Ness County Hospital

All Charges

Charge

Type

Setting

Price

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

INJ, SINGLE-LUMBAR,SACRAL

Facility

$600.00

Service Code	HCPCS 62322
Hospital Charge Code	6231100
Hospital Revenue Code	761
Min. Negotiated Rate	$277.20
Max. Negotiated Rate	$588.83
Rate for Payer: BCBS Commercial	$588.83
Rate for Payer: Cash Price	$450.00
Rate for Payer: Cash Price	$450.00
Rate for Payer: Celtic Commercial/Exchange	$277.20
Rate for Payer: Health Partners Plans Commercial	$570.00
Rate for Payer: UnitedHealthcare Commercial	$582.00
Rate for Payer: WPPA Commercial	$504.00

INJ, SINGLE-LUMBAR,SACRAL

Facility

$600.00

Service Code	HCPCS 62322
Hospital Charge Code	6231100
Hospital Revenue Code	761
Min. Negotiated Rate	$492.00
Max. Negotiated Rate	$582.00
Rate for Payer: Cash Price	$450.00
Rate for Payer: Health Partners Plans Commercial	$570.00
Rate for Payer: UnitedHealthcare Commercial	$582.00
Rate for Payer: WPPA Commercial	$492.00

INJ SNGL/MULT TRIGGER POINTS

Facility

$331.00

Service Code	HCPCS 20552
Hospital Charge Code	2055200
Hospital Revenue Code	761
Min. Negotiated Rate	$152.92
Max. Negotiated Rate	$330.53
Rate for Payer: BCBS Commercial	$330.53
Rate for Payer: Cash Price	$248.25
Rate for Payer: Cash Price	$248.25
Rate for Payer: Celtic Commercial/Exchange	$152.92
Rate for Payer: Health Partners Plans Commercial	$314.45
Rate for Payer: UnitedHealthcare Commercial	$321.07
Rate for Payer: WPPA Commercial	$278.04

INJ SNGL/MULT TRIGGER POINTS

Facility

$331.00

Service Code	HCPCS 20552
Hospital Charge Code	2055200
Hospital Revenue Code	761
Min. Negotiated Rate	$271.42
Max. Negotiated Rate	$321.07
Rate for Payer: Cash Price	$248.25
Rate for Payer: Health Partners Plans Commercial	$314.45
Rate for Payer: UnitedHealthcare Commercial	$321.07
Rate for Payer: WPPA Commercial	$271.42

INJ SNGL,NOT INCL. NEUROLYTIC

Facility

$585.00

Service Code	HCPCS 62310
Hospital Charge Code	6231000
Hospital Revenue Code	760
Min. Negotiated Rate	$479.70
Max. Negotiated Rate	$567.45
Rate for Payer: Cash Price	$438.75
Rate for Payer: Health Partners Plans Commercial	$555.75
Rate for Payer: UnitedHealthcare Commercial	$567.45
Rate for Payer: WPPA Commercial	$479.70

INJ SNGL,NOT INCL. NEUROLYTIC

Facility

$585.00

Service Code	HCPCS 62310
Hospital Charge Code	6231000
Hospital Revenue Code	760
Min. Negotiated Rate	$270.27
Max. Negotiated Rate	$567.45
Rate for Payer: Cash Price	$438.75
Rate for Payer: Celtic Commercial/Exchange	$270.27
Rate for Payer: Health Partners Plans Commercial	$555.75
Rate for Payer: UnitedHealthcare Commercial	$567.45
Rate for Payer: WPPA Commercial	$491.40

INJ SNGL TENDON SHEATH/LIGAMNT

Facility

$267.00

Service Code	HCPCS 20550
Hospital Charge Code	2055000
Hospital Revenue Code	761
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

INJ SNGL TENDON SHEATH/LIGAMNT

Facility

$267.00

Service Code	HCPCS 20550
Hospital Charge Code	2055000
Hospital Revenue Code	761
Min. Negotiated Rate	$123.35
Max. Negotiated Rate	$258.99
Rate for Payer: Celtic Commercial/Exchange	$123.35
Rate for Payer: BCBS Commercial	$142.41
Rate for Payer: Cash Price	$200.25
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	$224.28

INSERTION FOLEY CATH

Facility

$199.00

Service Code	HCPCS 51702
Hospital Charge Code	5170200
Hospital Revenue Code	761
Min. Negotiated Rate	$91.94
Max. Negotiated Rate	$193.03
Rate for Payer: BCBS Commercial	$144.89
Rate for Payer: Cash Price	$149.25
Rate for Payer: Cash Price	$149.25
Rate for Payer: Celtic Commercial/Exchange	$91.94
Rate for Payer: Health Partners Plans Commercial	$189.05
Rate for Payer: UnitedHealthcare Commercial	$193.03
Rate for Payer: WPPA Commercial	$167.16

INSERTION FOLEY CATH

Facility

$199.00

Service Code	HCPCS 51702
Hospital Charge Code	5170200
Hospital Revenue Code	761
Min. Negotiated Rate	$163.18
Max. Negotiated Rate	$193.03
Rate for Payer: Cash Price	$149.25
Rate for Payer: Health Partners Plans Commercial	$189.05
Rate for Payer: UnitedHealthcare Commercial	$193.03
Rate for Payer: WPPA Commercial	$163.18

Insertion of IUD

Facility

$456.00

Service Code	HCPCS 58300
Hospital Charge Code	5830000
Hospital Revenue Code	761
Min. Negotiated Rate	$133.52
Max. Negotiated Rate	$442.32
Rate for Payer: BCBS Commercial	$133.52
Rate for Payer: Cash Price	$342.00
Rate for Payer: Cash Price	$342.00
Rate for Payer: Celtic Commercial/Exchange	$210.67
Rate for Payer: Health Partners Plans Commercial	$433.20
Rate for Payer: UnitedHealthcare Commercial	$442.32
Rate for Payer: WPPA Commercial	$383.04

Insertion of IUD

Facility

$456.00

Service Code	HCPCS 58300
Hospital Charge Code	5830000
Hospital Revenue Code	761
Min. Negotiated Rate	$373.92
Max. Negotiated Rate	$442.32
Rate for Payer: Cash Price	$342.00
Rate for Payer: Health Partners Plans Commercial	$433.20
Rate for Payer: UnitedHealthcare Commercial	$442.32
Rate for Payer: WPPA Commercial	$373.92

INSERTION PICC W/IMAGE S&I

Facility

$2,232.00

Service Code	HCPCS 36584
Hospital Charge Code	3658400
Hospital Revenue Code	761
Min. Negotiated Rate	$1,031.18
Max. Negotiated Rate	$2,165.04
Rate for Payer: BCBS Commercial	$1,440.26
Rate for Payer: Cash Price	$1,674.00
Rate for Payer: Cash Price	$1,674.00
Rate for Payer: Celtic Commercial/Exchange	$1,031.18
Rate for Payer: Health Partners Plans Commercial	$2,120.40
Rate for Payer: UnitedHealthcare Commercial	$2,165.04
Rate for Payer: WPPA Commercial	$1,874.88

INSERTION PICC W/IMAGE S&I

Facility

$2,232.00

Service Code	HCPCS 36584
Hospital Charge Code	3658400
Hospital Revenue Code	761
Min. Negotiated Rate	$1,830.24
Max. Negotiated Rate	$2,165.04
Rate for Payer: Cash Price	$1,674.00
Rate for Payer: Health Partners Plans Commercial	$2,120.40
Rate for Payer: UnitedHealthcare Commercial	$2,165.04
Rate for Payer: WPPA Commercial	$1,830.24

INSERTION PICC W/IMAGING <5YRS

Facility

$934.00

Service Code	HCPCS 36572
Hospital Charge Code	3657200
Hospital Revenue Code	761
Min. Negotiated Rate	$765.88
Max. Negotiated Rate	$905.98
Rate for Payer: Cash Price	$700.50
Rate for Payer: Health Partners Plans Commercial	$887.30
Rate for Payer: UnitedHealthcare Commercial	$905.98
Rate for Payer: WPPA Commercial	$765.88

INSERTION PICC W/IMAGING <5YRS

Facility

$934.00

Service Code	HCPCS 36572
Hospital Charge Code	3657200
Hospital Revenue Code	761
Min. Negotiated Rate	$431.51
Max. Negotiated Rate	$905.98
Rate for Payer: Cash Price	$700.50
Rate for Payer: Celtic Commercial/Exchange	$431.51
Rate for Payer: Health Partners Plans Commercial	$887.30
Rate for Payer: UnitedHealthcare Commercial	$905.98
Rate for Payer: WPPA Commercial	$784.56

INSERTION PICC W/IMAGING 5YRS+

Facility

$2,537.00

Service Code	HCPCS 36573
Hospital Charge Code	3657300
Hospital Revenue Code	761
Min. Negotiated Rate	$1,172.09
Max. Negotiated Rate	$2,460.89
Rate for Payer: BCBS Commercial	$1,941.80
Rate for Payer: Cash Price	$1,902.75
Rate for Payer: Cash Price	$1,902.75
Rate for Payer: Celtic Commercial/Exchange	$1,172.09
Rate for Payer: Health Partners Plans Commercial	$2,410.15
Rate for Payer: UnitedHealthcare Commercial	$2,460.89
Rate for Payer: WPPA Commercial	$2,131.08

INSERTION PICC W/IMAGING 5YRS+

Facility

$2,537.00

Service Code	HCPCS 36573
Hospital Charge Code	3657300
Hospital Revenue Code	761
Min. Negotiated Rate	$2,080.34
Max. Negotiated Rate	$2,460.89
Rate for Payer: Cash Price	$1,902.75
Rate for Payer: Health Partners Plans Commercial	$2,410.15
Rate for Payer: UnitedHealthcare Commercial	$2,460.89
Rate for Payer: WPPA Commercial	$2,080.34

INSERT NON-INDWELL BLADER CATH

Facility

$145.00

Service Code	HCPCS 51701
Hospital Charge Code	5170100
Hospital Revenue Code	761
Min. Negotiated Rate	$118.90
Max. Negotiated Rate	$140.65
Rate for Payer: Cash Price	$108.75
Rate for Payer: Health Partners Plans Commercial	$137.75
Rate for Payer: UnitedHealthcare Commercial	$140.65
Rate for Payer: WPPA Commercial	$118.90

INSERT NON-INDWELL BLADER CATH

Facility

$145.00

Service Code	HCPCS 51701
Hospital Charge Code	5170100
Hospital Revenue Code	761
Min. Negotiated Rate	$66.99
Max. Negotiated Rate	$144.89
Rate for Payer: BCBS Commercial	$144.89
Rate for Payer: Cash Price	$108.75
Rate for Payer: Cash Price	$108.75
Rate for Payer: Celtic Commercial/Exchange	$66.99
Rate for Payer: Health Partners Plans Commercial	$137.75
Rate for Payer: UnitedHealthcare Commercial	$140.65
Rate for Payer: WPPA Commercial	$121.80

INSERT NON-TUNNELED CENTRALLY

Facility

$2,924.00

Hospital Charge Code	3655600
Hospital Revenue Code	500
Min. Negotiated Rate	$1,350.89
Max. Negotiated Rate	$2,836.28
Rate for Payer: Cash Price	$2,193.00
Rate for Payer: Celtic Commercial/Exchange	$1,350.89
Rate for Payer: Health Partners Plans Commercial	$2,777.80
Rate for Payer: UnitedHealthcare Commercial	$2,836.28
Rate for Payer: WPPA Commercial	$2,456.16

INSERT NON-TUNNELED CENTRALLY

Facility

$2,924.00

Hospital Charge Code	3655600
Hospital Revenue Code	500
Min. Negotiated Rate	$2,397.68
Max. Negotiated Rate	$2,836.28
Rate for Payer: Cash Price	$2,193.00
Rate for Payer: Health Partners Plans Commercial	$2,777.80
Rate for Payer: UnitedHealthcare Commercial	$2,836.28
Rate for Payer: WPPA Commercial	$2,397.68

INSERT PICC CATH-<5YRS,W/O GUI

Facility

$1,488.00

Service Code	HCPCS 36568
Hospital Charge Code	3656800
Hospital Revenue Code	761
Min. Negotiated Rate	$687.46
Max. Negotiated Rate	$1,941.80
Rate for Payer: BCBS Commercial	$1,941.80
Rate for Payer: Cash Price	$1,116.00
Rate for Payer: Cash Price	$1,116.00
Rate for Payer: Celtic Commercial/Exchange	$687.46
Rate for Payer: Health Partners Plans Commercial	$1,413.60
Rate for Payer: UnitedHealthcare Commercial	$1,443.36
Rate for Payer: WPPA Commercial	$1,249.92

INSERT PICC CATH-<5YRS,W/O GUI

Facility

$1,488.00

Service Code	HCPCS 36568
Hospital Charge Code	3656800
Hospital Revenue Code	761
Min. Negotiated Rate	$1,220.16
Max. Negotiated Rate	$1,443.36
Rate for Payer: Cash Price	$1,116.00
Rate for Payer: Health Partners Plans Commercial	$1,413.60
Rate for Payer: UnitedHealthcare Commercial	$1,443.36
Rate for Payer: WPPA Commercial	$1,220.16

Know your out-of-pocket cost for care.

All Charges