Ness County Hospital

All Charges

Charge

Type

Setting

Price

LEVEL 2 INTITAL VISIT

Facility

$120.00

Service Code	HCPCS 99202
Hospital Charge Code	9920223
Hospital Revenue Code	761
Min. Negotiated Rate	$98.40
Max. Negotiated Rate	$116.40
Rate for Payer: Cash Price	$90.00
Rate for Payer: Health Partners Plans Commercial	$114.00
Rate for Payer: UnitedHealthcare Commercial	$116.40
Rate for Payer: WPPA Commercial	$98.40

LEVEL 2 INTITAL VISIT

Facility

$120.00

Service Code	HCPCS 99202
Hospital Charge Code	9920223
Hospital Revenue Code	761
Min. Negotiated Rate	$55.44
Max. Negotiated Rate	$116.40
Rate for Payer: BCBS Commercial	$67.67
Rate for Payer: Cash Price	$90.00
Rate for Payer: Cash Price	$90.00
Rate for Payer: Celtic Commercial/Exchange	$55.44
Rate for Payer: Health Partners Plans Commercial	$114.00
Rate for Payer: UnitedHealthcare Commercial	$116.40
Rate for Payer: WPPA Commercial	$100.80

LEVEL 3 FOLLOW-UP VISIT

Facility

$178.00

Service Code	HCPCS 99213
Hospital Charge Code	9921323
Hospital Revenue Code	761
Min. Negotiated Rate	$145.96
Max. Negotiated Rate	$172.66
Rate for Payer: Cash Price	$133.50
Rate for Payer: Health Partners Plans Commercial	$169.10
Rate for Payer: UnitedHealthcare Commercial	$172.66
Rate for Payer: WPPA Commercial	$145.96

LEVEL 3 FOLLOW-UP VISIT

Facility

$178.00

Service Code	HCPCS 99213
Hospital Charge Code	9921323
Hospital Revenue Code	761
Min. Negotiated Rate	$82.24
Max. Negotiated Rate	$172.66
Rate for Payer: BCBS Commercial	$133.49
Rate for Payer: Cash Price	$133.50
Rate for Payer: Cash Price	$133.50
Rate for Payer: Celtic Commercial/Exchange	$82.24
Rate for Payer: Health Partners Plans Commercial	$169.10
Rate for Payer: UnitedHealthcare Commercial	$172.66
Rate for Payer: WPPA Commercial	$149.52

LEVEL 3 I&D DRAIN BURSA FOOT

Facility

$1,500.00

Service Code	HCPCS 28001
Hospital Charge Code	2800123
Hospital Revenue Code	761
Min. Negotiated Rate	$693.00
Max. Negotiated Rate	$1,455.00
Rate for Payer: BCBS Commercial	$1,454.40
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

LEVEL 3 I&D DRAIN BURSA FOOT

Facility

$1,500.00

Service Code	HCPCS 28001
Hospital Charge Code	2800123
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

LEVEL 3 INITIAL VISIT

Facility

$280.00

Service Code	HCPCS 99203
Hospital Charge Code	9920323
Hospital Revenue Code	761
Min. Negotiated Rate	$101.00
Max. Negotiated Rate	$271.60
Rate for Payer: BCBS Commercial	$101.00
Rate for Payer: Cash Price	$210.00
Rate for Payer: Cash Price	$210.00
Rate for Payer: Celtic Commercial/Exchange	$129.36
Rate for Payer: Health Partners Plans Commercial	$266.00
Rate for Payer: UnitedHealthcare Commercial	$271.60
Rate for Payer: WPPA Commercial	$235.20

LEVEL 3 INITIAL VISIT

Facility

$280.00

Service Code	HCPCS 99203
Hospital Charge Code	9920323
Hospital Revenue Code	761
Min. Negotiated Rate	$229.60
Max. Negotiated Rate	$271.60
Rate for Payer: Cash Price	$210.00
Rate for Payer: Health Partners Plans Commercial	$266.00
Rate for Payer: UnitedHealthcare Commercial	$271.60
Rate for Payer: WPPA Commercial	$229.60

LEVEL 4 FOLLOW-UP VISIT

Facility

$208.00

Service Code	HCPCS 99214
Hospital Charge Code	9921423
Hospital Revenue Code	761
Min. Negotiated Rate	$170.56
Max. Negotiated Rate	$201.76
Rate for Payer: Cash Price	$156.00
Rate for Payer: Health Partners Plans Commercial	$197.60
Rate for Payer: UnitedHealthcare Commercial	$201.76
Rate for Payer: WPPA Commercial	$170.56

LEVEL 4 FOLLOW-UP VISIT

Facility

$208.00

Service Code	HCPCS 99214
Hospital Charge Code	9921423
Hospital Revenue Code	761
Min. Negotiated Rate	$96.10
Max. Negotiated Rate	$201.76
Rate for Payer: BCBS Commercial	$188.57
Rate for Payer: Cash Price	$156.00
Rate for Payer: Cash Price	$156.00
Rate for Payer: Celtic Commercial/Exchange	$96.10
Rate for Payer: Health Partners Plans Commercial	$197.60
Rate for Payer: UnitedHealthcare Commercial	$201.76
Rate for Payer: WPPA Commercial	$174.72

LEVEL 4 INITIAL VISIT

Facility

$227.00

Service Code	HCPCS 99204
Hospital Charge Code	9920423
Hospital Revenue Code	761
Min. Negotiated Rate	$101.00
Max. Negotiated Rate	$220.19
Rate for Payer: BCBS Commercial	$101.00
Rate for Payer: Cash Price	$170.25
Rate for Payer: Cash Price	$170.25
Rate for Payer: Celtic Commercial/Exchange	$104.87
Rate for Payer: Health Partners Plans Commercial	$215.65
Rate for Payer: UnitedHealthcare Commercial	$220.19
Rate for Payer: WPPA Commercial	$190.68

LEVEL 4 INITIAL VISIT

Facility

$227.00

Service Code	HCPCS 99204
Hospital Charge Code	9920423
Hospital Revenue Code	761
Min. Negotiated Rate	$186.14
Max. Negotiated Rate	$220.19
Rate for Payer: Cash Price	$170.25
Rate for Payer: Health Partners Plans Commercial	$215.65
Rate for Payer: UnitedHealthcare Commercial	$220.19
Rate for Payer: WPPA Commercial	$186.14

LEVEL 5 FOLLOW-UP VISIT

Facility

$267.00

Service Code	HCPCS 99215
Hospital Charge Code	9921523
Hospital Revenue Code	761
Min. Negotiated Rate	$123.35
Max. Negotiated Rate	$266.24
Rate for Payer: BCBS Commercial	$266.24
Rate for Payer: Cash Price	$200.25
Rate for Payer: Cash Price	$200.25
Rate for Payer: Celtic Commercial/Exchange	$123.35
Rate for Payer: Health Partners Plans Commercial	$253.65
Rate for Payer: UnitedHealthcare Commercial	$258.99
Rate for Payer: WPPA Commercial	$224.28

LEVEL 5 FOLLOW-UP VISIT

Facility

$267.00

Service Code	HCPCS 99215
Hospital Charge Code	9921523
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

LEVEL 5 INITIAL VISIT

Facility

$225.00

Service Code	HCPCS 99205
Hospital Charge Code	9920523
Hospital Revenue Code	761
Min. Negotiated Rate	$103.95
Max. Negotiated Rate	$218.25
Rate for Payer: BCBS Commercial	$168.67
Rate for Payer: Cash Price	$168.75
Rate for Payer: Cash Price	$168.75
Rate for Payer: Celtic Commercial/Exchange	$103.95
Rate for Payer: Health Partners Plans Commercial	$213.75
Rate for Payer: UnitedHealthcare Commercial	$218.25
Rate for Payer: WPPA Commercial	$189.00

LEVEL 5 INITIAL VISIT

Facility

$225.00

Service Code	HCPCS 99205
Hospital Charge Code	9920523
Hospital Revenue Code	761
Min. Negotiated Rate	$184.50
Max. Negotiated Rate	$218.25
Rate for Payer: Cash Price	$168.75
Rate for Payer: Health Partners Plans Commercial	$213.75
Rate for Payer: UnitedHealthcare Commercial	$218.25
Rate for Payer: WPPA Commercial	$184.50

LEVEL III-SURG PATH, GROSS &

Facility

$140.00

Service Code	HCPCS 88304
Hospital Charge Code	8830400
Hospital Revenue Code	310
Min. Negotiated Rate	$64.68
Max. Negotiated Rate	$135.80
Rate for Payer: BCBS Commercial	$116.28
Rate for Payer: Cash Price	$105.00
Rate for Payer: Cash Price	$105.00
Rate for Payer: Celtic Commercial/Exchange	$64.68
Rate for Payer: Health Partners Plans Commercial	$133.00
Rate for Payer: UnitedHealthcare Commercial	$135.80
Rate for Payer: WPPA Commercial	$117.60

LEVEL III-SURG PATH, GROSS &

Facility

$140.00

Service Code	HCPCS 88304
Hospital Charge Code	8830400
Hospital Revenue Code	310
Min. Negotiated Rate	$114.80
Max. Negotiated Rate	$135.80
Rate for Payer: Cash Price	$105.00
Rate for Payer: Health Partners Plans Commercial	$133.00
Rate for Payer: UnitedHealthcare Commercial	$135.80
Rate for Payer: WPPA Commercial	$114.80

LEVEL II-SURG PATH, GROSS &

Facility

$105.00

Service Code	HCPCS 88302
Hospital Charge Code	8830200
Hospital Revenue Code	310
Min. Negotiated Rate	$86.10
Max. Negotiated Rate	$101.85
Rate for Payer: Cash Price	$78.75
Rate for Payer: Health Partners Plans Commercial	$99.75
Rate for Payer: UnitedHealthcare Commercial	$101.85
Rate for Payer: WPPA Commercial	$86.10

LEVEL II-SURG PATH, GROSS &

Facility

$105.00

Service Code	HCPCS 88302
Hospital Charge Code	8830200
Hospital Revenue Code	310
Min. Negotiated Rate	$48.51
Max. Negotiated Rate	$101.85
Rate for Payer: BCBS Commercial	$80.57
Rate for Payer: Cash Price	$78.75
Rate for Payer: Cash Price	$78.75
Rate for Payer: Celtic Commercial/Exchange	$48.51
Rate for Payer: Health Partners Plans Commercial	$99.75
Rate for Payer: UnitedHealthcare Commercial	$101.85
Rate for Payer: WPPA Commercial	$88.20

LEVEL I-SURG PATH,GROSS EXAM

Facility

$84.00

Service Code	HCPCS 88300
Hospital Charge Code	8830000
Hospital Revenue Code	310
Min. Negotiated Rate	$31.82
Max. Negotiated Rate	$81.48
Rate for Payer: BCBS Commercial	$31.82
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cash Price	$63.00
Rate for Payer: Celtic Commercial/Exchange	$38.81
Rate for Payer: Health Partners Plans Commercial	$79.80
Rate for Payer: UnitedHealthcare Commercial	$81.48
Rate for Payer: WPPA Commercial	$70.56

LEVEL I-SURG PATH,GROSS EXAM

Facility

$84.00

Service Code	HCPCS 88300
Hospital Charge Code	8830000
Hospital Revenue Code	310
Min. Negotiated Rate	$68.88
Max. Negotiated Rate	$81.48
Rate for Payer: Cash Price	$63.00
Rate for Payer: Health Partners Plans Commercial	$79.80
Rate for Payer: UnitedHealthcare Commercial	$81.48
Rate for Payer: WPPA Commercial	$68.88

LEVEL IV-SURG PATH, GROSS &

Facility

$302.00

Service Code	HCPCS 88305
Hospital Charge Code	8830500
Hospital Revenue Code	310
Min. Negotiated Rate	$247.64
Max. Negotiated Rate	$292.94
Rate for Payer: Cash Price	$226.50
Rate for Payer: Health Partners Plans Commercial	$286.90
Rate for Payer: UnitedHealthcare Commercial	$292.94
Rate for Payer: WPPA Commercial	$247.64

LEVEL IV-SURG PATH, GROSS &

Facility

$302.00

Service Code	HCPCS 88305
Hospital Charge Code	8830500
Hospital Revenue Code	310
Min. Negotiated Rate	$139.52
Max. Negotiated Rate	$292.94
Rate for Payer: BCBS Commercial	$195.61
Rate for Payer: Cash Price	$226.50
Rate for Payer: Cash Price	$226.50
Rate for Payer: Celtic Commercial/Exchange	$139.52
Rate for Payer: Health Partners Plans Commercial	$286.90
Rate for Payer: UnitedHealthcare Commercial	$292.94
Rate for Payer: WPPA Commercial	$253.68

LEVEL VI-SURG PATH, GROSS &

Facility

$777.00

Service Code	HCPCS 88309
Hospital Charge Code	8830900
Hospital Revenue Code	310
Min. Negotiated Rate	$358.97
Max. Negotiated Rate	$753.69
Rate for Payer: BCBS Commercial	$366.84
Rate for Payer: Cash Price	$582.75
Rate for Payer: Cash Price	$582.75
Rate for Payer: Celtic Commercial/Exchange	$358.97
Rate for Payer: Health Partners Plans Commercial	$738.15
Rate for Payer: UnitedHealthcare Commercial	$753.69
Rate for Payer: WPPA Commercial	$652.68

Know your out-of-pocket cost for care.

All Charges