Ness County Hospital

All Charges

Charge

Type

Setting

Price

UPPER EXT. INFANT 2 VIEW MIN

Facility

$160.00

Service Code	HCPCS 73092
Hospital Charge Code	3280014
Hospital Revenue Code	320
Min. Negotiated Rate	$131.20
Max. Negotiated Rate	$155.20
Rate for Payer: Cash Price	$120.45
Rate for Payer: Health Partners Plans Commercial	$152.00
Rate for Payer: UnitedHealthcare Commercial	$155.20
Rate for Payer: WPPA Commercial	$131.20

UPPER GASTRO.ENDOSCOPY W/BIOPS

Facility

$1,774.00

Service Code	HCPCS 43239
Hospital Charge Code	4323900
Hospital Revenue Code	761
Min. Negotiated Rate	$1,454.68
Max. Negotiated Rate	$1,720.78
Rate for Payer: Cash Price	$1,330.50
Rate for Payer: Health Partners Plans Commercial	$1,685.30
Rate for Payer: UnitedHealthcare Commercial	$1,720.78
Rate for Payer: WPPA Commercial	$1,454.68

UPPER GASTRO.ENDOSCOPY W/BIOPS

Facility

$1,774.00

Service Code	HCPCS 43239
Hospital Charge Code	4323900
Hospital Revenue Code	761
Min. Negotiated Rate	$819.59
Max. Negotiated Rate	$1,720.78
Rate for Payer: BCBS Commercial	$1,171.95
Rate for Payer: Cash Price	$1,330.50
Rate for Payer: Cash Price	$1,330.50
Rate for Payer: Celtic Commercial/Exchange	$819.59
Rate for Payer: Health Partners Plans Commercial	$1,685.30
Rate for Payer: UnitedHealthcare Commercial	$1,720.78
Rate for Payer: WPPA Commercial	$1,490.16

UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC

Facility

$13,348.38

Service Code	MSDRG 256
Min. Negotiated Rate	$13,348.38
Max. Negotiated Rate	$13,348.38
Rate for Payer: BCBS Commercial	$13,348.38

UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC

Facility

$22,732.12

Service Code	MSDRG 255
Min. Negotiated Rate	$22,732.12
Max. Negotiated Rate	$22,732.12
Rate for Payer: BCBS Commercial	$22,732.12

UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CC/MCC

Facility

$9,414.96

Service Code	MSDRG 257
Min. Negotiated Rate	$9,414.96
Max. Negotiated Rate	$9,414.96
Rate for Payer: BCBS Commercial	$9,414.96

UREA NITROGEN QUANT. (BUN)

Facility

$45.00

Service Code	HCPCS 84520
Hospital Charge Code	8452000
Hospital Revenue Code	301
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

UREA NITROGEN QUANT. (BUN)

Facility

$45.00

Service Code	HCPCS 84520
Hospital Charge Code	8452000
Hospital Revenue Code	301
Min. Negotiated Rate	$8.47
Max. Negotiated Rate	$43.65
Rate for Payer: BCBS Commercial	$8.47
Rate for Payer: Cash Price	$33.75
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

UREA NITROGEN, URINE

Facility

$26.00

Service Code	HCPCS 84540
Hospital Charge Code	8454000
Hospital Revenue Code	301
Min. Negotiated Rate	$21.32
Max. Negotiated Rate	$25.22
Rate for Payer: Cash Price	$19.50
Rate for Payer: Health Partners Plans Commercial	$24.70
Rate for Payer: UnitedHealthcare Commercial	$25.22
Rate for Payer: WPPA Commercial	$21.32

UREA NITROGEN, URINE

Facility

$26.00

Service Code	HCPCS 84540
Hospital Charge Code	8454000
Hospital Revenue Code	301
Min. Negotiated Rate	$12.01
Max. Negotiated Rate	$25.22
Rate for Payer: BCBS Commercial	$18.06
Rate for Payer: Cash Price	$19.50
Rate for Payer: Cash Price	$19.50
Rate for Payer: Celtic Commercial/Exchange	$12.01
Rate for Payer: Health Partners Plans Commercial	$24.70
Rate for Payer: UnitedHealthcare Commercial	$25.22
Rate for Payer: WPPA Commercial	$21.84

URECHOLINE 10 MG TAB (BETHANECHOL CHLORIDE)

Facility

$3.00

Service Code	NDC 68084036501
Hospital Charge Code	2519056
Hospital Revenue Code	250
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.92
Rate for Payer: Health Partners Plans Commercial	$2.85
Rate for Payer: UnitedHealthcare Commercial	$2.91
Rate for Payer: WPPA Commercial	$2.46

URECHOLINE 10 MG TAB (BETHANECHOL CHLORIDE)

Facility

$3.00

Service Code	NDC 68084036501
Hospital Charge Code	2519056
Hospital Revenue Code	250
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.92
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

URETHRAL PROCEDURES WITH CC/MCC

Facility

$12,954.16

Service Code	MSDRG 671
Min. Negotiated Rate	$12,954.16
Max. Negotiated Rate	$12,954.16
Rate for Payer: BCBS Commercial	$12,954.16

URETHRAL PROCEDURES WITHOUT CC/MCC

Facility

$9,412.99

Service Code	MSDRG 672
Min. Negotiated Rate	$9,412.99
Max. Negotiated Rate	$9,412.99
Rate for Payer: BCBS Commercial	$9,412.99

URETHRAL STRICTURE

Facility

$8,242.35

Service Code	MSDRG 697
Min. Negotiated Rate	$8,242.35
Max. Negotiated Rate	$8,242.35
Rate for Payer: BCBS Commercial	$8,242.35

URETHRAL TRAY

Facility

$19.00

Hospital Charge Code	2720233
Hospital Revenue Code	272
Min. Negotiated Rate	$15.58
Max. Negotiated Rate	$18.43
Rate for Payer: Cash Price	$14.62
Rate for Payer: Health Partners Plans Commercial	$18.05
Rate for Payer: UnitedHealthcare Commercial	$18.43
Rate for Payer: WPPA Commercial	$15.58

URETHRAL TRAY

Facility

$19.00

Hospital Charge Code	2720233
Hospital Revenue Code	272
Min. Negotiated Rate	$8.78
Max. Negotiated Rate	$18.43
Rate for Payer: Cash Price	$14.62
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

URIC ACID,24HR URINE W/O CREAT

Facility

$38.00

Service Code	HCPCS 84560
Hospital Charge Code	8456001
Hospital Revenue Code	301
Min. Negotiated Rate	$31.16
Max. Negotiated Rate	$36.86
Rate for Payer: Cash Price	$28.50
Rate for Payer: Health Partners Plans Commercial	$36.10
Rate for Payer: UnitedHealthcare Commercial	$36.86
Rate for Payer: WPPA Commercial	$31.16

URIC ACID,24HR URINE W/O CREAT

Facility

$38.00

Service Code	HCPCS 84560
Hospital Charge Code	8456001
Hospital Revenue Code	301
Min. Negotiated Rate	$17.56
Max. Negotiated Rate	$36.86
Rate for Payer: BCBS Commercial	$20.39
Rate for Payer: Cash Price	$28.50
Rate for Payer: Cash Price	$28.50
Rate for Payer: Celtic Commercial/Exchange	$17.56
Rate for Payer: Health Partners Plans Commercial	$36.10
Rate for Payer: UnitedHealthcare Commercial	$36.86
Rate for Payer: WPPA Commercial	$31.92

URIC ACID BLOOD

Facility

$53.00

Service Code	HCPCS 84550
Hospital Charge Code	8455000
Hospital Revenue Code	301
Min. Negotiated Rate	$43.46
Max. Negotiated Rate	$51.41
Rate for Payer: Cash Price	$39.75
Rate for Payer: Health Partners Plans Commercial	$50.35
Rate for Payer: UnitedHealthcare Commercial	$51.41
Rate for Payer: WPPA Commercial	$43.46

URIC ACID BLOOD

Facility

$53.00

Service Code	HCPCS 84550
Hospital Charge Code	8455000
Hospital Revenue Code	301
Min. Negotiated Rate	$14.72
Max. Negotiated Rate	$51.41
Rate for Payer: BCBS Commercial	$14.72
Rate for Payer: Cash Price	$39.75
Rate for Payer: Cash Price	$39.75
Rate for Payer: Celtic Commercial/Exchange	$24.49
Rate for Payer: Health Partners Plans Commercial	$50.35
Rate for Payer: UnitedHealthcare Commercial	$51.41
Rate for Payer: WPPA Commercial	$44.52

URIC ACID OTHER SOURCE

Facility

$55.00

Service Code	HCPCS 84560
Hospital Charge Code	8456000
Hospital Revenue Code	301
Min. Negotiated Rate	$45.10
Max. Negotiated Rate	$53.35
Rate for Payer: Cash Price	$41.25
Rate for Payer: Health Partners Plans Commercial	$52.25
Rate for Payer: UnitedHealthcare Commercial	$53.35
Rate for Payer: WPPA Commercial	$45.10

URIC ACID OTHER SOURCE

Facility

$55.00

Service Code	HCPCS 84560
Hospital Charge Code	8456000
Hospital Revenue Code	301
Min. Negotiated Rate	$20.39
Max. Negotiated Rate	$53.35
Rate for Payer: BCBS Commercial	$20.39
Rate for Payer: Cash Price	$41.25
Rate for Payer: Cash Price	$41.25
Rate for Payer: Celtic Commercial/Exchange	$25.41
Rate for Payer: Health Partners Plans Commercial	$52.25
Rate for Payer: UnitedHealthcare Commercial	$53.35
Rate for Payer: WPPA Commercial	$46.20

URINAL MALE LTC

Facility

$5.00

Hospital Charge Code	2707949LTC
Hospital Revenue Code	270
Min. Negotiated Rate	$4.10
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$3.75
Rate for Payer: Health Partners Plans Commercial	$4.75
Rate for Payer: UnitedHealthcare Commercial	$4.85
Rate for Payer: WPPA Commercial	$4.10

URINAL MALE LTC

Facility

$5.00

Hospital Charge Code	2707949LTC
Hospital Revenue Code	270
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$3.75
Rate for Payer: Celtic Commercial/Exchange	$2.31
Rate for Payer: Health Partners Plans Commercial	$4.75
Rate for Payer: UnitedHealthcare Commercial	$4.85
Rate for Payer: WPPA Commercial	$4.20

Know your out-of-pocket cost for care.

All Charges