Ness County Hospital

All Charges

Charge

Type

Setting

Price

HOME SUPPRT PT TX BY PT 1/4 HR

Facility

$49.00

Service Code	HCPCS G0151
Hospital Charge Code	4208833
Hospital Revenue Code	421
Min. Negotiated Rate	$22.64
Max. Negotiated Rate	$47.53
Rate for Payer: Cash Price	$36.75
Rate for Payer: Celtic Commercial/Exchange	$22.64
Rate for Payer: Health Partners Plans Commercial	$46.55
Rate for Payer: UnitedHealthcare Commercial	$47.53
Rate for Payer: WPPA Commercial	$41.16

HOME SUPPRT PT TX BY PT 1/4 HR

Facility

$49.00

Service Code	HCPCS G0151
Hospital Charge Code	4208833
Hospital Revenue Code	421
Min. Negotiated Rate	$40.18
Max. Negotiated Rate	$47.53
Rate for Payer: Cash Price	$36.75
Rate for Payer: Health Partners Plans Commercial	$46.55
Rate for Payer: UnitedHealthcare Commercial	$47.53
Rate for Payer: WPPA Commercial	$40.18

HOME SUPPRT-PT TX BY PTA 1/4HR

Facility

$24.00

Service Code	HCPCS G0157
Hospital Charge Code	4208822
Hospital Revenue Code	421
Min. Negotiated Rate	$11.09
Max. Negotiated Rate	$23.28
Rate for Payer: Cash Price	$18.00
Rate for Payer: Celtic Commercial/Exchange	$11.09
Rate for Payer: Health Partners Plans Commercial	$22.80
Rate for Payer: UnitedHealthcare Commercial	$23.28
Rate for Payer: WPPA Commercial	$20.16

HOME SUPPRT-PT TX BY PTA 1/4HR

Facility

$24.00

Service Code	HCPCS G0157
Hospital Charge Code	4208822
Hospital Revenue Code	421
Min. Negotiated Rate	$19.68
Max. Negotiated Rate	$23.28
Rate for Payer: Cash Price	$18.00
Rate for Payer: Health Partners Plans Commercial	$22.80
Rate for Payer: UnitedHealthcare Commercial	$23.28
Rate for Payer: WPPA Commercial	$19.68

HOME VISIT

Facility

$15.00

Service Code	HCPCS 99341
Hospital Charge Code	9934101
Hospital Revenue Code	761
Min. Negotiated Rate	$12.30
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$11.25
Rate for Payer: Health Partners Plans Commercial	$14.25
Rate for Payer: UnitedHealthcare Commercial	$14.55
Rate for Payer: WPPA Commercial	$12.30

HOME VISIT

Facility

$15.00

Service Code	HCPCS 99341
Hospital Charge Code	9934101
Hospital Revenue Code	761
Min. Negotiated Rate	$6.93
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$11.25
Rate for Payer: Celtic Commercial/Exchange	$6.93
Rate for Payer: Health Partners Plans Commercial	$14.25
Rate for Payer: UnitedHealthcare Commercial	$14.55
Rate for Payer: WPPA Commercial	$12.60

HOMOCYSTEINE

Facility

$322.00

Service Code	HCPCS 83090
Hospital Charge Code	8309000
Hospital Revenue Code	301
Min. Negotiated Rate	$148.76
Max. Negotiated Rate	$312.34
Rate for Payer: BCBS Commercial	$176.58
Rate for Payer: Cash Price	$241.50
Rate for Payer: Cash Price	$241.50
Rate for Payer: Celtic Commercial/Exchange	$148.76
Rate for Payer: Health Partners Plans Commercial	$305.90
Rate for Payer: UnitedHealthcare Commercial	$312.34
Rate for Payer: WPPA Commercial	$270.48

HOMOCYSTEINE

Facility

$322.00

Service Code	HCPCS 83090
Hospital Charge Code	8309000
Hospital Revenue Code	301
Min. Negotiated Rate	$264.04
Max. Negotiated Rate	$312.34
Rate for Payer: Cash Price	$241.50
Rate for Payer: Health Partners Plans Commercial	$305.90
Rate for Payer: UnitedHealthcare Commercial	$312.34
Rate for Payer: WPPA Commercial	$264.04

HOMOVANILLIC ACID (HVA)

Facility

$87.00

Service Code	HCPCS 83150
Hospital Charge Code	8315000
Hospital Revenue Code	301
Min. Negotiated Rate	$71.34
Max. Negotiated Rate	$84.39
Rate for Payer: Cash Price	$65.25
Rate for Payer: Health Partners Plans Commercial	$82.65
Rate for Payer: UnitedHealthcare Commercial	$84.39
Rate for Payer: WPPA Commercial	$71.34

HOMOVANILLIC ACID (HVA)

Facility

$87.00

Service Code	HCPCS 83150
Hospital Charge Code	8315000
Hospital Revenue Code	301
Min. Negotiated Rate	$40.19
Max. Negotiated Rate	$84.39
Rate for Payer: BCBS Commercial	$60.50
Rate for Payer: Cash Price	$65.25
Rate for Payer: Cash Price	$65.25
Rate for Payer: Celtic Commercial/Exchange	$40.19
Rate for Payer: Health Partners Plans Commercial	$82.65
Rate for Payer: UnitedHealthcare Commercial	$84.39
Rate for Payer: WPPA Commercial	$73.08

HOSP OP CLINIC VISIT

Facility

$323.00

Service Code	HCPCS G0463
Hospital Charge Code	G046323
Hospital Revenue Code	761
Min. Negotiated Rate	$45.57
Max. Negotiated Rate	$313.31
Rate for Payer: BCBS Commercial	$45.57
Rate for Payer: Cash Price	$242.25
Rate for Payer: Cash Price	$242.25
Rate for Payer: Celtic Commercial/Exchange	$149.23
Rate for Payer: Health Partners Plans Commercial	$306.85
Rate for Payer: UnitedHealthcare Commercial	$313.31
Rate for Payer: WPPA Commercial	$271.32

HOSP OP CLINIC VISIT

Facility

$323.00

Service Code	HCPCS G0463
Hospital Charge Code	G046323
Hospital Revenue Code	761
Min. Negotiated Rate	$264.86
Max. Negotiated Rate	$313.31
Rate for Payer: Cash Price	$242.25
Rate for Payer: Health Partners Plans Commercial	$306.85
Rate for Payer: UnitedHealthcare Commercial	$313.31
Rate for Payer: WPPA Commercial	$264.86

HOSP-TELEHEALTH CLINIC-EVAL

Facility

$49.00

Service Code	HCPCS 99211
Hospital Charge Code	9921121
Hospital Revenue Code	510
Min. Negotiated Rate	$40.18
Max. Negotiated Rate	$47.53
Rate for Payer: Cash Price	$36.75
Rate for Payer: Health Partners Plans Commercial	$46.55
Rate for Payer: UnitedHealthcare Commercial	$47.53
Rate for Payer: WPPA Commercial	$40.18

HOSP-TELEHEALTH CLINIC-EVAL

Facility

$49.00

Service Code	HCPCS 99211
Hospital Charge Code	9921121
Hospital Revenue Code	510
Min. Negotiated Rate	$22.64
Max. Negotiated Rate	$47.53
Rate for Payer: BCBS Commercial	$42.50
Rate for Payer: Cash Price	$36.75
Rate for Payer: Cash Price	$36.75
Rate for Payer: Celtic Commercial/Exchange	$22.64
Rate for Payer: Health Partners Plans Commercial	$46.55
Rate for Payer: UnitedHealthcare Commercial	$47.53
Rate for Payer: WPPA Commercial	$41.16

HOSP-TELEHEALTH ORIG SITE FACITY FEE

Facility

$77.00

Service Code	HCPCS Q3014 95
Hospital Charge Code	Q301421
Hospital Revenue Code	780
Min. Negotiated Rate	$63.14
Max. Negotiated Rate	$74.69
Rate for Payer: Cash Price	$57.75
Rate for Payer: Health Partners Plans Commercial	$73.15
Rate for Payer: UnitedHealthcare Commercial	$74.69
Rate for Payer: WPPA Commercial	$63.14

HOSP-TELEHEALTH ORIG SITE FACITY FEE

Facility

$77.00

Service Code	HCPCS Q3014 95
Hospital Charge Code	Q301421
Hospital Revenue Code	780
Min. Negotiated Rate	$35.57
Max. Negotiated Rate	$74.69
Rate for Payer: BCBS Commercial	$38.38
Rate for Payer: Cash Price	$57.75
Rate for Payer: Cash Price	$57.75
Rate for Payer: Celtic Commercial/Exchange	$35.57
Rate for Payer: Health Partners Plans Commercial	$73.15
Rate for Payer: UnitedHealthcare Commercial	$74.69
Rate for Payer: WPPA Commercial	$64.68

HOT/COLD PACKS

Facility

$49.00

Service Code	HCPCS 97010 GP
Hospital Charge Code	4200085
Hospital Revenue Code	420
Min. Negotiated Rate	$21.21
Max. Negotiated Rate	$47.53
Rate for Payer: BCBS Commercial	$21.21
Rate for Payer: Cash Price	$36.75
Rate for Payer: Cash Price	$36.75
Rate for Payer: Celtic Commercial/Exchange	$22.64
Rate for Payer: Health Partners Plans Commercial	$46.55
Rate for Payer: UnitedHealthcare Commercial	$47.53
Rate for Payer: WPPA Commercial	$41.16

HOT/COLD PACKS

Facility

$49.00

Service Code	HCPCS 97010 GP
Hospital Charge Code	4200085
Hospital Revenue Code	420
Min. Negotiated Rate	$40.18
Max. Negotiated Rate	$47.53
Rate for Payer: Cash Price	$36.75
Rate for Payer: Health Partners Plans Commercial	$46.55
Rate for Payer: UnitedHealthcare Commercial	$47.53
Rate for Payer: WPPA Commercial	$40.18

H PYLORI BREATH TEST

Facility

$273.00

Service Code	HCPCS 83013
Hospital Charge Code	8301300
Hospital Revenue Code	301
Min. Negotiated Rate	$126.13
Max. Negotiated Rate	$274.88
Rate for Payer: BCBS Commercial	$274.88
Rate for Payer: Cash Price	$204.75
Rate for Payer: Cash Price	$204.75
Rate for Payer: Celtic Commercial/Exchange	$126.13
Rate for Payer: Health Partners Plans Commercial	$259.35
Rate for Payer: UnitedHealthcare Commercial	$264.81
Rate for Payer: WPPA Commercial	$229.32

H PYLORI BREATH TEST

Facility

$273.00

Service Code	HCPCS 83013
Hospital Charge Code	8301300
Hospital Revenue Code	301
Min. Negotiated Rate	$223.86
Max. Negotiated Rate	$264.81
Rate for Payer: Cash Price	$204.75
Rate for Payer: Health Partners Plans Commercial	$259.35
Rate for Payer: UnitedHealthcare Commercial	$264.81
Rate for Payer: WPPA Commercial	$223.86

HS-PP-AIDE ATND CARE 1/4 HR

Facility

$6.00

Service Code	HCPCS G0156
Hospital Charge Code	5710006
Hospital Revenue Code	570
Min. Negotiated Rate	$2.77
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$4.50
Rate for Payer: Celtic Commercial/Exchange	$2.77
Rate for Payer: Health Partners Plans Commercial	$5.70
Rate for Payer: UnitedHealthcare Commercial	$5.82
Rate for Payer: WPPA Commercial	$5.04

HS-PP-AIDE ATND CARE 1/4 HR

Facility

$6.00

Service Code	HCPCS G0156
Hospital Charge Code	5710006
Hospital Revenue Code	570
Min. Negotiated Rate	$4.92
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$4.50
Rate for Payer: Health Partners Plans Commercial	$5.70
Rate for Payer: UnitedHealthcare Commercial	$5.82
Rate for Payer: WPPA Commercial	$4.92

HTLV OR HIV ANTIBODY, CONF TST

Facility

$130.00

Service Code	HCPCS 86689
Hospital Charge Code	8668900
Hospital Revenue Code	302
Min. Negotiated Rate	$50.53
Max. Negotiated Rate	$126.10
Rate for Payer: BCBS Commercial	$50.53
Rate for Payer: Cash Price	$97.50
Rate for Payer: Cash Price	$97.50
Rate for Payer: Celtic Commercial/Exchange	$60.06
Rate for Payer: Health Partners Plans Commercial	$123.50
Rate for Payer: UnitedHealthcare Commercial	$126.10
Rate for Payer: WPPA Commercial	$109.20

HTLV OR HIV ANTIBODY, CONF TST

Facility

$130.00

Service Code	HCPCS 86689
Hospital Charge Code	8668900
Hospital Revenue Code	302
Min. Negotiated Rate	$106.60
Max. Negotiated Rate	$126.10
Rate for Payer: Cash Price	$97.50
Rate for Payer: Health Partners Plans Commercial	$123.50
Rate for Payer: UnitedHealthcare Commercial	$126.10
Rate for Payer: WPPA Commercial	$106.60

HUMALOG INSULIN ¨C 3 ML VIAL(novolog)(admelog)(lispro)

Facility

$298.00

Service Code	NDC 00024592605
Hospital Charge Code	2500460
Hospital Revenue Code	250
Min. Negotiated Rate	$244.36
Max. Negotiated Rate	$289.06
Rate for Payer: Cash Price	$223.54
Rate for Payer: Health Partners Plans Commercial	$283.10
Rate for Payer: UnitedHealthcare Commercial	$289.06
Rate for Payer: WPPA Commercial	$244.36

Know your out-of-pocket cost for care.

All Charges