Ness County Hospital

All Charges

Charge

Type

Setting

Price

OB PACK

Facility

$49.00

Hospital Charge Code	2709757
Hospital Revenue Code	270
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

OBSTETRIC PANEL

Facility

$125.00

Service Code	HCPCS 80055
Hospital Charge Code	8005500
Hospital Revenue Code	301
Min. Negotiated Rate	$57.75
Max. Negotiated Rate	$121.25
Rate for Payer: BCBS Commercial	$89.39
Rate for Payer: Cash Price	$93.75
Rate for Payer: Cash Price	$93.75
Rate for Payer: Celtic Commercial/Exchange	$57.75
Rate for Payer: Health Partners Plans Commercial	$118.75
Rate for Payer: UnitedHealthcare Commercial	$121.25
Rate for Payer: WPPA Commercial	$105.00

OBSTETRIC PANEL

Facility

$125.00

Service Code	HCPCS 80055
Hospital Charge Code	8005500
Hospital Revenue Code	301
Min. Negotiated Rate	$102.50
Max. Negotiated Rate	$121.25
Rate for Payer: Cash Price	$93.75
Rate for Payer: Health Partners Plans Commercial	$118.75
Rate for Payer: UnitedHealthcare Commercial	$121.25
Rate for Payer: WPPA Commercial	$102.50

OCCUPATIONAL THER. EVAL-HIGH

Facility

$375.00

Service Code	HCPCS 97167 GO
Hospital Charge Code	9716700
Hospital Revenue Code	430
Min. Negotiated Rate	$117.24
Max. Negotiated Rate	$363.75
Rate for Payer: BCBS Commercial	$117.24
Rate for Payer: Cash Price	$281.25
Rate for Payer: Cash Price	$281.25
Rate for Payer: Celtic Commercial/Exchange	$173.25
Rate for Payer: Health Partners Plans Commercial	$356.25
Rate for Payer: UnitedHealthcare Commercial	$363.75
Rate for Payer: WPPA Commercial	$315.00

OCCUPATIONAL THER. EVAL-HIGH

Facility

$375.00

Service Code	HCPCS 97167 GO
Hospital Charge Code	9716700
Hospital Revenue Code	430
Min. Negotiated Rate	$307.50
Max. Negotiated Rate	$363.75
Rate for Payer: Cash Price	$281.25
Rate for Payer: Health Partners Plans Commercial	$356.25
Rate for Payer: UnitedHealthcare Commercial	$363.75
Rate for Payer: WPPA Commercial	$307.50

OCCUPATIONAL THER EVAL-LOW

Facility

$213.00

Service Code	HCPCS 97165 GO
Hospital Charge Code	9716500
Hospital Revenue Code	434
Min. Negotiated Rate	$174.66
Max. Negotiated Rate	$206.61
Rate for Payer: Cash Price	$159.75
Rate for Payer: Health Partners Plans Commercial	$202.35
Rate for Payer: UnitedHealthcare Commercial	$206.61
Rate for Payer: WPPA Commercial	$174.66

OCCUPATIONAL THER EVAL-LOW

Facility

$213.00

Service Code	HCPCS 97165 GO
Hospital Charge Code	9716500
Hospital Revenue Code	434
Min. Negotiated Rate	$98.41
Max. Negotiated Rate	$206.61
Rate for Payer: BCBS Commercial	$117.24
Rate for Payer: Cash Price	$159.75
Rate for Payer: Cash Price	$159.75
Rate for Payer: Celtic Commercial/Exchange	$98.41
Rate for Payer: Health Partners Plans Commercial	$202.35
Rate for Payer: UnitedHealthcare Commercial	$206.61
Rate for Payer: WPPA Commercial	$178.92

OCCUPATIONAL THER EVAL-MODERAT

Facility

$300.00

Service Code	HCPCS 97166 GO
Hospital Charge Code	9716600
Hospital Revenue Code	434
Min. Negotiated Rate	$246.00
Max. Negotiated Rate	$291.00
Rate for Payer: Cash Price	$225.00
Rate for Payer: Health Partners Plans Commercial	$285.00
Rate for Payer: UnitedHealthcare Commercial	$291.00
Rate for Payer: WPPA Commercial	$246.00

OCCUPATIONAL THER EVAL-MODERAT

Facility

$300.00

Service Code	HCPCS 97166 GO
Hospital Charge Code	9716600
Hospital Revenue Code	434
Min. Negotiated Rate	$117.24
Max. Negotiated Rate	$291.00
Rate for Payer: BCBS Commercial	$117.24
Rate for Payer: Cash Price	$225.00
Rate for Payer: Cash Price	$225.00
Rate for Payer: Celtic Commercial/Exchange	$138.60
Rate for Payer: Health Partners Plans Commercial	$285.00
Rate for Payer: UnitedHealthcare Commercial	$291.00
Rate for Payer: WPPA Commercial	$252.00

OCCUPATIONAL THER PARAFFIN WAX

Facility

$51.00

Service Code	HCPCS 97018 GO
Hospital Charge Code	9701800
Hospital Revenue Code	430
Min. Negotiated Rate	$23.23
Max. Negotiated Rate	$49.47
Rate for Payer: BCBS Commercial	$23.23
Rate for Payer: Cash Price	$38.25
Rate for Payer: Cash Price	$38.25
Rate for Payer: Celtic Commercial/Exchange	$23.56
Rate for Payer: Health Partners Plans Commercial	$48.45
Rate for Payer: UnitedHealthcare Commercial	$49.47
Rate for Payer: WPPA Commercial	$42.84

OCCUPATIONAL THER PARAFFIN WAX

Facility

$51.00

Service Code	HCPCS 97018 GO
Hospital Charge Code	9701800
Hospital Revenue Code	430
Min. Negotiated Rate	$41.82
Max. Negotiated Rate	$49.47
Rate for Payer: Cash Price	$38.25
Rate for Payer: Health Partners Plans Commercial	$48.45
Rate for Payer: UnitedHealthcare Commercial	$49.47
Rate for Payer: WPPA Commercial	$41.82

OCCUP THER BY ASSIST (AEGIS)

Facility

$180.00

Service Code	HCPCS G0158
Hospital Charge Code	4309966
Hospital Revenue Code	431
Min. Negotiated Rate	$147.60
Max. Negotiated Rate	$174.60
Rate for Payer: Cash Price	$135.00
Rate for Payer: Health Partners Plans Commercial	$171.00
Rate for Payer: UnitedHealthcare Commercial	$174.60
Rate for Payer: WPPA Commercial	$147.60

OCCUP THER BY ASSIST (AEGIS)

Facility

$180.00

Service Code	HCPCS G0158
Hospital Charge Code	4309966
Hospital Revenue Code	431
Min. Negotiated Rate	$83.16
Max. Negotiated Rate	$174.60
Rate for Payer: Cash Price	$135.00
Rate for Payer: Celtic Commercial/Exchange	$83.16
Rate for Payer: Health Partners Plans Commercial	$171.00
Rate for Payer: UnitedHealthcare Commercial	$174.60
Rate for Payer: WPPA Commercial	$151.20

OCCUP THER EVAL (AEGIS)

Facility

$212.00

Service Code	HCPCS G0152
Hospital Charge Code	4309988
Hospital Revenue Code	431
Min. Negotiated Rate	$97.94
Max. Negotiated Rate	$205.64
Rate for Payer: Cash Price	$159.00
Rate for Payer: Celtic Commercial/Exchange	$97.94
Rate for Payer: Health Partners Plans Commercial	$201.40
Rate for Payer: UnitedHealthcare Commercial	$205.64
Rate for Payer: WPPA Commercial	$178.08

OCCUP THER EVAL (AEGIS)

Facility

$212.00

Service Code	HCPCS G0152
Hospital Charge Code	4309988
Hospital Revenue Code	431
Min. Negotiated Rate	$173.84
Max. Negotiated Rate	$205.64
Rate for Payer: Cash Price	$159.00
Rate for Payer: Health Partners Plans Commercial	$201.40
Rate for Payer: UnitedHealthcare Commercial	$205.64
Rate for Payer: WPPA Commercial	$173.84

OCCUP THER TX BY OT (AEGIS)

Facility

$199.00

Service Code	HCPCS G0152
Hospital Charge Code	4309977
Hospital Revenue Code	431
Min. Negotiated Rate	$91.94
Max. Negotiated Rate	$193.03
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

OCCUP THER TX BY OT (AEGIS)

Facility

$199.00

Service Code	HCPCS G0152
Hospital Charge Code	4309977
Hospital Revenue Code	431
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

OCEAN NASAL SPRAY (SALINE NASAL SPRAY)

Facility

$12.00

Service Code	NDC 24385032558
Hospital Charge Code	2508752
Hospital Revenue Code	250
Min. Negotiated Rate	$9.84
Max. Negotiated Rate	$11.64
Rate for Payer: Cash Price	$9.00
Rate for Payer: Health Partners Plans Commercial	$11.40
Rate for Payer: UnitedHealthcare Commercial	$11.64
Rate for Payer: WPPA Commercial	$9.84

OCEAN NASAL SPRAY (SALINE NASAL SPRAY)

Facility

$12.00

Service Code	NDC 24385032558
Hospital Charge Code	2508752
Hospital Revenue Code	250
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$11.64
Rate for Payer: Cash Price	$9.00
Rate for Payer: Celtic Commercial/Exchange	$5.54
Rate for Payer: Health Partners Plans Commercial	$11.40
Rate for Payer: UnitedHealthcare Commercial	$11.64
Rate for Payer: WPPA Commercial	$10.08

OCUVITE TAB (EYE VITAMIN + ANTIOXIDANTS)

Facility

$3.00

Service Code	NDC 87701040786
Hospital Charge Code	2517804
Hospital Revenue Code	250
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.78
Rate for Payer: Celtic Commercial/Exchange	$1.39
Rate for Payer: Health Partners Plans Commercial	$2.85
Rate for Payer: UnitedHealthcare Commercial	$2.91
Rate for Payer: WPPA Commercial	$2.52

OCUVITE TAB (EYE VITAMIN + ANTIOXIDANTS)

Facility

$3.00

Service Code	NDC 87701040786
Hospital Charge Code	2517804
Hospital Revenue Code	250
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.78
Rate for Payer: Health Partners Plans Commercial	$2.85
Rate for Payer: UnitedHealthcare Commercial	$2.91
Rate for Payer: WPPA Commercial	$2.46

OLUMIANT 1 MG TAB

Facility

$285.00

Hospital Charge Code	2510105
Hospital Revenue Code	250
Min. Negotiated Rate	$233.70
Max. Negotiated Rate	$276.45
Rate for Payer: Cash Price	$214.05
Rate for Payer: Health Partners Plans Commercial	$270.75
Rate for Payer: UnitedHealthcare Commercial	$276.45
Rate for Payer: WPPA Commercial	$233.70

OLUMIANT 1 MG TAB

Facility

$285.00

Hospital Charge Code	2510105
Hospital Revenue Code	250
Min. Negotiated Rate	$131.67
Max. Negotiated Rate	$276.45
Rate for Payer: Cash Price	$214.05
Rate for Payer: Celtic Commercial/Exchange	$131.67
Rate for Payer: Health Partners Plans Commercial	$270.75
Rate for Payer: UnitedHealthcare Commercial	$276.45
Rate for Payer: WPPA Commercial	$239.40

OLYMPUS NEEDLE MAJ-70

Facility

$226.00

Hospital Charge Code	2725473
Hospital Revenue Code	272
Min. Negotiated Rate	$185.32
Max. Negotiated Rate	$219.22
Rate for Payer: Cash Price	$169.50
Rate for Payer: Health Partners Plans Commercial	$214.70
Rate for Payer: UnitedHealthcare Commercial	$219.22
Rate for Payer: WPPA Commercial	$185.32

OLYMPUS NEEDLE MAJ-70

Facility

$226.00

Hospital Charge Code	2725473
Hospital Revenue Code	272
Min. Negotiated Rate	$104.41
Max. Negotiated Rate	$219.22
Rate for Payer: Cash Price	$169.50
Rate for Payer: Celtic Commercial/Exchange	$104.41
Rate for Payer: Health Partners Plans Commercial	$214.70
Rate for Payer: UnitedHealthcare Commercial	$219.22
Rate for Payer: WPPA Commercial	$189.84

Know your out-of-pocket cost for care.

All Charges