Ness County Hospital

All Charges

Charge

Type

Setting

Price

TELEHEALTH ORIGIN SITE FAC FEE

Facility

$80.00

Service Code	HCPCS Q3014
Hospital Charge Code	Q301400
Hospital Revenue Code	510
Min. Negotiated Rate	$36.96
Max. Negotiated Rate	$77.60
Rate for Payer: BCBS Commercial	$38.38
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

TELEHEALTH ORIGIN SITE FAC FEE

Facility

$80.00

Service Code	HCPCS Q3014
Hospital Charge Code	Q301400
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

TELEMETRY MONITORING

Facility

$200.00

Hospital Charge Code	2702626
Hospital Revenue Code	732
Min. Negotiated Rate	$164.00
Max. Negotiated Rate	$194.00
Rate for Payer: Cash Price	$150.00
Rate for Payer: Health Partners Plans Commercial	$190.00
Rate for Payer: UnitedHealthcare Commercial	$194.00
Rate for Payer: WPPA Commercial	$164.00

TELEMETRY MONITORING

Facility

$200.00

Hospital Charge Code	2702626
Hospital Revenue Code	732
Min. Negotiated Rate	$92.40
Max. Negotiated Rate	$194.00
Rate for Payer: Cash Price	$150.00
Rate for Payer: Celtic Commercial/Exchange	$92.40
Rate for Payer: Health Partners Plans Commercial	$190.00
Rate for Payer: UnitedHealthcare Commercial	$194.00
Rate for Payer: WPPA Commercial	$168.00

TELFA MINI LTC

Facility

$9.00

Hospital Charge Code	2722585LTC
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

TELFA MINI LTC

Facility

$9.00

Hospital Charge Code	2722585LTC
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

TEMPORARY EXTERNAL PACING

Facility

$950.00

Service Code	HCPCS 92953
Hospital Charge Code	9295300
Hospital Revenue Code	761
Min. Negotiated Rate	$779.00
Max. Negotiated Rate	$921.50
Rate for Payer: Cash Price	$712.50
Rate for Payer: Health Partners Plans Commercial	$902.50
Rate for Payer: UnitedHealthcare Commercial	$921.50
Rate for Payer: WPPA Commercial	$779.00

TEMPORARY EXTERNAL PACING

Facility

$950.00

Service Code	HCPCS 92953
Hospital Charge Code	9295300
Hospital Revenue Code	761
Min. Negotiated Rate	$438.90
Max. Negotiated Rate	$921.50
Rate for Payer: Cash Price	$712.50
Rate for Payer: Celtic Commercial/Exchange	$438.90
Rate for Payer: Health Partners Plans Commercial	$902.50
Rate for Payer: UnitedHealthcare Commercial	$921.50
Rate for Payer: WPPA Commercial	$798.00

TENDER WET 1.6

Facility

$19.00

Hospital Charge Code	2725038
Hospital Revenue Code	270
Min. Negotiated Rate	$15.58
Max. Negotiated Rate	$18.43
Rate for Payer: Cash Price	$14.44
Rate for Payer: Health Partners Plans Commercial	$18.05
Rate for Payer: UnitedHealthcare Commercial	$18.43
Rate for Payer: WPPA Commercial	$15.58

TENDER WET 1.6

Facility

$19.00

Hospital Charge Code	2725038
Hospital Revenue Code	270
Min. Negotiated Rate	$8.78
Max. Negotiated Rate	$18.43
Rate for Payer: Cash Price	$14.44
Rate for Payer: Celtic Commercial/Exchange	$8.78
Rate for Payer: Health Partners Plans Commercial	$18.05
Rate for Payer: UnitedHealthcare Commercial	$18.43
Rate for Payer: WPPA Commercial	$15.96

TENDER WET 4X5

Facility

$28.00

Hospital Charge Code	2725040
Hospital Revenue Code	270
Min. Negotiated Rate	$22.96
Max. Negotiated Rate	$27.16
Rate for Payer: Cash Price	$21.45
Rate for Payer: Health Partners Plans Commercial	$26.60
Rate for Payer: UnitedHealthcare Commercial	$27.16
Rate for Payer: WPPA Commercial	$22.96

TENDER WET 4X5

Facility

$28.00

Hospital Charge Code	2725040
Hospital Revenue Code	270
Min. Negotiated Rate	$12.94
Max. Negotiated Rate	$27.16
Rate for Payer: Cash Price	$21.45
Rate for Payer: Celtic Commercial/Exchange	$12.94
Rate for Payer: Health Partners Plans Commercial	$26.60
Rate for Payer: UnitedHealthcare Commercial	$27.16
Rate for Payer: WPPA Commercial	$23.52

TENDONITIS, MYOSITIS AND BURSITIS WITH MCC

Facility

$11,431.22

Service Code	MSDRG 557
Min. Negotiated Rate	$11,431.22
Max. Negotiated Rate	$11,431.22
Rate for Payer: BCBS Commercial	$11,431.22

TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC

Facility

$7,645.35

Service Code	MSDRG 558
Min. Negotiated Rate	$7,645.35
Max. Negotiated Rate	$7,645.35
Rate for Payer: BCBS Commercial	$7,645.35

TENORMIN 25 MG TAB (ATENOLOL)

Facility

$3.00

Service Code	NDC 60687060511
Hospital Charge Code	2513349
Hospital Revenue Code	250
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.96
Rate for Payer: Celtic Commercial/Exchange	$1.39
Rate for Payer: Health Partners Plans Commercial	$2.85
Rate for Payer: UnitedHealthcare Commercial	$2.91
Rate for Payer: WPPA Commercial	$2.52

TENORMIN 25 MG TAB (ATENOLOL)

Facility

$3.00

Service Code	NDC 60687060511
Hospital Charge Code	2513349
Hospital Revenue Code	250
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.96
Rate for Payer: Health Partners Plans Commercial	$2.85
Rate for Payer: UnitedHealthcare Commercial	$2.91
Rate for Payer: WPPA Commercial	$2.46

TENOTOMY, TOE, SINGLE

Facility

$1,435.00

Service Code	HCPCS 28010
Hospital Charge Code	2801023
Hospital Revenue Code	761
Min. Negotiated Rate	$158.40
Max. Negotiated Rate	$1,391.95
Rate for Payer: BCBS Commercial	$158.40
Rate for Payer: Cash Price	$1,076.25
Rate for Payer: Cash Price	$1,076.25
Rate for Payer: Celtic Commercial/Exchange	$662.97
Rate for Payer: Health Partners Plans Commercial	$1,363.25
Rate for Payer: UnitedHealthcare Commercial	$1,391.95
Rate for Payer: WPPA Commercial	$1,205.40

TENOTOMY, TOE, SINGLE

Facility

$1,435.00

Service Code	HCPCS 28010
Hospital Charge Code	2801023
Hospital Revenue Code	761
Min. Negotiated Rate	$1,176.70
Max. Negotiated Rate	$1,391.95
Rate for Payer: Cash Price	$1,076.25
Rate for Payer: Health Partners Plans Commercial	$1,363.25
Rate for Payer: UnitedHealthcare Commercial	$1,391.95
Rate for Payer: WPPA Commercial	$1,176.70

TESSALON PERLES 100 MG CAP (BENZONATATE)

Facility

$7.00

Service Code	NDC 00904656461
Hospital Charge Code	2507010
Hospital Revenue Code	250
Min. Negotiated Rate	$3.23
Max. Negotiated Rate	$6.79
Rate for Payer: Cash Price	$5.62
Rate for Payer: Celtic Commercial/Exchange	$3.23
Rate for Payer: Health Partners Plans Commercial	$6.65
Rate for Payer: UnitedHealthcare Commercial	$6.79
Rate for Payer: WPPA Commercial	$5.88

TESSALON PERLES 100 MG CAP (BENZONATATE)

Facility

$7.00

Service Code	NDC 00904656461
Hospital Charge Code	2507010
Hospital Revenue Code	250
Min. Negotiated Rate	$5.74
Max. Negotiated Rate	$6.79
Rate for Payer: Cash Price	$5.62
Rate for Payer: Health Partners Plans Commercial	$6.65
Rate for Payer: UnitedHealthcare Commercial	$6.79
Rate for Payer: WPPA Commercial	$5.74

TESTES PROCEDURES WITH CC/MCC

Facility

$18,919.03

Service Code	MSDRG 711
Min. Negotiated Rate	$18,919.03
Max. Negotiated Rate	$18,919.03
Rate for Payer: BCBS Commercial	$18,919.03

TESTES PROCEDURES WITHOUT CC/MCC

Facility

$9,434.62

Service Code	MSDRG 712
Min. Negotiated Rate	$9,434.62
Max. Negotiated Rate	$9,434.62
Rate for Payer: BCBS Commercial	$9,434.62

TESTOSTERONE FREE

Facility

$213.00

Service Code	HCPCS 84402
Hospital Charge Code	8440200
Hospital Revenue Code	301
Min. Negotiated Rate	$98.41
Max. Negotiated Rate	$206.61
Rate for Payer: BCBS Commercial	$108.65
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

TESTOSTERONE FREE

Facility

$213.00

Service Code	HCPCS 84402
Hospital Charge Code	8440200
Hospital Revenue Code	301
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

TESTOSTERONE TOTAL

Facility

$211.00

Service Code	HCPCS 84403
Hospital Charge Code	8440300
Hospital Revenue Code	301
Min. Negotiated Rate	$173.02
Max. Negotiated Rate	$204.67
Rate for Payer: Cash Price	$158.25
Rate for Payer: Health Partners Plans Commercial	$200.45
Rate for Payer: UnitedHealthcare Commercial	$204.67
Rate for Payer: WPPA Commercial	$173.02

Know your out-of-pocket cost for care.

All Charges