Ness County Hospital

All Charges

Charge

Type

Setting

Price

Prof Fee Wnd Clinic-Chemical cauterization of granulation tissue

Facility

$75.00

Service Code	HCPCS 17250
Hospital Charge Code	17250WC
Hospital Revenue Code	983
Min. Negotiated Rate	$34.65
Max. Negotiated Rate	$388.85
Rate for Payer: BCBS Commercial	$388.85
Rate for Payer: Cash Price	$56.25
Rate for Payer: Cash Price	$56.25
Rate for Payer: Celtic Commercial/Exchange	$34.65
Rate for Payer: Health Partners Plans Commercial	$71.25
Rate for Payer: UnitedHealthcare Commercial	$72.75
Rate for Payer: WPPA Commercial	$63.00

PROF FEE WND CLIN-NEW PATIENT E&M

Facility

$175.00

Service Code	HCPCS 99202 GF
Hospital Charge Code	99202WC
Hospital Revenue Code	983
Min. Negotiated Rate	$67.67
Max. Negotiated Rate	$169.75
Rate for Payer: BCBS Commercial	$67.67
Rate for Payer: Cash Price	$131.25
Rate for Payer: Cash Price	$131.25
Rate for Payer: Celtic Commercial/Exchange	$80.85
Rate for Payer: Health Partners Plans Commercial	$166.25
Rate for Payer: UnitedHealthcare Commercial	$169.75
Rate for Payer: WPPA Commercial	$147.00

PROF FEE WND CLIN-NEW PATIENT E&M

Facility

$175.00

Service Code	HCPCS 99202 GF
Hospital Charge Code	99202WC
Hospital Revenue Code	983
Min. Negotiated Rate	$143.50
Max. Negotiated Rate	$169.75
Rate for Payer: Cash Price	$131.25
Rate for Payer: Health Partners Plans Commercial	$166.25
Rate for Payer: UnitedHealthcare Commercial	$169.75
Rate for Payer: WPPA Commercial	$143.50

PROF-I & D ABSCESS SIMPLE/SINGLE

Facility

$180.00

Service Code	HCPCS 10060 GF
Hospital Charge Code	10060WC
Hospital Revenue Code	983
Min. Negotiated Rate	$83.16
Max. Negotiated Rate	$248.38
Rate for Payer: BCBS Commercial	$248.38
Rate for Payer: Cash Price	$135.00
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

PROF-I & D ABSCESS SIMPLE/SINGLE

Facility

$180.00

Service Code	HCPCS 10060 GF
Hospital Charge Code	10060WC
Hospital Revenue Code	983
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

Prof-Incisional Biopsy of skin, 1st lesion

Facility

$180.00

Service Code	HCPCS 11106
Hospital Charge Code	11106WC
Hospital Revenue Code	983
Min. Negotiated Rate	$83.16
Max. Negotiated Rate	$639.33
Rate for Payer: BCBS Commercial	$639.33
Rate for Payer: Cash Price	$135.00
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

Prof-Incisional Biopsy of skin, 1st lesion

Facility

$180.00

Service Code	HCPCS 11106
Hospital Charge Code	11106WC
Hospital Revenue Code	983
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

Prof-Incisional Biopsy of Skin, additional lesions

Facility

$120.00

Service Code	HCPCS 11107
Hospital Charge Code	11107WC
Hospital Revenue Code	983
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

Prof-Incisional Biopsy of Skin, additional lesions

Facility

$120.00

Service Code	HCPCS 11107
Hospital Charge Code	11107WC
Hospital Revenue Code	983
Min. Negotiated Rate	$55.44
Max. Negotiated Rate	$639.33
Rate for Payer: BCBS Commercial	$639.33
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

PROF-INITIAL OBS E&M HIGH

Facility

$256.00

Service Code	HCPCS 99223 GF
Hospital Charge Code	9922300
Hospital Revenue Code	982
Min. Negotiated Rate	$118.27
Max. Negotiated Rate	$248.32
Rate for Payer: Cash Price	$192.00
Rate for Payer: Celtic Commercial/Exchange	$118.27
Rate for Payer: Health Partners Plans Commercial	$243.20
Rate for Payer: UnitedHealthcare Commercial	$248.32
Rate for Payer: WPPA Commercial	$215.04

PROF-INITIAL OBS E&M HIGH

Facility

$256.00

Service Code	HCPCS 99223 GF
Hospital Charge Code	9922300
Hospital Revenue Code	982
Min. Negotiated Rate	$209.92
Max. Negotiated Rate	$248.32
Rate for Payer: Cash Price	$192.00
Rate for Payer: Health Partners Plans Commercial	$243.20
Rate for Payer: UnitedHealthcare Commercial	$248.32
Rate for Payer: WPPA Commercial	$209.92

PROF-INITIAL OBS E&M-LOW

Facility

$150.00

Service Code	HCPCS 99221
Hospital Charge Code	9922100
Hospital Revenue Code	982
Min. Negotiated Rate	$123.00
Max. Negotiated Rate	$145.50
Rate for Payer: Cash Price	$112.50
Rate for Payer: Health Partners Plans Commercial	$142.50
Rate for Payer: UnitedHealthcare Commercial	$145.50
Rate for Payer: WPPA Commercial	$123.00

PROF-INITIAL OBS E&M-LOW

Facility

$150.00

Service Code	HCPCS 99221
Hospital Charge Code	9922100
Hospital Revenue Code	982
Min. Negotiated Rate	$69.30
Max. Negotiated Rate	$145.50
Rate for Payer: BCBS Commercial	$135.78
Rate for Payer: Cash Price	$112.50
Rate for Payer: Cash Price	$112.50
Rate for Payer: Celtic Commercial/Exchange	$69.30
Rate for Payer: Health Partners Plans Commercial	$142.50
Rate for Payer: UnitedHealthcare Commercial	$145.50
Rate for Payer: WPPA Commercial	$126.00

PROF-INITIAL OBS E&M MOD

Facility

$191.00

Service Code	HCPCS 99222 GF
Hospital Charge Code	9922200
Hospital Revenue Code	982
Min. Negotiated Rate	$156.62
Max. Negotiated Rate	$185.27
Rate for Payer: Cash Price	$143.25
Rate for Payer: Health Partners Plans Commercial	$181.45
Rate for Payer: UnitedHealthcare Commercial	$185.27
Rate for Payer: WPPA Commercial	$156.62

PROF-INITIAL OBS E&M MOD

Facility

$191.00

Service Code	HCPCS 99222 GF
Hospital Charge Code	9922200
Hospital Revenue Code	982
Min. Negotiated Rate	$88.24
Max. Negotiated Rate	$195.31
Rate for Payer: BCBS Commercial	$195.31
Rate for Payer: Cash Price	$143.25
Rate for Payer: Cash Price	$143.25
Rate for Payer: Celtic Commercial/Exchange	$88.24
Rate for Payer: Health Partners Plans Commercial	$181.45
Rate for Payer: UnitedHealthcare Commercial	$185.27
Rate for Payer: WPPA Commercial	$160.44

PROF LAYER CLOSURE 2.6-7.5 CM

Facility

$438.00

Service Code	HCPCS 12032
Hospital Charge Code	1203201
Hospital Revenue Code	981
Min. Negotiated Rate	$359.16
Max. Negotiated Rate	$424.86
Rate for Payer: Cash Price	$328.50
Rate for Payer: Health Partners Plans Commercial	$416.10
Rate for Payer: UnitedHealthcare Commercial	$424.86
Rate for Payer: WPPA Commercial	$359.16

PROF LAYER CLOSURE 2.6-7.5 CM

Facility

$438.00

Service Code	HCPCS 12032
Hospital Charge Code	1203201
Hospital Revenue Code	981
Min. Negotiated Rate	$202.36
Max. Negotiated Rate	$451.17
Rate for Payer: BCBS Commercial	$451.17
Rate for Payer: Cash Price	$328.50
Rate for Payer: Cash Price	$328.50
Rate for Payer: Celtic Commercial/Exchange	$202.36
Rate for Payer: Health Partners Plans Commercial	$416.10
Rate for Payer: UnitedHealthcare Commercial	$424.86
Rate for Payer: WPPA Commercial	$367.92

PROF LEVEL 4 FOLLOWUP VISIT

Facility

$135.00

Service Code	HCPCS 99214 GF
Hospital Charge Code	99214WC
Hospital Revenue Code	983
Min. Negotiated Rate	$110.70
Max. Negotiated Rate	$130.95
Rate for Payer: Cash Price	$101.25
Rate for Payer: Health Partners Plans Commercial	$128.25
Rate for Payer: UnitedHealthcare Commercial	$130.95
Rate for Payer: WPPA Commercial	$110.70

PROF LEVEL 4 FOLLOWUP VISIT

Facility

$135.00

Service Code	HCPCS 99214 GF
Hospital Charge Code	99214WC
Hospital Revenue Code	983
Min. Negotiated Rate	$62.37
Max. Negotiated Rate	$188.57
Rate for Payer: BCBS Commercial	$188.57
Rate for Payer: Cash Price	$101.25
Rate for Payer: Cash Price	$101.25
Rate for Payer: Celtic Commercial/Exchange	$62.37
Rate for Payer: Health Partners Plans Commercial	$128.25
Rate for Payer: UnitedHealthcare Commercial	$130.95
Rate for Payer: WPPA Commercial	$113.40

PROF OBSERVATION DISCHG

Facility

$118.00

Service Code	HCPCS 99238 GF
Hospital Charge Code	9810094
Hospital Revenue Code	982
Min. Negotiated Rate	$54.52
Max. Negotiated Rate	$114.46
Rate for Payer: BCBS Commercial	$106.95
Rate for Payer: Cash Price	$88.50
Rate for Payer: Cash Price	$88.50
Rate for Payer: Celtic Commercial/Exchange	$54.52
Rate for Payer: Health Partners Plans Commercial	$112.10
Rate for Payer: UnitedHealthcare Commercial	$114.46
Rate for Payer: WPPA Commercial	$99.12

PROF OBSERVATION DISCHG

Facility

$118.00

Service Code	HCPCS 99238 GF
Hospital Charge Code	9810094
Hospital Revenue Code	982
Min. Negotiated Rate	$96.76
Max. Negotiated Rate	$114.46
Rate for Payer: Cash Price	$88.50
Rate for Payer: Health Partners Plans Commercial	$112.10
Rate for Payer: UnitedHealthcare Commercial	$114.46
Rate for Payer: WPPA Commercial	$96.76

PROF OP E&M EST PT-LOW COMPLEX

Facility

$90.00

Service Code	HCPCS 99213 GF
Hospital Charge Code	99213WC
Hospital Revenue Code	983
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

PROF OP E&M EST PT-LOW COMPLEX

Facility

$90.00

Service Code	HCPCS 99213 GF
Hospital Charge Code	99213WC
Hospital Revenue Code	983
Min. Negotiated Rate	$41.58
Max. Negotiated Rate	$133.49
Rate for Payer: BCBS Commercial	$133.49
Rate for Payer: Cash Price	$67.50
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

PROF OP E&M EST PT-MINOR

Facility

$75.00

Service Code	HCPCS 99212 GF
Hospital Charge Code	99212WC
Hospital Revenue Code	983
Min. Negotiated Rate	$61.50
Max. Negotiated Rate	$72.75
Rate for Payer: Cash Price	$56.25
Rate for Payer: Health Partners Plans Commercial	$71.25
Rate for Payer: UnitedHealthcare Commercial	$72.75
Rate for Payer: WPPA Commercial	$61.50

PROF OP E&M EST PT-MINOR

Facility

$75.00

Service Code	HCPCS 99212 GF
Hospital Charge Code	99212WC
Hospital Revenue Code	983
Min. Negotiated Rate	$34.65
Max. Negotiated Rate	$85.38
Rate for Payer: BCBS Commercial	$85.38
Rate for Payer: Cash Price	$56.25
Rate for Payer: Cash Price	$56.25
Rate for Payer: Celtic Commercial/Exchange	$34.65
Rate for Payer: Health Partners Plans Commercial	$71.25
Rate for Payer: UnitedHealthcare Commercial	$72.75
Rate for Payer: WPPA Commercial	$63.00

Know your out-of-pocket cost for care.

All Charges