Ness County Hospital

All Charges

Charge

Type

Setting

Price

Mirena 52mg (levonorgestrel) utrn intrauterine device

Facility

$4,627.00

Service Code	NDC 50419042301
Hospital Charge Code	2511541
Hospital Revenue Code	250
Min. Negotiated Rate	$2,137.67
Max. Negotiated Rate	$4,488.19
Rate for Payer: Cash Price	$3,470.37
Rate for Payer: Celtic Commercial/Exchange	$2,137.67
Rate for Payer: Health Partners Plans Commercial	$4,395.65
Rate for Payer: UnitedHealthcare Commercial	$4,488.19
Rate for Payer: WPPA Commercial	$3,886.68

MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC

Facility

$11,035.64

Service Code	MSDRG 640
Min. Negotiated Rate	$11,035.64
Max. Negotiated Rate	$11,035.64
Rate for Payer: BCBS Commercial	$11,035.64

MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC

Facility

$7,250.72

Service Code	MSDRG 641
Min. Negotiated Rate	$7,250.72
Max. Negotiated Rate	$7,250.72
Rate for Payer: BCBS Commercial	$7,250.72

MITOCHONDRIAL ANTIB W/REFLEX

Facility

$93.00

Service Code	HCPCS 86255
Hospital Charge Code	8625501
Hospital Revenue Code	302
Min. Negotiated Rate	$42.97
Max. Negotiated Rate	$90.21
Rate for Payer: BCBS Commercial	$49.98
Rate for Payer: Cash Price	$69.75
Rate for Payer: Cash Price	$69.75
Rate for Payer: Celtic Commercial/Exchange	$42.97
Rate for Payer: Health Partners Plans Commercial	$88.35
Rate for Payer: UnitedHealthcare Commercial	$90.21
Rate for Payer: WPPA Commercial	$78.12

MITOCHONDRIAL ANTIB W/REFLEX

Facility

$93.00

Service Code	HCPCS 86255
Hospital Charge Code	8625501
Hospital Revenue Code	302
Min. Negotiated Rate	$76.26
Max. Negotiated Rate	$90.21
Rate for Payer: Cash Price	$69.75
Rate for Payer: Health Partners Plans Commercial	$88.35
Rate for Payer: UnitedHealthcare Commercial	$90.21
Rate for Payer: WPPA Commercial	$76.26

MITOCHONDRIAL W/REFL OR TITER

Facility

$49.00

Service Code	HCPCS 86381
Hospital Charge Code	8638100
Hospital Revenue Code	302
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

MITOCHONDRIAL W/REFL OR TITER

Facility

$49.00

Service Code	HCPCS 86381
Hospital Charge Code	8638100
Hospital Revenue Code	302
Min. Negotiated Rate	$22.64
Max. Negotiated Rate	$47.72
Rate for Payer: BCBS Commercial	$47.72
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

MOBIC 7.5 MG TAB (MELOXICAM)

Facility

$9.00

Service Code	NDC 50268052511
Hospital Charge Code	2517043
Hospital Revenue Code	250
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$7.12
Rate for Payer: Celtic Commercial/Exchange	$4.16
Rate for Payer: Health Partners Plans Commercial	$8.55
Rate for Payer: UnitedHealthcare Commercial	$8.73
Rate for Payer: WPPA Commercial	$7.56

MOBIC 7.5 MG TAB (MELOXICAM)

Facility

$9.00

Service Code	NDC 50268052511
Hospital Charge Code	2517043
Hospital Revenue Code	250
Min. Negotiated Rate	$7.38
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$7.12
Rate for Payer: Health Partners Plans Commercial	$8.55
Rate for Payer: UnitedHealthcare Commercial	$8.73
Rate for Payer: WPPA Commercial	$7.38

Moderate conscious sedation, 1st 15 min, 5yrs of age & older, diff. prof than treating provider

Facility

$330.00

Service Code	HCPCS 99156
Hospital Charge Code	9915600
Hospital Revenue Code	450
Min. Negotiated Rate	$270.60
Max. Negotiated Rate	$320.10
Rate for Payer: Cash Price	$247.50
Rate for Payer: Health Partners Plans Commercial	$313.50
Rate for Payer: UnitedHealthcare Commercial	$320.10
Rate for Payer: WPPA Commercial	$270.60

Moderate conscious sedation, 1st 15 min, 5yrs of age & older, diff. prof than treating provider

Facility

$330.00

Service Code	HCPCS 99156
Hospital Charge Code	9915600
Hospital Revenue Code	450
Min. Negotiated Rate	$112.64
Max. Negotiated Rate	$320.10
Rate for Payer: BCBS Commercial	$112.64
Rate for Payer: Cash Price	$247.50
Rate for Payer: Cash Price	$247.50
Rate for Payer: Celtic Commercial/Exchange	$152.46
Rate for Payer: Health Partners Plans Commercial	$313.50
Rate for Payer: UnitedHealthcare Commercial	$320.10
Rate for Payer: WPPA Commercial	$277.20

Moderate sedation services, ea. addtl 15 min., diff prof than treating patient

Facility

$170.00

Service Code	HCPCS 99157
Hospital Charge Code	9915700
Hospital Revenue Code	450
Min. Negotiated Rate	$139.40
Max. Negotiated Rate	$164.90
Rate for Payer: Cash Price	$127.50
Rate for Payer: Health Partners Plans Commercial	$161.50
Rate for Payer: UnitedHealthcare Commercial	$164.90
Rate for Payer: WPPA Commercial	$139.40

Moderate sedation services, ea. addtl 15 min., diff prof than treating patient

Facility

$170.00

Service Code	HCPCS 99157
Hospital Charge Code	9915700
Hospital Revenue Code	450
Min. Negotiated Rate	$78.54
Max. Negotiated Rate	$164.90
Rate for Payer: BCBS Commercial	$87.23
Rate for Payer: Cash Price	$127.50
Rate for Payer: Cash Price	$127.50
Rate for Payer: Celtic Commercial/Exchange	$78.54
Rate for Payer: Health Partners Plans Commercial	$161.50
Rate for Payer: UnitedHealthcare Commercial	$164.90
Rate for Payer: WPPA Commercial	$142.80

MOD SEDATION <5YO 1ST 15MN

Facility

$290.00

Service Code	HCPCS 99151 25
Hospital Charge Code	9915100
Hospital Revenue Code	450
Min. Negotiated Rate	$34.84
Max. Negotiated Rate	$281.30
Rate for Payer: BCBS Commercial	$34.84
Rate for Payer: Cash Price	$217.50
Rate for Payer: Cash Price	$217.50
Rate for Payer: Celtic Commercial/Exchange	$133.98
Rate for Payer: Health Partners Plans Commercial	$275.50
Rate for Payer: UnitedHealthcare Commercial	$281.30
Rate for Payer: WPPA Commercial	$243.60

MOD SEDATION <5YO 1ST 15MN

Facility

$290.00

Service Code	HCPCS 99151 25
Hospital Charge Code	9915100
Hospital Revenue Code	450
Min. Negotiated Rate	$237.80
Max. Negotiated Rate	$281.30
Rate for Payer: Cash Price	$217.50
Rate for Payer: Health Partners Plans Commercial	$275.50
Rate for Payer: UnitedHealthcare Commercial	$281.30
Rate for Payer: WPPA Commercial	$237.80

MOD SEDATION =>5YO 1ST 15MN

Facility

$108.00

Service Code	HCPCS 99152 25
Hospital Charge Code	9915200
Hospital Revenue Code	450
Min. Negotiated Rate	$49.90
Max. Negotiated Rate	$104.76
Rate for Payer: BCBS Commercial	$72.02
Rate for Payer: Cash Price	$81.00
Rate for Payer: Cash Price	$81.00
Rate for Payer: Celtic Commercial/Exchange	$49.90
Rate for Payer: Health Partners Plans Commercial	$102.60
Rate for Payer: UnitedHealthcare Commercial	$104.76
Rate for Payer: WPPA Commercial	$90.72

MOD SEDATION =>5YO 1ST 15MN

Facility

$108.00

Service Code	HCPCS 99152 25
Hospital Charge Code	9915200
Hospital Revenue Code	450
Min. Negotiated Rate	$88.56
Max. Negotiated Rate	$104.76
Rate for Payer: Cash Price	$81.00
Rate for Payer: Health Partners Plans Commercial	$102.60
Rate for Payer: UnitedHealthcare Commercial	$104.76
Rate for Payer: WPPA Commercial	$88.56

MOD SEDATION BY PHYS, 2ND 15"

Facility

$138.00

Service Code	HCPCS 99153 25
Hospital Charge Code	9915300
Hospital Revenue Code	450
Min. Negotiated Rate	$15.23
Max. Negotiated Rate	$133.86
Rate for Payer: BCBS Commercial	$15.23
Rate for Payer: Cash Price	$103.50
Rate for Payer: Cash Price	$103.50
Rate for Payer: Celtic Commercial/Exchange	$63.76
Rate for Payer: Health Partners Plans Commercial	$131.10
Rate for Payer: UnitedHealthcare Commercial	$133.86
Rate for Payer: WPPA Commercial	$115.92

MOD SEDATION BY PHYS, 2ND 15"

Facility

$138.00

Service Code	HCPCS 99153 25
Hospital Charge Code	9915300
Hospital Revenue Code	450
Min. Negotiated Rate	$113.16
Max. Negotiated Rate	$133.86
Rate for Payer: Cash Price	$103.50
Rate for Payer: Health Partners Plans Commercial	$131.10
Rate for Payer: UnitedHealthcare Commercial	$133.86
Rate for Payer: WPPA Commercial	$113.16

MOLECULAR CYTOGENETICS;DNA PRB

Facility

$171.00

Service Code	HCPCS 88271
Hospital Charge Code	8827100
Hospital Revenue Code	300
Min. Negotiated Rate	$140.22
Max. Negotiated Rate	$165.87
Rate for Payer: Cash Price	$128.25
Rate for Payer: Health Partners Plans Commercial	$162.45
Rate for Payer: UnitedHealthcare Commercial	$165.87
Rate for Payer: WPPA Commercial	$140.22

MOLECULAR CYTOGENETICS;DNA PRB

Facility

$171.00

Service Code	HCPCS 88271
Hospital Charge Code	8827100
Hospital Revenue Code	300
Min. Negotiated Rate	$79.00
Max. Negotiated Rate	$165.87
Rate for Payer: BCBS Commercial	$147.53
Rate for Payer: Cash Price	$128.25
Rate for Payer: Cash Price	$128.25
Rate for Payer: Celtic Commercial/Exchange	$79.00
Rate for Payer: Health Partners Plans Commercial	$162.45
Rate for Payer: UnitedHealthcare Commercial	$165.87
Rate for Payer: WPPA Commercial	$143.64

MOLECULAR CYTOGENETICS;INTERPH

Facility

$171.00

Service Code	HCPCS 88275
Hospital Charge Code	8827500
Hospital Revenue Code	300
Min. Negotiated Rate	$140.22
Max. Negotiated Rate	$165.87
Rate for Payer: Cash Price	$128.25
Rate for Payer: Health Partners Plans Commercial	$162.45
Rate for Payer: UnitedHealthcare Commercial	$165.87
Rate for Payer: WPPA Commercial	$140.22

MOLECULAR CYTOGENETICS;INTERPH

Facility

$171.00

Service Code	HCPCS 88275
Hospital Charge Code	8827500
Hospital Revenue Code	300
Min. Negotiated Rate	$79.00
Max. Negotiated Rate	$165.87
Rate for Payer: BCBS Commercial	$147.53
Rate for Payer: Cash Price	$128.25
Rate for Payer: Cash Price	$128.25
Rate for Payer: Celtic Commercial/Exchange	$79.00
Rate for Payer: Health Partners Plans Commercial	$162.45
Rate for Payer: UnitedHealthcare Commercial	$165.87
Rate for Payer: WPPA Commercial	$143.64

Molecular Pathology Proc., Level 7

Facility

$244.00

Service Code	HCPCS 81406
Hospital Charge Code	8140600
Hospital Revenue Code	300
Min. Negotiated Rate	$200.08
Max. Negotiated Rate	$236.68
Rate for Payer: Cash Price	$183.00
Rate for Payer: Health Partners Plans Commercial	$231.80
Rate for Payer: UnitedHealthcare Commercial	$236.68
Rate for Payer: WPPA Commercial	$200.08

Molecular Pathology Proc., Level 7

Facility

$244.00

Service Code	HCPCS 81406
Hospital Charge Code	8140600
Hospital Revenue Code	300
Min. Negotiated Rate	$112.73
Max. Negotiated Rate	$236.68
Rate for Payer: BCBS Commercial	$194.12
Rate for Payer: Cash Price	$183.00
Rate for Payer: Cash Price	$183.00
Rate for Payer: Celtic Commercial/Exchange	$112.73
Rate for Payer: Health Partners Plans Commercial	$231.80
Rate for Payer: UnitedHealthcare Commercial	$236.68
Rate for Payer: WPPA Commercial	$204.96

Know your out-of-pocket cost for care.

All Charges