Ness County Hospital

All Charges

Charge

Type

Setting

Price

REMERON 15 MG TAB (MIRTAZAPINE)

Facility

$8.00

Service Code	NDC 68084011911
Hospital Charge Code	2515088
Hospital Revenue Code	250
Min. Negotiated Rate	$6.56
Max. Negotiated Rate	$7.76
Rate for Payer: Cash Price	$6.15
Rate for Payer: Health Partners Plans Commercial	$7.60
Rate for Payer: UnitedHealthcare Commercial	$7.76
Rate for Payer: WPPA Commercial	$6.56

REM FB MUSC/TENDON SHEATH SMPL

Facility

$1,545.00

Service Code	HCPCS 20520
Hospital Charge Code	2052000
Hospital Revenue Code	761
Min. Negotiated Rate	$606.00
Max. Negotiated Rate	$1,498.65
Rate for Payer: BCBS Commercial	$606.00
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

REM FB MUSC/TENDON SHEATH SMPL

Facility

$1,545.00

Service Code	HCPCS 20520
Hospital Charge Code	2052000
Hospital Revenue Code	761
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

REM FB UPPER ARM/ELB AREA SUBQ

Facility

$1,545.00

Service Code	HCPCS 24200
Hospital Charge Code	2420000
Hospital Revenue Code	450
Min. Negotiated Rate	$713.79
Max. Negotiated Rate	$1,498.65
Rate for Payer: BCBS Commercial	$730.23
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

REM FB UPPER ARM/ELB AREA SUBQ

Facility

$1,545.00

Service Code	HCPCS 24200
Hospital Charge Code	2420000
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

REMOVAL DRUG DELIVERING IMPLA

Facility

$378.00

Service Code	HCPCS 11982
Hospital Charge Code	1198200
Hospital Revenue Code	761
Min. Negotiated Rate	$174.64
Max. Negotiated Rate	$498.80
Rate for Payer: BCBS Commercial	$498.80
Rate for Payer: Cash Price	$283.50
Rate for Payer: Cash Price	$283.50
Rate for Payer: Celtic Commercial/Exchange	$174.64
Rate for Payer: Health Partners Plans Commercial	$359.10
Rate for Payer: UnitedHealthcare Commercial	$366.66
Rate for Payer: WPPA Commercial	$317.52

REMOVAL DRUG DELIVERING IMPLA

Facility

$378.00

Service Code	HCPCS 11982
Hospital Charge Code	1198200
Hospital Revenue Code	761
Min. Negotiated Rate	$309.96
Max. Negotiated Rate	$366.66
Rate for Payer: Cash Price	$283.50
Rate for Payer: Health Partners Plans Commercial	$359.10
Rate for Payer: UnitedHealthcare Commercial	$366.66
Rate for Payer: WPPA Commercial	$309.96

REMOVAL FOREIGN BODY CORNEAL/

Facility

$162.00

Service Code	HCPCS 65222
Hospital Charge Code	6522200
Hospital Revenue Code	450
Min. Negotiated Rate	$132.84
Max. Negotiated Rate	$157.14
Rate for Payer: Cash Price	$121.50
Rate for Payer: Health Partners Plans Commercial	$153.90
Rate for Payer: UnitedHealthcare Commercial	$157.14
Rate for Payer: WPPA Commercial	$132.84

REMOVAL FOREIGN BODY CORNEAL/

Facility

$162.00

Service Code	HCPCS 65222
Hospital Charge Code	6522200
Hospital Revenue Code	450
Min. Negotiated Rate	$74.84
Max. Negotiated Rate	$521.72
Rate for Payer: BCBS Commercial	$521.72
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cash Price	$121.50
Rate for Payer: Celtic Commercial/Exchange	$74.84
Rate for Payer: Health Partners Plans Commercial	$153.90
Rate for Payer: UnitedHealthcare Commercial	$157.14
Rate for Payer: WPPA Commercial	$136.08

REMOVAL FOREIGN BODY, EXT EYE

Facility

$378.00

Service Code	HCPCS 65220
Hospital Charge Code	6522000
Hospital Revenue Code	450
Min. Negotiated Rate	$309.96
Max. Negotiated Rate	$366.66
Rate for Payer: Cash Price	$283.50
Rate for Payer: Health Partners Plans Commercial	$359.10
Rate for Payer: UnitedHealthcare Commercial	$366.66
Rate for Payer: WPPA Commercial	$309.96

REMOVAL FOREIGN BODY, EXT EYE

Facility

$378.00

Service Code	HCPCS 65220
Hospital Charge Code	6522000
Hospital Revenue Code	450
Min. Negotiated Rate	$174.64
Max. Negotiated Rate	$541.36
Rate for Payer: BCBS Commercial	$541.36
Rate for Payer: Cash Price	$283.50
Rate for Payer: Cash Price	$283.50
Rate for Payer: Celtic Commercial/Exchange	$174.64
Rate for Payer: Health Partners Plans Commercial	$359.10
Rate for Payer: UnitedHealthcare Commercial	$366.66
Rate for Payer: WPPA Commercial	$317.52

REMOVAL FOREIGN BODY FOOT SUBQ

Facility

$1,290.00

Service Code	HCPCS 28190
Hospital Charge Code	2819000
Hospital Revenue Code	450
Min. Negotiated Rate	$1,057.80
Max. Negotiated Rate	$1,251.30
Rate for Payer: Cash Price	$967.50
Rate for Payer: Health Partners Plans Commercial	$1,225.50
Rate for Payer: UnitedHealthcare Commercial	$1,251.30
Rate for Payer: WPPA Commercial	$1,057.80

REMOVAL FOREIGN BODY FOOT SUBQ

Facility

$1,290.00

Service Code	HCPCS 28190
Hospital Charge Code	2819000
Hospital Revenue Code	450
Min. Negotiated Rate	$595.98
Max. Negotiated Rate	$1,991.72
Rate for Payer: BCBS Commercial	$1,991.72
Rate for Payer: Cash Price	$967.50
Rate for Payer: Cash Price	$967.50
Rate for Payer: Celtic Commercial/Exchange	$595.98
Rate for Payer: Health Partners Plans Commercial	$1,225.50
Rate for Payer: UnitedHealthcare Commercial	$1,251.30
Rate for Payer: WPPA Commercial	$1,083.60

REMOVAL FOREIGN BODY,FT,DEEP

Facility

$1,545.00

Service Code	HCPCS 28192
Hospital Charge Code	2819200
Hospital Revenue Code	450
Min. Negotiated Rate	$713.79
Max. Negotiated Rate	$1,498.65
Rate for Payer: BCBS Commercial	$1,246.34
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

REMOVAL FOREIGN BODY,FT,DEEP

Facility

$1,545.00

Service Code	HCPCS 28192
Hospital Charge Code	2819200
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

REMOVAL FOREIGN BODY SUBQ FOOT

Facility

$1,300.00

Service Code	HCPCS 28190
Hospital Charge Code	2819023
Hospital Revenue Code	761
Min. Negotiated Rate	$600.60
Max. Negotiated Rate	$1,991.72
Rate for Payer: BCBS Commercial	$1,991.72
Rate for Payer: Cash Price	$975.00
Rate for Payer: Cash Price	$975.00
Rate for Payer: Celtic Commercial/Exchange	$600.60
Rate for Payer: Health Partners Plans Commercial	$1,235.00
Rate for Payer: UnitedHealthcare Commercial	$1,261.00
Rate for Payer: WPPA Commercial	$1,092.00

REMOVAL FOREIGN BODY SUBQ FOOT

Facility

$1,300.00

Service Code	HCPCS 28190
Hospital Charge Code	2819023
Hospital Revenue Code	761
Min. Negotiated Rate	$1,066.00
Max. Negotiated Rate	$1,261.00
Rate for Payer: Cash Price	$975.00
Rate for Payer: Health Partners Plans Commercial	$1,235.00
Rate for Payer: UnitedHealthcare Commercial	$1,261.00
Rate for Payer: WPPA Commercial	$1,066.00

REMOVAL GAUNTLET/BOOT/BODYCAST

Facility

$350.00

Service Code	HCPCS 29700
Hospital Charge Code	2970023
Hospital Revenue Code	761
Min. Negotiated Rate	$287.00
Max. Negotiated Rate	$339.50
Rate for Payer: Cash Price	$262.50
Rate for Payer: Health Partners Plans Commercial	$332.50
Rate for Payer: UnitedHealthcare Commercial	$339.50
Rate for Payer: WPPA Commercial	$287.00

REMOVAL GAUNTLET/BOOT/BODYCAST

Facility

$350.00

Service Code	HCPCS 29700
Hospital Charge Code	2970023
Hospital Revenue Code	761
Min. Negotiated Rate	$161.70
Max. Negotiated Rate	$339.50
Rate for Payer: BCBS Commercial	$278.76
Rate for Payer: Cash Price	$262.50
Rate for Payer: Cash Price	$262.50
Rate for Payer: Celtic Commercial/Exchange	$161.70
Rate for Payer: Health Partners Plans Commercial	$332.50
Rate for Payer: UnitedHealthcare Commercial	$339.50
Rate for Payer: WPPA Commercial	$294.00

REMOVAL IMPACTED CERUMEN,IRRIG

Facility

$108.00

Service Code	HCPCS 69209
Hospital Charge Code	6920900
Hospital Revenue Code	450
Min. Negotiated Rate	$49.90
Max. Negotiated Rate	$586.49
Rate for Payer: BCBS Commercial	$586.49
Rate for Payer: Cash Price	$81.00
Rate for Payer: Cash Price	$81.00
Rate for Payer: Celtic Commercial/Exchange	$49.90
Rate for Payer: Health Partners Plans Commercial	$102.60
Rate for Payer: UnitedHealthcare Commercial	$104.76
Rate for Payer: WPPA Commercial	$90.72

REMOVAL IMPACTED CERUMEN,IRRIG

Facility

$108.00

Service Code	HCPCS 69209
Hospital Charge Code	6920900
Hospital Revenue Code	450
Min. Negotiated Rate	$88.56
Max. Negotiated Rate	$104.76
Rate for Payer: Cash Price	$81.00
Rate for Payer: Health Partners Plans Commercial	$102.60
Rate for Payer: UnitedHealthcare Commercial	$104.76
Rate for Payer: WPPA Commercial	$88.56

REMOVAL OF FOREIGN BODY EX EYE

Facility

$311.00

Service Code	HCPCS 65205
Hospital Charge Code	6520500
Hospital Revenue Code	450
Min. Negotiated Rate	$143.68
Max. Negotiated Rate	$310.07
Rate for Payer: BCBS Commercial	$310.07
Rate for Payer: Cash Price	$233.25
Rate for Payer: Cash Price	$233.25
Rate for Payer: Celtic Commercial/Exchange	$143.68
Rate for Payer: Health Partners Plans Commercial	$295.45
Rate for Payer: UnitedHealthcare Commercial	$301.67
Rate for Payer: WPPA Commercial	$261.24

REMOVAL OF FOREIGN BODY EX EYE

Facility

$311.00

Service Code	HCPCS 65205
Hospital Charge Code	6520500
Hospital Revenue Code	450
Min. Negotiated Rate	$255.02
Max. Negotiated Rate	$301.67
Rate for Payer: Cash Price	$233.25
Rate for Payer: Health Partners Plans Commercial	$295.45
Rate for Payer: UnitedHealthcare Commercial	$301.67
Rate for Payer: WPPA Commercial	$255.02

REMOVAL-TUNLD CNTRL VENOUS ACC

Facility

$1,907.00

Service Code	HCPCS 36590
Hospital Charge Code	3659000
Hospital Revenue Code	761
Min. Negotiated Rate	$881.03
Max. Negotiated Rate	$1,941.80
Rate for Payer: BCBS Commercial	$1,941.80
Rate for Payer: Cash Price	$1,430.25
Rate for Payer: Cash Price	$1,430.25
Rate for Payer: Celtic Commercial/Exchange	$881.03
Rate for Payer: Health Partners Plans Commercial	$1,811.65
Rate for Payer: UnitedHealthcare Commercial	$1,849.79
Rate for Payer: WPPA Commercial	$1,601.88

REMOVAL-TUNLD CNTRL VENOUS ACC

Facility

$1,907.00

Service Code	HCPCS 36590
Hospital Charge Code	3659000
Hospital Revenue Code	761
Min. Negotiated Rate	$1,563.74
Max. Negotiated Rate	$1,849.79
Rate for Payer: Cash Price	$1,430.25
Rate for Payer: Health Partners Plans Commercial	$1,811.65
Rate for Payer: UnitedHealthcare Commercial	$1,849.79
Rate for Payer: WPPA Commercial	$1,563.74

Know your out-of-pocket cost for care.

All Charges