Ness County Hospital

All Charges

Charge

Type

Setting

Price

COMPLEMENT ANTIG EA COMPONENT

Facility

$150.00

Service Code	HCPCS 86160
Hospital Charge Code	8616000
Hospital Revenue Code	302
Min. Negotiated Rate	$55.68
Max. Negotiated Rate	$145.50
Rate for Payer: BCBS Commercial	$55.68
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

COMPLEMENT ANTIG EA COMPONENT

Facility

$150.00

Service Code	HCPCS 86160
Hospital Charge Code	8616000
Hospital Revenue Code	302
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

COMPLEMENT FUNC ACTV EA CMPNT

Facility

$99.00

Service Code	HCPCS 86161
Hospital Charge Code	8616100
Hospital Revenue Code	302
Min. Negotiated Rate	$45.74
Max. Negotiated Rate	$96.03
Rate for Payer: BCBS Commercial	$55.57
Rate for Payer: Cash Price	$74.25
Rate for Payer: Cash Price	$74.25
Rate for Payer: Celtic Commercial/Exchange	$45.74
Rate for Payer: Health Partners Plans Commercial	$94.05
Rate for Payer: UnitedHealthcare Commercial	$96.03
Rate for Payer: WPPA Commercial	$83.16

COMPLEMENT FUNC ACTV EA CMPNT

Facility

$99.00

Service Code	HCPCS 86161
Hospital Charge Code	8616100
Hospital Revenue Code	302
Min. Negotiated Rate	$81.18
Max. Negotiated Rate	$96.03
Rate for Payer: Cash Price	$74.25
Rate for Payer: Health Partners Plans Commercial	$94.05
Rate for Payer: UnitedHealthcare Commercial	$96.03
Rate for Payer: WPPA Commercial	$81.18

COMPLEMENT TOTAL HEMOLYTIC

Facility

$171.00

Service Code	HCPCS 86162
Hospital Charge Code	8616200
Hospital Revenue Code	302
Min. Negotiated Rate	$79.00
Max. Negotiated Rate	$165.87
Rate for Payer: BCBS Commercial	$79.39
Rate for Payer: Cash Price	$128.25
Rate for Payer: Cash Price	$128.25
Rate for Payer: Celtic Commercial/Exchange	$79.00
Rate for Payer: Health Partners Plans Commercial	$162.45
Rate for Payer: UnitedHealthcare Commercial	$165.87
Rate for Payer: WPPA Commercial	$143.64

COMPLEMENT TOTAL HEMOLYTIC

Facility

$171.00

Service Code	HCPCS 86162
Hospital Charge Code	8616200
Hospital Revenue Code	302
Min. Negotiated Rate	$140.22
Max. Negotiated Rate	$165.87
Rate for Payer: Cash Price	$128.25
Rate for Payer: Health Partners Plans Commercial	$162.45
Rate for Payer: UnitedHealthcare Commercial	$165.87
Rate for Payer: WPPA Commercial	$140.22

COMPLICATED PEPTIC ULCER WITH CC

Facility

$9,401.81

Service Code	MSDRG 381
Min. Negotiated Rate	$9,401.81
Max. Negotiated Rate	$9,401.81
Rate for Payer: BCBS Commercial	$9,401.81

COMPLICATED PEPTIC ULCER WITH MCC

Facility

$16,744.53

Service Code	MSDRG 380
Min. Negotiated Rate	$16,744.53
Max. Negotiated Rate	$16,744.53
Rate for Payer: BCBS Commercial	$16,744.53

COMPLICATED PEPTIC ULCER WITHOUT CC/MCC

Facility

$6,643.47

Service Code	MSDRG 382
Min. Negotiated Rate	$6,643.47
Max. Negotiated Rate	$6,643.47
Rate for Payer: BCBS Commercial	$6,643.47

COMPLICATIONS OF TREATMENT WITH CC

Facility

$9,093.83

Service Code	MSDRG 920
Min. Negotiated Rate	$9,093.83
Max. Negotiated Rate	$9,093.83
Rate for Payer: BCBS Commercial	$9,093.83

COMPLICATIONS OF TREATMENT WITH MCC

Facility

$16,367.31

Service Code	MSDRG 919
Min. Negotiated Rate	$16,367.31
Max. Negotiated Rate	$16,367.31
Rate for Payer: BCBS Commercial	$16,367.31

COMPLICATIONS OF TREATMENT WITHOUT CC/MCC

Facility

$6,194.21

Service Code	MSDRG 921
Min. Negotiated Rate	$6,194.21
Max. Negotiated Rate	$6,194.21
Rate for Payer: BCBS Commercial	$6,194.21

COMP METABOLIC

Facility

$176.00

Service Code	HCPCS 80053
Hospital Charge Code	8005300
Hospital Revenue Code	301
Min. Negotiated Rate	$22.68
Max. Negotiated Rate	$170.72
Rate for Payer: BCBS Commercial	$22.68
Rate for Payer: Cash Price	$132.00
Rate for Payer: Cash Price	$132.00
Rate for Payer: Celtic Commercial/Exchange	$81.31
Rate for Payer: Health Partners Plans Commercial	$167.20
Rate for Payer: UnitedHealthcare Commercial	$170.72
Rate for Payer: WPPA Commercial	$147.84

COMP METABOLIC

Facility

$176.00

Service Code	HCPCS 80053
Hospital Charge Code	8005300
Hospital Revenue Code	301
Min. Negotiated Rate	$144.32
Max. Negotiated Rate	$170.72
Rate for Payer: Cash Price	$132.00
Rate for Payer: Health Partners Plans Commercial	$167.20
Rate for Payer: UnitedHealthcare Commercial	$170.72
Rate for Payer: WPPA Commercial	$144.32

CONCENTRATION FOR INFEC AGENTS

Facility

$52.00

Service Code	HCPCS 87015
Hospital Charge Code	8701500
Hospital Revenue Code	306
Min. Negotiated Rate	$24.02
Max. Negotiated Rate	$50.44
Rate for Payer: BCBS Commercial	$35.75
Rate for Payer: Cash Price	$39.00
Rate for Payer: Cash Price	$39.00
Rate for Payer: Celtic Commercial/Exchange	$24.02
Rate for Payer: Health Partners Plans Commercial	$49.40
Rate for Payer: UnitedHealthcare Commercial	$50.44
Rate for Payer: WPPA Commercial	$43.68

CONCENTRATION FOR INFEC AGENTS

Facility

$52.00

Service Code	HCPCS 87015
Hospital Charge Code	8701500
Hospital Revenue Code	306
Min. Negotiated Rate	$42.64
Max. Negotiated Rate	$50.44
Rate for Payer: Cash Price	$39.00
Rate for Payer: Health Partners Plans Commercial	$49.40
Rate for Payer: UnitedHealthcare Commercial	$50.44
Rate for Payer: WPPA Commercial	$42.64

CONCENTRATOR SERV/HOME MEDICAL

Facility

$20.00

Hospital Charge Code	4120101
Hospital Revenue Code	270
Min. Negotiated Rate	$9.24
Max. Negotiated Rate	$19.40
Rate for Payer: Cash Price	$15.00
Rate for Payer: Celtic Commercial/Exchange	$9.24
Rate for Payer: Health Partners Plans Commercial	$19.00
Rate for Payer: UnitedHealthcare Commercial	$19.40
Rate for Payer: WPPA Commercial	$16.80

CONCENTRATOR SERV/HOME MEDICAL

Facility

$20.00

Hospital Charge Code	4120101
Hospital Revenue Code	270
Min. Negotiated Rate	$16.40
Max. Negotiated Rate	$19.40
Rate for Payer: Cash Price	$15.00
Rate for Payer: Health Partners Plans Commercial	$19.00
Rate for Payer: UnitedHealthcare Commercial	$19.40
Rate for Payer: WPPA Commercial	$16.40

CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES

Facility

$114,104.49

Service Code	MSDRG 212
Min. Negotiated Rate	$114,104.49
Max. Negotiated Rate	$114,104.49
Rate for Payer: BCBS Commercial	$114,104.49

CONCOMITANT LEFT ATRIAL APPENDAGE CLOSURE AND CARDIAC ABLATION

Facility

$64,816.20

Service Code	MSDRG 317
Min. Negotiated Rate	$64,816.20
Max. Negotiated Rate	$64,816.20
Rate for Payer: BCBS Commercial	$64,816.20

CONCURRENT IV INFUSION

Facility

$135.00

Service Code	HCPCS 96368
Hospital Charge Code	9636800
Hospital Revenue Code	761
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

CONCURRENT IV INFUSION

Facility

$135.00

Service Code	HCPCS 96368
Hospital Charge Code	9636800
Hospital Revenue Code	761
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$130.95
Rate for Payer: BCBS Commercial	$1.01
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

CONCUSSION WITH CC

Facility

$9,312.93

Service Code	MSDRG 089
Min. Negotiated Rate	$9,312.93
Max. Negotiated Rate	$9,312.93
Rate for Payer: BCBS Commercial	$9,312.93

CONCUSSION WITH MCC

Facility

$12,219.13

Service Code	MSDRG 088
Min. Negotiated Rate	$12,219.13
Max. Negotiated Rate	$12,219.13
Rate for Payer: BCBS Commercial	$12,219.13

CONCUSSION WITHOUT CC/MCC

Facility

$6,618.96

Service Code	MSDRG 090
Min. Negotiated Rate	$6,618.96
Max. Negotiated Rate	$6,618.96
Rate for Payer: BCBS Commercial	$6,618.96

Know your out-of-pocket cost for care.

All Charges