Ness County Hospital

All Charges

Charge

Type

Setting

Price

EXCISION OF NEUROFIBROMA OR

Facility

$3,225.00

Service Code	HCPCS 64788
Hospital Charge Code	6478800
Hospital Revenue Code	450
Min. Negotiated Rate	$2,644.50
Max. Negotiated Rate	$3,128.25
Rate for Payer: Cash Price	$2,418.75
Rate for Payer: Health Partners Plans Commercial	$3,063.75
Rate for Payer: UnitedHealthcare Commercial	$3,128.25
Rate for Payer: WPPA Commercial	$2,644.50

EXCISION OF NEUROFIBROMA OR

Facility

$3,225.00

Service Code	HCPCS 64788
Hospital Charge Code	6478800
Hospital Revenue Code	450
Min. Negotiated Rate	$952.00
Max. Negotiated Rate	$3,128.25
Rate for Payer: BCBS Commercial	$952.00
Rate for Payer: Cash Price	$2,418.75
Rate for Payer: Cash Price	$2,418.75
Rate for Payer: Celtic Commercial/Exchange	$1,489.95
Rate for Payer: Health Partners Plans Commercial	$3,063.75
Rate for Payer: UnitedHealthcare Commercial	$3,128.25
Rate for Payer: WPPA Commercial	$2,709.00

EXCISION TUMOR S TISSUE BACK/

Facility

$3,500.00

Service Code	HCPCS 21930
Hospital Charge Code	2193000
Hospital Revenue Code	510
Min. Negotiated Rate	$2,870.00
Max. Negotiated Rate	$3,395.00
Rate for Payer: Cash Price	$2,625.00
Rate for Payer: Health Partners Plans Commercial	$3,325.00
Rate for Payer: UnitedHealthcare Commercial	$3,395.00
Rate for Payer: WPPA Commercial	$2,870.00

EXCISION TUMOR S TISSUE BACK/

Facility

$3,500.00

Service Code	HCPCS 21930
Hospital Charge Code	2193000
Hospital Revenue Code	510
Min. Negotiated Rate	$1,617.00
Max. Negotiated Rate	$3,395.00
Rate for Payer: BCBS Commercial	$2,025.30
Rate for Payer: Cash Price	$2,625.00
Rate for Payer: Cash Price	$2,625.00
Rate for Payer: Celtic Commercial/Exchange	$1,617.00
Rate for Payer: Health Partners Plans Commercial	$3,325.00
Rate for Payer: UnitedHealthcare Commercial	$3,395.00
Rate for Payer: WPPA Commercial	$2,940.00

EXCISION-VASOTOMY UNIL OR BILA

Facility

$4,000.00

Service Code	HCPCS 55250
Hospital Charge Code	5525000
Hospital Revenue Code	450
Min. Negotiated Rate	$1,848.00
Max. Negotiated Rate	$3,880.00
Rate for Payer: BCBS Commercial	$2,560.64
Rate for Payer: Cash Price	$3,000.00
Rate for Payer: Cash Price	$3,000.00
Rate for Payer: Celtic Commercial/Exchange	$1,848.00
Rate for Payer: Health Partners Plans Commercial	$3,800.00
Rate for Payer: UnitedHealthcare Commercial	$3,880.00
Rate for Payer: WPPA Commercial	$3,360.00

EXCISION-VASOTOMY UNIL OR BILA

Facility

$4,000.00

Service Code	HCPCS 55250
Hospital Charge Code	5525000
Hospital Revenue Code	450
Min. Negotiated Rate	$3,280.00
Max. Negotiated Rate	$3,880.00
Rate for Payer: Cash Price	$3,000.00
Rate for Payer: Health Partners Plans Commercial	$3,800.00
Rate for Payer: UnitedHealthcare Commercial	$3,880.00
Rate for Payer: WPPA Commercial	$3,280.00

EXCIS TUMOR,SOFT TISSUE NECK

Facility

$1,500.00

Service Code	HCPCS 21555
Hospital Charge Code	2155500
Hospital Revenue Code	761
Min. Negotiated Rate	$693.00
Max. Negotiated Rate	$2,104.84
Rate for Payer: BCBS Commercial	$2,104.84
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

EXCIS TUMOR,SOFT TISSUE NECK

Facility

$1,500.00

Service Code	HCPCS 21555
Hospital Charge Code	2155500
Hospital Revenue Code	761
Min. Negotiated Rate	$1,230.00
Max. Negotiated Rate	$1,455.00
Rate for Payer: Cash Price	$1,125.00
Rate for Payer: Health Partners Plans Commercial	$1,425.00
Rate for Payer: UnitedHealthcare Commercial	$1,455.00
Rate for Payer: WPPA Commercial	$1,230.00

EXC MALIG LES .6 TO 1 CN

Facility

$649.00

Service Code	HCPCS 11621
Hospital Charge Code	1162100
Hospital Revenue Code	761
Min. Negotiated Rate	$532.18
Max. Negotiated Rate	$629.53
Rate for Payer: Cash Price	$486.75
Rate for Payer: Health Partners Plans Commercial	$616.55
Rate for Payer: UnitedHealthcare Commercial	$629.53
Rate for Payer: WPPA Commercial	$532.18

EXC MALIG LES .6 TO 1 CN

Facility

$649.00

Service Code	HCPCS 11621
Hospital Charge Code	1162100
Hospital Revenue Code	761
Min. Negotiated Rate	$299.84
Max. Negotiated Rate	$783.57
Rate for Payer: BCBS Commercial	$783.57
Rate for Payer: Cash Price	$486.75
Rate for Payer: Cash Price	$486.75
Rate for Payer: Celtic Commercial/Exchange	$299.84
Rate for Payer: Health Partners Plans Commercial	$616.55
Rate for Payer: UnitedHealthcare Commercial	$629.53
Rate for Payer: WPPA Commercial	$545.16

EXC MALIG LES,FACE >4.0 CM

Facility

$2,584.00

Service Code	HCPCS 11646
Hospital Charge Code	1164600
Hospital Revenue Code	761
Min. Negotiated Rate	$2,118.88
Max. Negotiated Rate	$2,506.48
Rate for Payer: Cash Price	$1,938.00
Rate for Payer: Health Partners Plans Commercial	$2,454.80
Rate for Payer: UnitedHealthcare Commercial	$2,506.48
Rate for Payer: WPPA Commercial	$2,118.88

EXC MALIG LES,FACE >4.0 CM

Facility

$2,584.00

Service Code	HCPCS 11646
Hospital Charge Code	1164600
Hospital Revenue Code	761
Min. Negotiated Rate	$1,193.81
Max. Negotiated Rate	$2,506.48
Rate for Payer: BCBS Commercial	$1,896.78
Rate for Payer: Cash Price	$1,938.00
Rate for Payer: Cash Price	$1,938.00
Rate for Payer: Celtic Commercial/Exchange	$1,193.81
Rate for Payer: Health Partners Plans Commercial	$2,454.80
Rate for Payer: UnitedHealthcare Commercial	$2,506.48
Rate for Payer: WPPA Commercial	$2,170.56

EXC MALIG LES INCL MARG >4.0CM

Facility

$1,500.00

Service Code	HCPCS 11606
Hospital Charge Code	1160600
Hospital Revenue Code	761
Min. Negotiated Rate	$1,230.00
Max. Negotiated Rate	$1,455.00
Rate for Payer: Cash Price	$1,125.00
Rate for Payer: Health Partners Plans Commercial	$1,425.00
Rate for Payer: UnitedHealthcare Commercial	$1,455.00
Rate for Payer: WPPA Commercial	$1,230.00

EXC MALIG LES INCL MARG >4.0CM

Facility

$1,500.00

Service Code	HCPCS 11606
Hospital Charge Code	1160600
Hospital Revenue Code	761
Min. Negotiated Rate	$693.00
Max. Negotiated Rate	$1,998.79
Rate for Payer: BCBS Commercial	$1,998.79
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

EXC,MALIG LESION,SCALP,NECK,

Facility

$1,500.00

Service Code	HCPCS 11620
Hospital Charge Code	1162000
Hospital Revenue Code	761
Min. Negotiated Rate	$1,230.00
Max. Negotiated Rate	$1,455.00
Rate for Payer: Cash Price	$1,125.00
Rate for Payer: Health Partners Plans Commercial	$1,425.00
Rate for Payer: UnitedHealthcare Commercial	$1,455.00
Rate for Payer: WPPA Commercial	$1,230.00

EXC,MALIG LESION,SCALP,NECK,

Facility

$1,500.00

Service Code	HCPCS 11620
Hospital Charge Code	1162000
Hospital Revenue Code	761
Min. Negotiated Rate	$693.00
Max. Negotiated Rate	$1,805.43
Rate for Payer: BCBS Commercial	$1,805.43
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

EXERCISE,15 MIN & HOT/COLD PAK

Facility

$155.00

Service Code	HCPCS 97110 GP
Hospital Charge Code	4200950
Hospital Revenue Code	420
Min. Negotiated Rate	$127.10
Max. Negotiated Rate	$150.35
Rate for Payer: Cash Price	$116.62
Rate for Payer: Health Partners Plans Commercial	$147.25
Rate for Payer: UnitedHealthcare Commercial	$150.35
Rate for Payer: WPPA Commercial	$127.10

EXERCISE,15 MIN & HOT/COLD PAK

Facility

$155.00

Service Code	HCPCS 97110 GP
Hospital Charge Code	4200950
Hospital Revenue Code	420
Min. Negotiated Rate	$56.91
Max. Negotiated Rate	$150.35
Rate for Payer: BCBS Commercial	$56.91
Rate for Payer: Cash Price	$116.62
Rate for Payer: Cash Price	$116.62
Rate for Payer: Celtic Commercial/Exchange	$71.61
Rate for Payer: Health Partners Plans Commercial	$147.25
Rate for Payer: UnitedHealthcare Commercial	$150.35
Rate for Payer: WPPA Commercial	$130.20

EXHALATION PORT SWIVEL PASSIVE

Facility

$35.00

Hospital Charge Code	4100400
Hospital Revenue Code	272
Min. Negotiated Rate	$16.17
Max. Negotiated Rate	$33.95
Rate for Payer: Cash Price	$26.25
Rate for Payer: Celtic Commercial/Exchange	$16.17
Rate for Payer: Health Partners Plans Commercial	$33.25
Rate for Payer: UnitedHealthcare Commercial	$33.95
Rate for Payer: WPPA Commercial	$29.40

EXHALATION PORT SWIVEL PASSIVE

Facility

$35.00

Hospital Charge Code	4100400
Hospital Revenue Code	272
Min. Negotiated Rate	$28.70
Max. Negotiated Rate	$33.95
Rate for Payer: Cash Price	$26.25
Rate for Payer: Health Partners Plans Commercial	$33.25
Rate for Payer: UnitedHealthcare Commercial	$33.95
Rate for Payer: WPPA Commercial	$28.70

EXPLORATION OF PENETRAT WOUND

Facility

$1,613.00

Service Code	HCPCS 20103
Hospital Charge Code	2010300
Hospital Revenue Code	450
Min. Negotiated Rate	$310.07
Max. Negotiated Rate	$1,564.61
Rate for Payer: BCBS Commercial	$310.07
Rate for Payer: Cash Price	$1,209.75
Rate for Payer: Cash Price	$1,209.75
Rate for Payer: Celtic Commercial/Exchange	$745.21
Rate for Payer: Health Partners Plans Commercial	$1,532.35
Rate for Payer: UnitedHealthcare Commercial	$1,564.61
Rate for Payer: WPPA Commercial	$1,354.92

EXPLORATION OF PENETRAT WOUND

Facility

$1,613.00

Service Code	HCPCS 20103
Hospital Charge Code	2010300
Hospital Revenue Code	450
Min. Negotiated Rate	$1,322.66
Max. Negotiated Rate	$1,564.61
Rate for Payer: Cash Price	$1,209.75
Rate for Payer: Health Partners Plans Commercial	$1,532.35
Rate for Payer: UnitedHealthcare Commercial	$1,564.61
Rate for Payer: WPPA Commercial	$1,322.66

EXPL PENETRAT WOUND-NECK SEP P

Facility

$1,075.00

Service Code	HCPCS 20100
Hospital Charge Code	2010000
Hospital Revenue Code	450
Min. Negotiated Rate	$881.50
Max. Negotiated Rate	$1,042.75
Rate for Payer: Cash Price	$806.25
Rate for Payer: Health Partners Plans Commercial	$1,021.25
Rate for Payer: UnitedHealthcare Commercial	$1,042.75
Rate for Payer: WPPA Commercial	$881.50

EXPL PENETRAT WOUND-NECK SEP P

Facility

$1,075.00

Service Code	HCPCS 20100
Hospital Charge Code	2010000
Hospital Revenue Code	450
Min. Negotiated Rate	$310.07
Max. Negotiated Rate	$1,042.75
Rate for Payer: BCBS Commercial	$310.07
Rate for Payer: Cash Price	$806.25
Rate for Payer: Cash Price	$806.25
Rate for Payer: Celtic Commercial/Exchange	$496.65
Rate for Payer: Health Partners Plans Commercial	$1,021.25
Rate for Payer: UnitedHealthcare Commercial	$1,042.75
Rate for Payer: WPPA Commercial	$903.00

EXTENSION SET 72"

Facility

$50.00

Hospital Charge Code	2519676
Hospital Revenue Code	270
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

Know your out-of-pocket cost for care.

All Charges