Ness County Hospital

All Charges

Charge

Type

Setting

Price

INHIBIN A

Facility

$141.00

Service Code	HCPCS 86336
Hospital Charge Code	8633600
Hospital Revenue Code	302
Min. Negotiated Rate	$115.62
Max. Negotiated Rate	$136.77
Rate for Payer: Cash Price	$105.75
Rate for Payer: Health Partners Plans Commercial	$133.95
Rate for Payer: UnitedHealthcare Commercial	$136.77
Rate for Payer: WPPA Commercial	$115.62

INHIBIN A

Facility

$141.00

Service Code	HCPCS 86336
Hospital Charge Code	8633600
Hospital Revenue Code	302
Min. Negotiated Rate	$65.14
Max. Negotiated Rate	$136.77
Rate for Payer: BCBS Commercial	$100.50
Rate for Payer: Cash Price	$105.75
Rate for Payer: Cash Price	$105.75
Rate for Payer: Celtic Commercial/Exchange	$65.14
Rate for Payer: Health Partners Plans Commercial	$133.95
Rate for Payer: UnitedHealthcare Commercial	$136.77
Rate for Payer: WPPA Commercial	$118.44

INITIAL TREATMENT OF BURNS

Facility

$250.00

Service Code	HCPCS 16000
Hospital Charge Code	1600023
Hospital Revenue Code	761
Min. Negotiated Rate	$205.00
Max. Negotiated Rate	$242.50
Rate for Payer: Cash Price	$187.50
Rate for Payer: Health Partners Plans Commercial	$237.50
Rate for Payer: UnitedHealthcare Commercial	$242.50
Rate for Payer: WPPA Commercial	$205.00

INITIAL TREATMENT OF BURNS

Facility

$250.00

Service Code	HCPCS 16000
Hospital Charge Code	1600023
Hospital Revenue Code	761
Min. Negotiated Rate	$115.50
Max. Negotiated Rate	$248.38
Rate for Payer: BCBS Commercial	$248.38
Rate for Payer: Cash Price	$187.50
Rate for Payer: Cash Price	$187.50
Rate for Payer: Celtic Commercial/Exchange	$115.50
Rate for Payer: Health Partners Plans Commercial	$237.50
Rate for Payer: UnitedHealthcare Commercial	$242.50
Rate for Payer: WPPA Commercial	$210.00

INIT TX 1ST DEGREE BURN-LOCAL

Facility

$198.00

Service Code	HCPCS 16000
Hospital Charge Code	1600000
Hospital Revenue Code	450
Min. Negotiated Rate	$162.36
Max. Negotiated Rate	$192.06
Rate for Payer: Cash Price	$148.50
Rate for Payer: Health Partners Plans Commercial	$188.10
Rate for Payer: UnitedHealthcare Commercial	$192.06
Rate for Payer: WPPA Commercial	$162.36

INIT TX 1ST DEGREE BURN-LOCAL

Facility

$198.00

Service Code	HCPCS 16000
Hospital Charge Code	1600000
Hospital Revenue Code	450
Min. Negotiated Rate	$91.48
Max. Negotiated Rate	$248.38
Rate for Payer: BCBS Commercial	$248.38
Rate for Payer: Cash Price	$148.50
Rate for Payer: Cash Price	$148.50
Rate for Payer: Celtic Commercial/Exchange	$91.48
Rate for Payer: Health Partners Plans Commercial	$188.10
Rate for Payer: UnitedHealthcare Commercial	$192.06
Rate for Payer: WPPA Commercial	$166.32

INJ ADMN-ALLERGEN IMMUN-SINGLE

Facility

$70.00

Service Code	HCPCS 95115
Hospital Charge Code	9511500
Hospital Revenue Code	761
Min. Negotiated Rate	$32.34
Max. Negotiated Rate	$67.90
Rate for Payer: BCBS Commercial	$57.68
Rate for Payer: Cash Price	$52.50
Rate for Payer: Cash Price	$52.50
Rate for Payer: Celtic Commercial/Exchange	$32.34
Rate for Payer: Health Partners Plans Commercial	$66.50
Rate for Payer: UnitedHealthcare Commercial	$67.90
Rate for Payer: WPPA Commercial	$58.80

INJ ADMN-ALLERGEN IMMUN-SINGLE

Facility

$70.00

Service Code	HCPCS 95115
Hospital Charge Code	9511500
Hospital Revenue Code	761
Min. Negotiated Rate	$57.40
Max. Negotiated Rate	$67.90
Rate for Payer: Cash Price	$52.50
Rate for Payer: Health Partners Plans Commercial	$66.50
Rate for Payer: UnitedHealthcare Commercial	$67.90
Rate for Payer: WPPA Commercial	$57.40

INJ ANES AGENT,DX/THER,EX NERV

Facility

$435.00

Service Code	HCPCS 64400
Hospital Charge Code	6440000
Hospital Revenue Code	450
Min. Negotiated Rate	$356.70
Max. Negotiated Rate	$421.95
Rate for Payer: Cash Price	$326.25
Rate for Payer: Health Partners Plans Commercial	$413.25
Rate for Payer: UnitedHealthcare Commercial	$421.95
Rate for Payer: WPPA Commercial	$356.70

INJ ANES AGENT,DX/THER,EX NERV

Facility

$435.00

Service Code	HCPCS 64400
Hospital Charge Code	6440000
Hospital Revenue Code	450
Min. Negotiated Rate	$200.97
Max. Negotiated Rate	$421.95
Rate for Payer: BCBS Commercial	$361.58
Rate for Payer: Cash Price	$326.25
Rate for Payer: Cash Price	$326.25
Rate for Payer: Celtic Commercial/Exchange	$200.97
Rate for Payer: Health Partners Plans Commercial	$413.25
Rate for Payer: UnitedHealthcare Commercial	$421.95
Rate for Payer: WPPA Commercial	$365.40

INJ ANES AGENT ILIO-ING/HYPOGI

Facility

$649.00

Service Code	HCPCS 64425
Hospital Charge Code	6442500
Hospital Revenue Code	761
Min. Negotiated Rate	$299.84
Max. Negotiated Rate	$629.53
Rate for Payer: BCBS Commercial	$310.07
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

INJ ANES AGENT ILIO-ING/HYPOGI

Facility

$649.00

Service Code	HCPCS 64425
Hospital Charge Code	6442500
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

INJ ANES AGENT &/OR STEROID

Facility

$323.00

Service Code	HCPCS 64455
Hospital Charge Code	6445500
Hospital Revenue Code	450
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

INJ ANES AGENT &/OR STEROID

Facility

$323.00

Service Code	HCPCS 64455
Hospital Charge Code	6445500
Hospital Revenue Code	450
Min. Negotiated Rate	$149.23
Max. Negotiated Rate	$368.20
Rate for Payer: BCBS Commercial	$368.20
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

INJ ANES AGENT OTHER PERIPHERL

Facility

$698.00

Service Code	HCPCS 64450
Hospital Charge Code	6445000
Hospital Revenue Code	450
Min. Negotiated Rate	$322.48
Max. Negotiated Rate	$859.51
Rate for Payer: BCBS Commercial	$859.51
Rate for Payer: Cash Price	$523.50
Rate for Payer: Cash Price	$523.50
Rate for Payer: Celtic Commercial/Exchange	$322.48
Rate for Payer: Health Partners Plans Commercial	$663.10
Rate for Payer: UnitedHealthcare Commercial	$677.06
Rate for Payer: WPPA Commercial	$586.32

INJ ANES AGENT OTHER PERIPHERL

Facility

$698.00

Service Code	HCPCS 64450
Hospital Charge Code	6445000
Hospital Revenue Code	450
Min. Negotiated Rate	$572.36
Max. Negotiated Rate	$677.06
Rate for Payer: Cash Price	$523.50
Rate for Payer: Health Partners Plans Commercial	$663.10
Rate for Payer: UnitedHealthcare Commercial	$677.06
Rate for Payer: WPPA Commercial	$572.36

INJ DIAGNOSTIC/THERAPUTIC SUBS

Facility

$649.00

Service Code	HCPCS 62320
Hospital Charge Code	6232000
Hospital Revenue Code	762
Min. Negotiated Rate	$299.84
Max. Negotiated Rate	$629.53
Rate for Payer: BCBS Commercial	$588.83
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

INJ DIAGNOSTIC/THERAPUTIC SUBS

Facility

$649.00

Service Code	HCPCS 62320
Hospital Charge Code	6232000
Hospital Revenue Code	762
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

INJ/DRAIN JOINT/BURSA W/US

Facility

$630.00

Service Code	HCPCS 20611
Hospital Charge Code	2061100
Hospital Revenue Code	761
Min. Negotiated Rate	$516.60
Max. Negotiated Rate	$611.10
Rate for Payer: Cash Price	$472.50
Rate for Payer: Health Partners Plans Commercial	$598.50
Rate for Payer: UnitedHealthcare Commercial	$611.10
Rate for Payer: WPPA Commercial	$516.60

INJ/DRAIN JOINT/BURSA W/US

Facility

$630.00

Service Code	HCPCS 20611
Hospital Charge Code	2061100
Hospital Revenue Code	761
Min. Negotiated Rate	$291.06
Max. Negotiated Rate	$611.10
Rate for Payer: BCBS Commercial	$368.99
Rate for Payer: Cash Price	$472.50
Rate for Payer: Cash Price	$472.50
Rate for Payer: Celtic Commercial/Exchange	$291.06
Rate for Payer: Health Partners Plans Commercial	$598.50
Rate for Payer: UnitedHealthcare Commercial	$611.10
Rate for Payer: WPPA Commercial	$529.20

INJECTAFER 750 MG (FERRIC CARBOXYMALTOSE) IV

Facility

$4,670.00

Service Code	NDC 00517065001
Hospital Charge Code	2513548
Hospital Revenue Code	250
Min. Negotiated Rate	$3,829.40
Max. Negotiated Rate	$4,529.90
Rate for Payer: Cash Price	$3,502.55
Rate for Payer: Health Partners Plans Commercial	$4,436.50
Rate for Payer: UnitedHealthcare Commercial	$4,529.90
Rate for Payer: WPPA Commercial	$3,829.40

INJECTAFER 750 MG (FERRIC CARBOXYMALTOSE) IV

Facility

$4,670.00

Service Code	NDC 00517065001
Hospital Charge Code	2513548
Hospital Revenue Code	250
Min. Negotiated Rate	$2,157.54
Max. Negotiated Rate	$4,529.90
Rate for Payer: Cash Price	$3,502.55
Rate for Payer: Celtic Commercial/Exchange	$2,157.54
Rate for Payer: Health Partners Plans Commercial	$4,436.50
Rate for Payer: UnitedHealthcare Commercial	$4,529.90
Rate for Payer: WPPA Commercial	$3,922.80

INJECTION MAJOR JOINT OR BURSA

Facility

$323.00

Service Code	HCPCS 20610
Hospital Charge Code	2061001
Hospital Revenue Code	450
Min. Negotiated Rate	$149.23
Max. Negotiated Rate	$368.99
Rate for Payer: BCBS Commercial	$368.99
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

INJECTION MAJOR JOINT OR BURSA

Facility

$323.00

Service Code	HCPCS 20610
Hospital Charge Code	2061001
Hospital Revenue Code	450
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

Inj, epinephrine (belcher), 0.1 mg

Facility

$46.00

Hospital Charge Code	2515476
Hospital Revenue Code	250
Min. Negotiated Rate	$21.25
Max. Negotiated Rate	$44.62
Rate for Payer: Cash Price	$35.03
Rate for Payer: Celtic Commercial/Exchange	$21.25
Rate for Payer: Health Partners Plans Commercial	$43.70
Rate for Payer: UnitedHealthcare Commercial	$44.62
Rate for Payer: WPPA Commercial	$38.64

Know your out-of-pocket cost for care.

All Charges