Ness County Hospital

All Charges

Charge

Type

Setting

Price

PROF OP VISIT E&M, HIGH COMPLX

Facility

$175.00

Service Code	HCPCS 99215 GF
Hospital Charge Code	99215WC
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 OP VISIT E&M, HIGH COMPLX

Facility

$175.00

Service Code	HCPCS 99215 GF
Hospital Charge Code	99215WC
Hospital Revenue Code	983
Min. Negotiated Rate	$80.85
Max. Negotiated Rate	$266.24
Rate for Payer: BCBS Commercial	$266.24
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 OSB DISCHARGE-FACE TO FACE OVER 30 MIN

Facility

$125.00

Service Code	HCPCS 99239
Hospital Charge Code	9923900
Hospital Revenue Code	982
Min. Negotiated Rate	$57.75
Max. Negotiated Rate	$153.35
Rate for Payer: BCBS Commercial	$153.35
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

PROF OSB DISCHARGE-FACE TO FACE OVER 30 MIN

Facility

$125.00

Service Code	HCPCS 99239
Hospital Charge Code	9923900
Hospital Revenue Code	982
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

Prof. Prolonged IP/Obs Eval beyond initial, ea 15 min.

Facility

$150.00

Service Code	HCPCS 99418
Hospital Charge Code	9941800
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. Prolonged IP/Obs Eval beyond initial, ea 15 min.

Facility

$150.00

Service Code	HCPCS 99418
Hospital Charge Code	9941800
Hospital Revenue Code	982
Min. Negotiated Rate	$69.30
Max. Negotiated Rate	$145.50
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-PUNC ASPIR ABSCESS, CYST

Facility

$168.00

Service Code	HCPCS 10160
Hospital Charge Code	1016002
Hospital Revenue Code	981
Min. Negotiated Rate	$137.76
Max. Negotiated Rate	$162.96
Rate for Payer: Cash Price	$126.00
Rate for Payer: Health Partners Plans Commercial	$159.60
Rate for Payer: UnitedHealthcare Commercial	$162.96
Rate for Payer: WPPA Commercial	$137.76

PROF-PUNC ASPIR ABSCESS, CYST

Facility

$168.00

Service Code	HCPCS 10160
Hospital Charge Code	1016002
Hospital Revenue Code	981
Min. Negotiated Rate	$77.62
Max. Negotiated Rate	$947.38
Rate for Payer: BCBS Commercial	$947.38
Rate for Payer: Cash Price	$126.00
Rate for Payer: Cash Price	$126.00
Rate for Payer: Celtic Commercial/Exchange	$77.62
Rate for Payer: Health Partners Plans Commercial	$159.60
Rate for Payer: UnitedHealthcare Commercial	$162.96
Rate for Payer: WPPA Commercial	$141.12

PROF-SAME DAY ADMIT/DISCHG OBS -HIGH

Facility

$330.00

Service Code	HCPCS 99236 GF
Hospital Charge Code	9923600
Hospital Revenue Code	982
Min. Negotiated Rate	$152.46
Max. Negotiated Rate	$320.10
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

PROF-SAME DAY ADMIT/DISCHG OBS -HIGH

Facility

$330.00

Service Code	HCPCS 99236 GF
Hospital Charge Code	9923600
Hospital Revenue Code	982
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

PROF-SAME DAY ADMIT/DISCHG OBS-MOD

Facility

$265.00

Service Code	HCPCS 99235 GF
Hospital Charge Code	9923500
Hospital Revenue Code	982
Min. Negotiated Rate	$217.30
Max. Negotiated Rate	$257.05
Rate for Payer: Cash Price	$198.75
Rate for Payer: Health Partners Plans Commercial	$251.75
Rate for Payer: UnitedHealthcare Commercial	$257.05
Rate for Payer: WPPA Commercial	$217.30

PROF-SAME DAY ADMIT/DISCHG OBS-MOD

Facility

$265.00

Service Code	HCPCS 99235 GF
Hospital Charge Code	9923500
Hospital Revenue Code	982
Min. Negotiated Rate	$122.43
Max. Negotiated Rate	$257.05
Rate for Payer: Cash Price	$198.75
Rate for Payer: Celtic Commercial/Exchange	$122.43
Rate for Payer: Health Partners Plans Commercial	$251.75
Rate for Payer: UnitedHealthcare Commercial	$257.05
Rate for Payer: WPPA Commercial	$222.60

PROF-SUBSEQUENT OBS E&M HIGH

Facility

$235.00

Service Code	HCPCS 99233 GF
Hospital Charge Code	9923300
Hospital Revenue Code	982
Min. Negotiated Rate	$108.57
Max. Negotiated Rate	$227.95
Rate for Payer: Cash Price	$176.25
Rate for Payer: Celtic Commercial/Exchange	$108.57
Rate for Payer: Health Partners Plans Commercial	$223.25
Rate for Payer: UnitedHealthcare Commercial	$227.95
Rate for Payer: WPPA Commercial	$197.40

PROF-SUBSEQUENT OBS E&M HIGH

Facility

$235.00

Service Code	HCPCS 99233 GF
Hospital Charge Code	9923300
Hospital Revenue Code	982
Min. Negotiated Rate	$192.70
Max. Negotiated Rate	$227.95
Rate for Payer: Cash Price	$176.25
Rate for Payer: Health Partners Plans Commercial	$223.25
Rate for Payer: UnitedHealthcare Commercial	$227.95
Rate for Payer: WPPA Commercial	$192.70

PROF-SUBSEQUENT OBS E&M LOW

Facility

$140.00

Service Code	HCPCS 99231 GF
Hospital Charge Code	9923100
Hospital Revenue Code	982
Min. Negotiated Rate	$60.75
Max. Negotiated Rate	$135.80
Rate for Payer: BCBS Commercial	$60.75
Rate for Payer: Cash Price	$105.00
Rate for Payer: Cash Price	$105.00
Rate for Payer: Celtic Commercial/Exchange	$64.68
Rate for Payer: Health Partners Plans Commercial	$133.00
Rate for Payer: UnitedHealthcare Commercial	$135.80
Rate for Payer: WPPA Commercial	$117.60

PROF-SUBSEQUENT OBS E&M LOW

Facility

$140.00

Service Code	HCPCS 99231 GF
Hospital Charge Code	9923100
Hospital Revenue Code	982
Min. Negotiated Rate	$114.80
Max. Negotiated Rate	$135.80
Rate for Payer: Cash Price	$105.00
Rate for Payer: Health Partners Plans Commercial	$133.00
Rate for Payer: UnitedHealthcare Commercial	$135.80
Rate for Payer: WPPA Commercial	$114.80

PROF-SUBSEQUENT OBS E&M MOD

Facility

$191.00

Service Code	HCPCS 99232 GF
Hospital Charge Code	9923200
Hospital Revenue Code	982
Min. Negotiated Rate	$88.24
Max. Negotiated Rate	$185.27
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-SUBSEQUENT OBS E&M MOD

Facility

$191.00

Service Code	HCPCS 99232 GF
Hospital Charge Code	9923200
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-TELEHEALTH CLINIC 15-29 MIN

Facility

$125.00

Service Code	HCPCS 99202 GT
Hospital Charge Code	9920200
Hospital Revenue Code	983
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

PROF-TELEHEALTH CLINIC 15-29 MIN

Facility

$125.00

Service Code	HCPCS 99202 GT
Hospital Charge Code	9920200
Hospital Revenue Code	983
Min. Negotiated Rate	$57.75
Max. Negotiated Rate	$121.25
Rate for Payer: BCBS Commercial	$67.67
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

PROF-TELEHEALTH CLINIC 30-44 MIN

Facility

$204.00

Service Code	HCPCS 99203 GT
Hospital Charge Code	9920300
Hospital Revenue Code	983
Min. Negotiated Rate	$167.28
Max. Negotiated Rate	$197.88
Rate for Payer: Cash Price	$153.00
Rate for Payer: Health Partners Plans Commercial	$193.80
Rate for Payer: UnitedHealthcare Commercial	$197.88
Rate for Payer: WPPA Commercial	$167.28

PROF-TELEHEALTH CLINIC 30-44 MIN

Facility

$204.00

Service Code	HCPCS 99203 GT
Hospital Charge Code	9920300
Hospital Revenue Code	983
Min. Negotiated Rate	$94.25
Max. Negotiated Rate	$197.88
Rate for Payer: BCBS Commercial	$101.00
Rate for Payer: Cash Price	$153.00
Rate for Payer: Cash Price	$153.00
Rate for Payer: Celtic Commercial/Exchange	$94.25
Rate for Payer: Health Partners Plans Commercial	$193.80
Rate for Payer: UnitedHealthcare Commercial	$197.88
Rate for Payer: WPPA Commercial	$171.36

PROF-TELEHEALTH CLINIC 30 MIN

Facility

$213.00

Service Code	HCPCS 99214 GT
Hospital Charge Code	9921421
Hospital Revenue Code	983
Min. Negotiated Rate	$98.41
Max. Negotiated Rate	$206.61
Rate for Payer: BCBS Commercial	$188.57
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

PROF-TELEHEALTH CLINIC 30 MIN

Facility

$213.00

Service Code	HCPCS 99214 GT
Hospital Charge Code	9921421
Hospital Revenue Code	983
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

PROF-TELEHEALTH CLINIC 40 MIN

Facility

$227.00

Service Code	HCPCS 99215 GT
Hospital Charge Code	9921521
Hospital Revenue Code	983
Min. Negotiated Rate	$104.87
Max. Negotiated Rate	$266.24
Rate for Payer: BCBS Commercial	$266.24
Rate for Payer: Cash Price	$170.25
Rate for Payer: Cash Price	$170.25
Rate for Payer: Celtic Commercial/Exchange	$104.87
Rate for Payer: Health Partners Plans Commercial	$215.65
Rate for Payer: UnitedHealthcare Commercial	$220.19
Rate for Payer: WPPA Commercial	$190.68

Know your out-of-pocket cost for care.

All Charges