commercial	$5,625.48

EVISTA 60MG TAB

Facility

$22.00

Hospital Charge Code	2515922
Hospital Revenue Code	250
Min. Negotiated Rate	$18.04
Max. Negotiated Rate	$21.34
Rate for Payer: Cash Price	$16.50
Rate for Payer: Health Partners Plans Commercial	$20.90
Rate for Payer: UnitedHealthcare Commercial	$21.34
Rate for Payer: WPPA Commercial	$18.04

EVISTA 60MG TAB

Facility

$22.00

Hospital Charge Code	2515922
Hospital Revenue Code	250
Min. Negotiated Rate	$10.16
Max. Negotiated Rate	$21.34
Rate for Payer: Cash Price	$16.50
Rate for Payer: Celtic Commercial/Exchange	$10.16
Rate for Payer: Health Partners Plans Commercial	$20.90
Rate for Payer: UnitedHealthcare Commercial	$21.34
Rate for Payer: WPPA Commercial	$18.48

EXC BENIGN LESION DIA .6-1CM

Facility

$374.00

Service Code	HCPCS 11401
Hospital Charge Code	1140102
Hospital Revenue Code	761
Min. Negotiated Rate	$172.79
Max. Negotiated Rate	$499.41
Rate for Payer: BCBS Commercial	$499.41
Rate for Payer: Cash Price	$280.50
Rate for Payer: Cash Price	$280.50
Rate for Payer: Celtic Commercial/Exchange	$172.79
Rate for Payer: Health Partners Plans Commercial	$355.30
Rate for Payer: UnitedHealthcare Commercial	$362.78
Rate for Payer: WPPA Commercial	$314.16

EXC BENIGN LESION DIA .6-1CM

Facility

$374.00

Service Code	HCPCS 11401
Hospital Charge Code	1140102
Hospital Revenue Code	761
Min. Negotiated Rate	$306.68
Max. Negotiated Rate	$362.78
Rate for Payer: Cash Price	$280.50
Rate for Payer: Health Partners Plans Commercial	$355.30
Rate for Payer: UnitedHealthcare Commercial	$362.78
Rate for Payer: WPPA Commercial	$306.68

EXC/BEN/LES-FACE,EN-0.5CM<

Facility

$636.00

Service Code	HCPCS 11440
Hospital Charge Code	1144000
Hospital Revenue Code	761
Min. Negotiated Rate	$521.52
Max. Negotiated Rate	$616.92
Rate for Payer: Cash Price	$477.00
Rate for Payer: Health Partners Plans Commercial	$604.20
Rate for Payer: UnitedHealthcare Commercial	$616.92
Rate for Payer: WPPA Commercial	$521.52

EXC/BEN/LES-FACE,EN-0.5CM<

Facility

$636.00

Service Code	HCPCS 11440
Hospital Charge Code	1144000
Hospital Revenue Code	761
Min. Negotiated Rate	$293.83
Max. Negotiated Rate	$783.57
Rate for Payer: BCBS Commercial	$783.57
Rate for Payer: Cash Price	$477.00
Rate for Payer: Cash Price	$477.00
Rate for Payer: Celtic Commercial/Exchange	$293.83
Rate for Payer: Health Partners Plans Commercial	$604.20
Rate for Payer: UnitedHealthcare Commercial	$616.92
Rate for Payer: WPPA Commercial	$534.24

EXC/BEN/LES-FACE/EN-0.6-1.0CM

Facility

$684.00

Service Code	HCPCS 11441
Hospital Charge Code	1144100
Hospital Revenue Code	450
Min. Negotiated Rate	$316.01
Max. Negotiated Rate	$783.57
Rate for Payer: BCBS Commercial	$783.57
Rate for Payer: Cash Price	$513.00
Rate for Payer: Cash Price	$513.00
Rate for Payer: Celtic Commercial/Exchange	$316.01
Rate for Payer: Health Partners Plans Commercial	$649.80
Rate for Payer: UnitedHealthcare Commercial	$663.48
Rate for Payer: WPPA Commercial	$574.56

EXC/BEN/LES-FACE/EN-0.6-1.0CM

Facility

$684.00

Service Code	HCPCS 11441
Hospital Charge Code	1144100
Hospital Revenue Code	450
Min. Negotiated Rate	$560.88
Max. Negotiated Rate	$663.48
Rate for Payer: Cash Price	$513.00
Rate for Payer: Health Partners Plans Commercial	$649.80
Rate for Payer: UnitedHealthcare Commercial	$663.48
Rate for Payer: WPPA Commercial	$560.88

EXC/BEN/LES-FACE,EN-1.1-2.0CM

Facility

$636.00

Service Code	HCPCS 11442
Hospital Charge Code	1144200
Hospital Revenue Code	761
Min. Negotiated Rate	$293.83
Max. Negotiated Rate	$1,226.14
Rate for Payer: BCBS Commercial	$1,226.14
Rate for Payer: Cash Price	$477.00
Rate for Payer: Cash Price	$477.00
Rate for Payer: Celtic Commercial/Exchange	$293.83
Rate for Payer: Health Partners Plans Commercial	$604.20
Rate for Payer: UnitedHealthcare Commercial	$616.92
Rate for Payer: WPPA Commercial	$534.24

EXC/BEN/LES-FACE,EN-1.1-2.0CM

Facility

$636.00

Service Code	HCPCS 11442
Hospital Charge Code	1144200
Hospital Revenue Code	761
Min. Negotiated Rate	$521.52
Max. Negotiated Rate	$616.92
Rate for Payer: Cash Price	$477.00
Rate for Payer: Health Partners Plans Commercial	$604.20
Rate for Payer: UnitedHealthcare Commercial	$616.92
Rate for Payer: WPPA Commercial	$521.52

EXC/BEN/LES-SCALP/NECK-0.5CM<

Facility

$1,545.00

Service Code	HCPCS 11420
Hospital Charge Code	1142000
Hospital Revenue Code	450
Min. Negotiated Rate	$1,266.90
Max. Negotiated Rate	$1,498.65
Rate for Payer: Cash Price	$1,158.75
Rate for Payer: Health Partners Plans Commercial	$1,467.75
Rate for Payer: UnitedHealthcare Commercial	$1,498.65
Rate for Payer: WPPA Commercial	$1,266.90

EXC/BEN/LES-SCALP/NECK-0.5CM<

Facility

$1,545.00

Service Code	HCPCS 11420
Hospital Charge Code	1142000
Hospital Revenue Code	450
Min. Negotiated Rate	$713.79
Max. Negotiated Rate	$2,025.30
Rate for Payer: BCBS Commercial	$2,025.30
Rate for Payer: Cash Price	$1,158.75
Rate for Payer: Cash Price	$1,158.75
Rate for Payer: Celtic Commercial/Exchange	$713.79
Rate for Payer: Health Partners Plans Commercial	$1,467.75
Rate for Payer: UnitedHealthcare Commercial	$1,498.65
Rate for Payer: WPPA Commercial	$1,297.80

EXC/BEN/LES-SCALP/NECK 0.6-1.0

Facility

$1,200.00

Service Code	HCPCS 11421
Hospital Charge Code	1142100
Hospital Revenue Code	761
Min. Negotiated Rate	$554.40
Max. Negotiated Rate	$1,164.00
Rate for Payer: BCBS Commercial	$879.49
Rate for Payer: Cash Price	$900.00
Rate for Payer: Cash Price	$900.00
Rate for Payer: Celtic Commercial/Exchange	$554.40
Rate for Payer: Health Partners Plans Commercial	$1,140.00
Rate for Payer: UnitedHealthcare Commercial	$1,164.00
Rate for Payer: WPPA Commercial	$1,008.00

EXC/BEN/LES-SCALP/NECK 0.6-1.0

Facility

$1,200.00

Service Code	HCPCS 11421
Hospital Charge Code	1142100
Hospital Revenue Code	761
Min. Negotiated Rate	$984.00
Max. Negotiated Rate	$1,164.00
Rate for Payer: Cash Price	$900.00
Rate for Payer: Health Partners Plans Commercial	$1,140.00
Rate for Payer: UnitedHealthcare Commercial	$1,164.00
Rate for Payer: WPPA Commercial	$984.00

EXC/BEN/LES-SCALP/NECK-1.1-2.0

Facility

$1,500.00

Service Code	HCPCS 11422
Hospital Charge Code	1142200
Hospital Revenue Code	761
Min. Negotiated Rate	$693.00
Max. Negotiated Rate	$2,025.30
Rate for Payer: BCBS Commercial	$2,025.30
Rate for Payer: Cash Price	$1,125.00
Rate for Payer: Cash Price	$1,125.00
Rate for Payer: Celtic Commercial/Exchange	$693.00
Rate for Payer: Health Partners Plans Commercial	$1,425.00
Rate for Payer: UnitedHealthcare Commercial	$1,455.00
Rate for Payer: WPPA Commercial	$1,260.00

Know your out-of-pocket cost for care.

All Charges