Ness County Hospital

All Charges

Charge

Type

Setting

Price

DRESSING ADAPTIC N-ADH 3X8"

Facility

$9.00

Hospital Charge Code	2720862
Hospital Revenue Code	270
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

DRESSING AQUACEL AG ADVANGTAGE 4X5

Facility

$29.00

Hospital Charge Code	2726478LTC
Hospital Revenue Code	272
Min. Negotiated Rate	$13.40
Max. Negotiated Rate	$28.13
Rate for Payer: Cash Price	$21.75
Rate for Payer: Celtic Commercial/Exchange	$13.40
Rate for Payer: Health Partners Plans Commercial	$27.55
Rate for Payer: UnitedHealthcare Commercial	$28.13
Rate for Payer: WPPA Commercial	$24.36

DRESSING AQUACEL AG ADVANGTAGE 4X5

Facility

$29.00

Hospital Charge Code	2726478LTC
Hospital Revenue Code	272
Min. Negotiated Rate	$23.78
Max. Negotiated Rate	$28.13
Rate for Payer: Cash Price	$21.75
Rate for Payer: Health Partners Plans Commercial	$27.55
Rate for Payer: UnitedHealthcare Commercial	$28.13
Rate for Payer: WPPA Commercial	$23.78

DRESSING AQUACEL FOAM SACRALS

Facility

$26.00

Hospital Charge Code	2709412
Hospital Revenue Code	270
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

DRESSING AQUACEL FOAM SACRALS

Facility

$18.00

Hospital Charge Code	2709413
Hospital Revenue Code	270
Min. Negotiated Rate	$8.32
Max. Negotiated Rate	$17.46
Rate for Payer: Cash Price	$13.50
Rate for Payer: Celtic Commercial/Exchange	$8.32
Rate for Payer: Health Partners Plans Commercial	$17.10
Rate for Payer: UnitedHealthcare Commercial	$17.46
Rate for Payer: WPPA Commercial	$15.12

DRESSING AQUACEL FOAM SACRALS

Facility

$18.00

Hospital Charge Code	2709413
Hospital Revenue Code	270
Min. Negotiated Rate	$14.76
Max. Negotiated Rate	$17.46
Rate for Payer: Cash Price	$13.50
Rate for Payer: Health Partners Plans Commercial	$17.10
Rate for Payer: UnitedHealthcare Commercial	$17.46
Rate for Payer: WPPA Commercial	$14.76

DRESSING AQUACEL FOAM SACRALS

Facility

$26.00

Hospital Charge Code	2709412
Hospital Revenue Code	270
Min. Negotiated Rate	$12.01
Max. Negotiated Rate	$25.22
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

DRESSING BORDERED GAUZE ADH ISLAND 4X4

Facility

$9.00

Hospital Charge Code	2725609LTC
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

DRESSING BORDERED GAUZE ADH ISLAND 4X4

Facility

$9.00

Hospital Charge Code	2725609LTC
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

DRESSING BORDERED ISLAND 4X4

Facility

$15.00

Hospital Charge Code	2725611LTC
Hospital Revenue Code	272
Min. Negotiated Rate	$6.93
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$11.25
Rate for Payer: Celtic Commercial/Exchange	$6.93
Rate for Payer: Health Partners Plans Commercial	$14.25
Rate for Payer: UnitedHealthcare Commercial	$14.55
Rate for Payer: WPPA Commercial	$12.60

DRESSING BORDERED ISLAND 4X4

Facility

$15.00

Hospital Charge Code	2725611LTC
Hospital Revenue Code	272
Min. Negotiated Rate	$12.30
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$11.25
Rate for Payer: Health Partners Plans Commercial	$14.25
Rate for Payer: UnitedHealthcare Commercial	$14.55
Rate for Payer: WPPA Commercial	$12.30

DRESSING BORDER GAUZE ADH 4X4

Facility

$9.00

Hospital Charge Code	2725609
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

DRESSING BORDER GAUZE ADH 4X4

Facility

$9.00

Hospital Charge Code	2725609
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

DRESSING BORDER GAUZE ADH 6X6

Facility

$9.00

Hospital Charge Code	2725610
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

DRESSING BORDER GAUZE ADH 6X6

Facility

$9.00

Hospital Charge Code	2725610
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

DRESSING CUTIMED SORBACT 4X5

Facility

$18.00

Hospital Charge Code	2726356
Hospital Revenue Code	272
Min. Negotiated Rate	$14.76
Max. Negotiated Rate	$17.46
Rate for Payer: Cash Price	$13.50
Rate for Payer: Health Partners Plans Commercial	$17.10
Rate for Payer: UnitedHealthcare Commercial	$17.46
Rate for Payer: WPPA Commercial	$14.76

DRESSING CUTIMED SORBACT 4X5

Facility

$18.00

Hospital Charge Code	2726356
Hospital Revenue Code	272
Min. Negotiated Rate	$8.32
Max. Negotiated Rate	$17.46
Rate for Payer: Cash Price	$13.50
Rate for Payer: Celtic Commercial/Exchange	$8.32
Rate for Payer: Health Partners Plans Commercial	$17.10
Rate for Payer: UnitedHealthcare Commercial	$17.46
Rate for Payer: WPPA Commercial	$15.12

DRESSING EXUDERM HYDROCOLLOID

Facility

$30.00

Hospital Charge Code	2723149
Hospital Revenue Code	272
Min. Negotiated Rate	$13.86
Max. Negotiated Rate	$29.10
Rate for Payer: Cash Price	$22.50
Rate for Payer: Celtic Commercial/Exchange	$13.86
Rate for Payer: Health Partners Plans Commercial	$28.50
Rate for Payer: UnitedHealthcare Commercial	$29.10
Rate for Payer: WPPA Commercial	$25.20

DRESSING EXUDERM HYDROCOLLOID

Facility

$30.00

Hospital Charge Code	2723149
Hospital Revenue Code	272
Min. Negotiated Rate	$24.60
Max. Negotiated Rate	$29.10
Rate for Payer: Cash Price	$22.50
Rate for Payer: Health Partners Plans Commercial	$28.50
Rate for Payer: UnitedHealthcare Commercial	$29.10
Rate for Payer: WPPA Commercial	$24.60

DRESSING IV3000 LTC

Facility

$9.00

Hospital Charge Code	2725051LTC
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

DRESSING IV3000 LTC

Facility

$9.00

Hospital Charge Code	2725051LTC
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

DRESSING IV3000 STANDARD

Facility

$9.00

Hospital Charge Code	2725051
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

DRESSING IV3000 STANDARD

Facility

$9.00

Hospital Charge Code	2725051
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

DRESSING KERRAMAX 2X2

Facility

$9.00

Hospital Charge Code	2722602
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

DRESSING KERRAMAX 2X2

Facility

$9.00

Hospital Charge Code	2722602
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

Know your out-of-pocket cost for care.

All Charges