Ness County Hospital

All Charges

Charge

Type

Setting

Price

OMNICEF 125 MG/5 ML (CEFDINIR) OS 60 ML

Facility

$153.00

Service Code	NDC 00093413664
Hospital Charge Code	2509750
Hospital Revenue Code	250
Min. Negotiated Rate	$70.69
Max. Negotiated Rate	$148.41
Rate for Payer: Cash Price	$114.77
Rate for Payer: Celtic Commercial/Exchange	$70.69
Rate for Payer: Health Partners Plans Commercial	$145.35
Rate for Payer: UnitedHealthcare Commercial	$148.41
Rate for Payer: WPPA Commercial	$128.52

OMNICEF 125 MG/5 ML (CEFDINIR) OS 60 ML

Facility

$153.00

Service Code	NDC 00093413664
Hospital Charge Code	2509750
Hospital Revenue Code	250
Min. Negotiated Rate	$125.46
Max. Negotiated Rate	$148.41
Rate for Payer: Cash Price	$114.77
Rate for Payer: Health Partners Plans Commercial	$145.35
Rate for Payer: UnitedHealthcare Commercial	$148.41
Rate for Payer: WPPA Commercial	$125.46

OMNICEF 300 MG (CEFDINIR) CAP

Facility

$12.00

Service Code	NDC 60687069921
Hospital Charge Code	2510451
Hospital Revenue Code	250
Min. Negotiated Rate	$9.84
Max. Negotiated Rate	$11.64
Rate for Payer: Cash Price	$9.26
Rate for Payer: Health Partners Plans Commercial	$11.40
Rate for Payer: UnitedHealthcare Commercial	$11.64
Rate for Payer: WPPA Commercial	$9.84

OMNICEF 300 MG (CEFDINIR) CAP

Facility

$12.00

Service Code	NDC 60687069921
Hospital Charge Code	2510451
Hospital Revenue Code	250
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$11.64
Rate for Payer: Cash Price	$9.26
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

ONE STEP ELECTRODES-ADULT

Facility

$372.00

Hospital Charge Code	2704823
Hospital Revenue Code	270
Min. Negotiated Rate	$305.04
Max. Negotiated Rate	$360.84
Rate for Payer: Cash Price	$279.00
Rate for Payer: Health Partners Plans Commercial	$353.40
Rate for Payer: UnitedHealthcare Commercial	$360.84
Rate for Payer: WPPA Commercial	$305.04

ONE STEP ELECTRODES-ADULT

Facility

$372.00

Hospital Charge Code	2704823
Hospital Revenue Code	270
Min. Negotiated Rate	$171.86
Max. Negotiated Rate	$360.84
Rate for Payer: Cash Price	$279.00
Rate for Payer: Celtic Commercial/Exchange	$171.86
Rate for Payer: Health Partners Plans Commercial	$353.40
Rate for Payer: UnitedHealthcare Commercial	$360.84
Rate for Payer: WPPA Commercial	$312.48

ONE STEP ELECTRODES-PEDS

Facility

$224.00

Hospital Charge Code	2708966
Hospital Revenue Code	270
Min. Negotiated Rate	$103.49
Max. Negotiated Rate	$217.28
Rate for Payer: Cash Price	$168.30
Rate for Payer: Celtic Commercial/Exchange	$103.49
Rate for Payer: Health Partners Plans Commercial	$212.80
Rate for Payer: UnitedHealthcare Commercial	$217.28
Rate for Payer: WPPA Commercial	$188.16

ONE STEP ELECTRODES-PEDS

Facility

$224.00

Hospital Charge Code	2708966
Hospital Revenue Code	270
Min. Negotiated Rate	$183.68
Max. Negotiated Rate	$217.28
Rate for Payer: Cash Price	$168.30
Rate for Payer: Health Partners Plans Commercial	$212.80
Rate for Payer: UnitedHealthcare Commercial	$217.28
Rate for Payer: WPPA Commercial	$183.68

OP CLASS,EST,DETAIL EXAM,MOD

Facility

$189.00

Service Code	HCPCS 99214
Hospital Charge Code	4590681
Hospital Revenue Code	761
Min. Negotiated Rate	$154.98
Max. Negotiated Rate	$183.33
Rate for Payer: Cash Price	$141.75
Rate for Payer: Health Partners Plans Commercial	$179.55
Rate for Payer: UnitedHealthcare Commercial	$183.33
Rate for Payer: WPPA Commercial	$154.98

OP CLASS,EST,DETAIL EXAM,MOD

Facility

$189.00

Service Code	HCPCS 99214
Hospital Charge Code	4590681
Hospital Revenue Code	761
Min. Negotiated Rate	$87.32
Max. Negotiated Rate	$188.57
Rate for Payer: BCBS Commercial	$188.57
Rate for Payer: Cash Price	$141.75
Rate for Payer: Cash Price	$141.75
Rate for Payer: Celtic Commercial/Exchange	$87.32
Rate for Payer: Health Partners Plans Commercial	$179.55
Rate for Payer: UnitedHealthcare Commercial	$183.33
Rate for Payer: WPPA Commercial	$158.76

OP CLASS EST, EXP EXAM, LOW

Facility

$110.00

Service Code	HCPCS 99070
Hospital Charge Code	4590625
Hospital Revenue Code	761
Min. Negotiated Rate	$50.82
Max. Negotiated Rate	$106.70
Rate for Payer: Cash Price	$82.50
Rate for Payer: Celtic Commercial/Exchange	$50.82
Rate for Payer: Health Partners Plans Commercial	$104.50
Rate for Payer: UnitedHealthcare Commercial	$106.70
Rate for Payer: WPPA Commercial	$92.40

OP CLASS EST, EXP EXAM, LOW

Facility

$110.00

Service Code	HCPCS 99070
Hospital Charge Code	4590625
Hospital Revenue Code	761
Min. Negotiated Rate	$90.20
Max. Negotiated Rate	$106.70
Rate for Payer: Cash Price	$82.50
Rate for Payer: Health Partners Plans Commercial	$104.50
Rate for Payer: UnitedHealthcare Commercial	$106.70
Rate for Payer: WPPA Commercial	$90.20

OP CONSULT-EST PAT.-COMPREHENS

Facility

$125.00

Service Code	HCPCS 99214
Hospital Charge Code	4590028
Hospital Revenue Code	761
Min. Negotiated Rate	$57.75
Max. Negotiated Rate	$188.57
Rate for Payer: BCBS Commercial	$188.57
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

OP CONSULT-EST PAT.-COMPREHENS

Facility

$125.00

Service Code	HCPCS 99214
Hospital Charge Code	4590028
Hospital Revenue Code	761
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

OP CONSULT-EST PAT-DETAILED

Facility

$100.00

Service Code	HCPCS 99213
Hospital Charge Code	4590027
Hospital Revenue Code	761
Min. Negotiated Rate	$46.20
Max. Negotiated Rate	$133.49
Rate for Payer: BCBS Commercial	$133.49
Rate for Payer: Cash Price	$75.00
Rate for Payer: Cash Price	$75.00
Rate for Payer: Celtic Commercial/Exchange	$46.20
Rate for Payer: Health Partners Plans Commercial	$95.00
Rate for Payer: UnitedHealthcare Commercial	$97.00
Rate for Payer: WPPA Commercial	$84.00

OP CONSULT-EST PAT-DETAILED

Facility

$100.00

Service Code	HCPCS 99213
Hospital Charge Code	4590027
Hospital Revenue Code	761
Min. Negotiated Rate	$82.00
Max. Negotiated Rate	$97.00
Rate for Payer: Cash Price	$75.00
Rate for Payer: Health Partners Plans Commercial	$95.00
Rate for Payer: UnitedHealthcare Commercial	$97.00
Rate for Payer: WPPA Commercial	$82.00

OP CONSULT-EST PATIENT

Facility

$119.00

Service Code	HCPCS 99211
Hospital Charge Code	4590025
Hospital Revenue Code	761
Min. Negotiated Rate	$97.58
Max. Negotiated Rate	$115.43
Rate for Payer: Cash Price	$89.25
Rate for Payer: Health Partners Plans Commercial	$113.05
Rate for Payer: UnitedHealthcare Commercial	$115.43
Rate for Payer: WPPA Commercial	$97.58

OP CONSULT-EST PATIENT

Facility

$119.00

Service Code	HCPCS 99211
Hospital Charge Code	4590025
Hospital Revenue Code	761
Min. Negotiated Rate	$42.50
Max. Negotiated Rate	$115.43
Rate for Payer: BCBS Commercial	$42.50
Rate for Payer: Cash Price	$89.25
Rate for Payer: Cash Price	$89.25
Rate for Payer: Celtic Commercial/Exchange	$54.98
Rate for Payer: Health Partners Plans Commercial	$113.05
Rate for Payer: UnitedHealthcare Commercial	$115.43
Rate for Payer: WPPA Commercial	$99.96

OP CONSULT-NEW PAT.

Facility

$80.00

Service Code	HCPCS 99202
Hospital Charge Code	4590029
Hospital Revenue Code	510
Min. Negotiated Rate	$36.96
Max. Negotiated Rate	$77.60
Rate for Payer: BCBS Commercial	$67.67
Rate for Payer: Cash Price	$60.00
Rate for Payer: Cash Price	$60.00
Rate for Payer: Celtic Commercial/Exchange	$36.96
Rate for Payer: Health Partners Plans Commercial	$76.00
Rate for Payer: UnitedHealthcare Commercial	$77.60
Rate for Payer: WPPA Commercial	$67.20

OP CONSULT-NEW PAT.

Facility

$80.00

Service Code	HCPCS 99202
Hospital Charge Code	4590029
Hospital Revenue Code	510
Min. Negotiated Rate	$65.60
Max. Negotiated Rate	$77.60
Rate for Payer: Cash Price	$60.00
Rate for Payer: Health Partners Plans Commercial	$76.00
Rate for Payer: UnitedHealthcare Commercial	$77.60
Rate for Payer: WPPA Commercial	$65.60

OP CONSULT-NEW PAT.-EXPANDED

Facility

$85.00

Service Code	HCPCS 99070
Hospital Charge Code	4590031
Hospital Revenue Code	761
Min. Negotiated Rate	$69.70
Max. Negotiated Rate	$82.45
Rate for Payer: Cash Price	$63.75
Rate for Payer: Health Partners Plans Commercial	$80.75
Rate for Payer: UnitedHealthcare Commercial	$82.45
Rate for Payer: WPPA Commercial	$69.70

OP CONSULT-NEW PAT.-EXPANDED

Facility

$85.00

Service Code	HCPCS 99070
Hospital Charge Code	4590031
Hospital Revenue Code	761
Min. Negotiated Rate	$39.27
Max. Negotiated Rate	$82.45
Rate for Payer: Cash Price	$63.75
Rate for Payer: Celtic Commercial/Exchange	$39.27
Rate for Payer: Health Partners Plans Commercial	$80.75
Rate for Payer: UnitedHealthcare Commercial	$82.45
Rate for Payer: WPPA Commercial	$71.40

OPEN CHEST TUBE PLACEMENT,SUTU

Facility

$1,545.00

Service Code	HCPCS 32551
Hospital Charge Code	3255100
Hospital Revenue Code	450
Min. Negotiated Rate	$1,266.90
Max. Negotiated Rate	$1,498.65
Rate for Payer: Cash Price	$1,158.75
Rate for Payer: Health Partners Plans Commercial	$1,467.75
Rate for Payer: UnitedHealthcare Commercial	$1,498.65
Rate for Payer: WPPA Commercial	$1,266.90

OPEN CHEST TUBE PLACEMENT,SUTU

Facility

$1,545.00

Service Code	HCPCS 32551
Hospital Charge Code	3255100
Hospital Revenue Code	450
Min. Negotiated Rate	$713.79
Max. Negotiated Rate	$1,941.80
Rate for Payer: BCBS Commercial	$1,941.80
Rate for Payer: Cash Price	$1,158.75
Rate for Payer: Cash Price	$1,158.75
Rate for Payer: Celtic Commercial/Exchange	$713.79
Rate for Payer: Health Partners Plans Commercial	$1,467.75
Rate for Payer: UnitedHealthcare Commercial	$1,498.65
Rate for Payer: WPPA Commercial	$1,297.80

OPEN TX DIST PHALANG FX W/WO F

Facility

$4,300.00

Service Code	HCPCS 26765
Hospital Charge Code	2676500
Hospital Revenue Code	450
Min. Negotiated Rate	$1,986.60
Max. Negotiated Rate	$4,171.00
Rate for Payer: BCBS Commercial	$2,094.74
Rate for Payer: Cash Price	$3,225.00
Rate for Payer: Cash Price	$3,225.00
Rate for Payer: Celtic Commercial/Exchange	$1,986.60
Rate for Payer: Health Partners Plans Commercial	$4,085.00
Rate for Payer: UnitedHealthcare Commercial	$4,171.00
Rate for Payer: WPPA Commercial	$3,612.00

Know your out-of-pocket cost for care.

All Charges