Ness County Hospital

All Charges

Charge

Type

Setting

Price

OTHER VASCULAR PROCEDURES WITH CC

Facility

$24,327.58

Service Code	MSDRG 253
Min. Negotiated Rate	$24,327.58
Max. Negotiated Rate	$24,327.58
Rate for Payer: BCBS Commercial	$24,327.58

OTHER VASCULAR PROCEDURES WITH MCC

Facility

$31,241.59

Service Code	MSDRG 252
Min. Negotiated Rate	$31,241.59
Max. Negotiated Rate	$31,241.59
Rate for Payer: BCBS Commercial	$31,241.59

OTHER VASCULAR PROCEDURES WITHOUT CC/MCC

Facility

$16,936.53

Service Code	MSDRG 254
Min. Negotiated Rate	$16,936.53
Max. Negotiated Rate	$16,936.53
Rate for Payer: BCBS Commercial	$16,936.53

OTITIS MEDIA AND URI WITH MCC

Facility

$9,688.01

Service Code	MSDRG 152
Min. Negotiated Rate	$9,688.01
Max. Negotiated Rate	$9,688.01
Rate for Payer: BCBS Commercial	$9,688.01

OTITIS MEDIA AND URI WITHOUT MCC

Facility

$6,329.99

Service Code	MSDRG 153
Min. Negotiated Rate	$6,329.99
Max. Negotiated Rate	$6,329.99
Rate for Payer: BCBS Commercial	$6,329.99

OT TX BY OTA (AEGIS) EA 1/4 HR

Facility

$45.00

Service Code	HCPCS G0158
Hospital Charge Code	4309933
Hospital Revenue Code	431
Min. Negotiated Rate	$36.90
Max. Negotiated Rate	$43.65
Rate for Payer: Cash Price	$33.75
Rate for Payer: Health Partners Plans Commercial	$42.75
Rate for Payer: UnitedHealthcare Commercial	$43.65
Rate for Payer: WPPA Commercial	$36.90

OT TX BY OTA (AEGIS) EA 1/4 HR

Facility

$45.00

Service Code	HCPCS G0158
Hospital Charge Code	4309933
Hospital Revenue Code	431
Min. Negotiated Rate	$20.79
Max. Negotiated Rate	$43.65
Rate for Payer: Cash Price	$33.75
Rate for Payer: Celtic Commercial/Exchange	$20.79
Rate for Payer: Health Partners Plans Commercial	$42.75
Rate for Payer: UnitedHealthcare Commercial	$43.65
Rate for Payer: WPPA Commercial	$37.80

OT TX BY OT (AEGIS) EA 1/4 HR

Facility

$46.00

Service Code	HCPCS G0152
Hospital Charge Code	4309911
Hospital Revenue Code	431
Min. Negotiated Rate	$21.25
Max. Negotiated Rate	$44.62
Rate for Payer: Cash Price	$34.69
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

OT TX BY OT (AEGIS) EA 1/4 HR

Facility

$46.00

Service Code	HCPCS G0152
Hospital Charge Code	4309911
Hospital Revenue Code	431
Min. Negotiated Rate	$37.72
Max. Negotiated Rate	$44.62
Rate for Payer: Cash Price	$34.69
Rate for Payer: Health Partners Plans Commercial	$43.70
Rate for Payer: UnitedHealthcare Commercial	$44.62
Rate for Payer: WPPA Commercial	$37.72

OUTPATIENT CLASS 1-EST PATIENT

Facility

$122.00

Service Code	HCPCS 99211
Hospital Charge Code	4590088
Hospital Revenue Code	761
Min. Negotiated Rate	$100.04
Max. Negotiated Rate	$118.34
Rate for Payer: Cash Price	$91.50
Rate for Payer: Health Partners Plans Commercial	$115.90
Rate for Payer: UnitedHealthcare Commercial	$118.34
Rate for Payer: WPPA Commercial	$100.04

OUTPATIENT CLASS 1-EST PATIENT

Facility

$122.00

Service Code	HCPCS 99211
Hospital Charge Code	4590088
Hospital Revenue Code	761
Min. Negotiated Rate	$42.50
Max. Negotiated Rate	$118.34
Rate for Payer: BCBS Commercial	$42.50
Rate for Payer: Cash Price	$91.50
Rate for Payer: Cash Price	$91.50
Rate for Payer: Celtic Commercial/Exchange	$56.36
Rate for Payer: Health Partners Plans Commercial	$115.90
Rate for Payer: UnitedHealthcare Commercial	$118.34
Rate for Payer: WPPA Commercial	$102.48

OUTPATIENT CLASS 1-NEW PATIENT

Facility

$80.00

Service Code	HCPCS 99070
Hospital Charge Code	4590048
Hospital Revenue Code	761
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

OUTPATIENT CLASS 1-NEW PATIENT

Facility

$80.00

Service Code	HCPCS 99070
Hospital Charge Code	4590048
Hospital Revenue Code	761
Min. Negotiated Rate	$36.96
Max. Negotiated Rate	$77.60
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

OUTPATIENT CLASS 2-EST PATIENT

Facility

$90.00

Service Code	HCPCS 99070
Hospital Charge Code	4590066
Hospital Revenue Code	761
Min. Negotiated Rate	$73.80
Max. Negotiated Rate	$87.30
Rate for Payer: Cash Price	$67.50
Rate for Payer: Health Partners Plans Commercial	$85.50
Rate for Payer: UnitedHealthcare Commercial	$87.30
Rate for Payer: WPPA Commercial	$73.80

OUTPATIENT CLASS 2-EST PATIENT

Facility

$90.00

Service Code	HCPCS 99070
Hospital Charge Code	4590066
Hospital Revenue Code	761
Min. Negotiated Rate	$41.58
Max. Negotiated Rate	$87.30
Rate for Payer: Cash Price	$67.50
Rate for Payer: Celtic Commercial/Exchange	$41.58
Rate for Payer: Health Partners Plans Commercial	$85.50
Rate for Payer: UnitedHealthcare Commercial	$87.30
Rate for Payer: WPPA Commercial	$75.60

OVAL EYE PAD

Facility

$9.00

Hospital Charge Code	2720761
Hospital Revenue Code	272
Min. Negotiated Rate	$7.38
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$6.75
Rate for Payer: Health Partners Plans Commercial	$8.55
Rate for Payer: UnitedHealthcare Commercial	$8.73
Rate for Payer: WPPA Commercial	$7.38

OVAL EYE PAD

Facility

$9.00

Hospital Charge Code	2720761
Hospital Revenue Code	272
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$6.75
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

OVA & PARASITES, DIRECT SMEARS

Facility

$97.00

Service Code	HCPCS 87177
Hospital Charge Code	8717700
Hospital Revenue Code	306
Min. Negotiated Rate	$79.54
Max. Negotiated Rate	$94.09
Rate for Payer: Cash Price	$72.75
Rate for Payer: Health Partners Plans Commercial	$92.15
Rate for Payer: UnitedHealthcare Commercial	$94.09
Rate for Payer: WPPA Commercial	$79.54

OVA & PARASITES, DIRECT SMEARS

Facility

$97.00

Service Code	HCPCS 87177
Hospital Charge Code	8717700
Hospital Revenue Code	306
Min. Negotiated Rate	$31.41
Max. Negotiated Rate	$94.09
Rate for Payer: BCBS Commercial	$31.41
Rate for Payer: Cash Price	$72.75
Rate for Payer: Cash Price	$72.75
Rate for Payer: Celtic Commercial/Exchange	$44.81
Rate for Payer: Health Partners Plans Commercial	$92.15
Rate for Payer: UnitedHealthcare Commercial	$94.09
Rate for Payer: WPPA Commercial	$81.48

OVER 30.0CM SUPERFICIAL WOUNDS

Facility

$269.00

Service Code	HCPCS 12018
Hospital Charge Code	1201800
Hospital Revenue Code	450
Min. Negotiated Rate	$220.58
Max. Negotiated Rate	$260.93
Rate for Payer: Cash Price	$201.75
Rate for Payer: Health Partners Plans Commercial	$255.55
Rate for Payer: UnitedHealthcare Commercial	$260.93
Rate for Payer: WPPA Commercial	$220.58

OVER 30.0CM SUPERFICIAL WOUNDS

Facility

$269.00

Service Code	HCPCS 12018
Hospital Charge Code	1201800
Hospital Revenue Code	450
Min. Negotiated Rate	$124.28
Max. Negotiated Rate	$1,538.23
Rate for Payer: BCBS Commercial	$1,538.23
Rate for Payer: Cash Price	$201.75
Rate for Payer: Cash Price	$201.75
Rate for Payer: Celtic Commercial/Exchange	$124.28
Rate for Payer: Health Partners Plans Commercial	$255.55
Rate for Payer: UnitedHealthcare Commercial	$260.93
Rate for Payer: WPPA Commercial	$225.96

oxacillin (oxacillin) inj recon soln

Facility

$405.00

Service Code	NDC 25021014610
Hospital Charge Code	2512424
Hospital Revenue Code	250
Min. Negotiated Rate	$332.10
Max. Negotiated Rate	$392.85
Rate for Payer: Cash Price	$303.75
Rate for Payer: Health Partners Plans Commercial	$384.75
Rate for Payer: UnitedHealthcare Commercial	$392.85
Rate for Payer: WPPA Commercial	$332.10

oxacillin (oxacillin) inj recon soln

Facility

$405.00

Service Code	NDC 25021014610
Hospital Charge Code	2512424
Hospital Revenue Code	250
Min. Negotiated Rate	$187.11
Max. Negotiated Rate	$392.85
Rate for Payer: Cash Price	$303.75
Rate for Payer: Celtic Commercial/Exchange	$187.11
Rate for Payer: Health Partners Plans Commercial	$384.75
Rate for Payer: UnitedHealthcare Commercial	$392.85
Rate for Payer: WPPA Commercial	$340.20

OXALATE

Facility

$110.00

Service Code	HCPCS 83945
Hospital Charge Code	8394500
Hospital Revenue Code	301
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

OXALATE

Facility

$110.00

Service Code	HCPCS 83945
Hospital Charge Code	8394500
Hospital Revenue Code	301
Min. Negotiated Rate	$48.36
Max. Negotiated Rate	$106.70
Rate for Payer: BCBS Commercial	$48.36
Rate for Payer: Cash Price	$82.50
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

Know your out-of-pocket cost for care.

All Charges