Ness County Hospital

All Charges

Charge

Type

Setting

Price

EXTENSION SET 72"

Facility

$50.00

Hospital Charge Code	2519676
Hospital Revenue Code	270
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$48.50
Rate for Payer: Cash Price	$37.50
Rate for Payer: Celtic Commercial/Exchange	$23.10
Rate for Payer: Health Partners Plans Commercial	$47.50
Rate for Payer: UnitedHealthcare Commercial	$48.50
Rate for Payer: WPPA Commercial	$42.00

EXTENSION TUBING 30"

Facility

$38.00

Hospital Charge Code	2580249
Hospital Revenue Code	270
Min. Negotiated Rate	$17.56
Max. Negotiated Rate	$36.86
Rate for Payer: Cash Price	$28.80
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

EXTENSION TUBING 30"

Facility

$38.00

Hospital Charge Code	2580249
Hospital Revenue Code	270
Min. Negotiated Rate	$31.16
Max. Negotiated Rate	$36.86
Rate for Payer: Cash Price	$28.80
Rate for Payer: Health Partners Plans Commercial	$36.10
Rate for Payer: UnitedHealthcare Commercial	$36.86
Rate for Payer: WPPA Commercial	$31.16

EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT

Facility

$20,611.98

Service Code	MSDRG 933
Min. Negotiated Rate	$20,611.98
Max. Negotiated Rate	$20,611.98
Rate for Payer: BCBS Commercial	$20,611.98

EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT

Facility

$125,771.83

Service Code	MSDRG 927
Min. Negotiated Rate	$125,771.83
Max. Negotiated Rate	$125,771.83
Rate for Payer: BCBS Commercial	$125,771.83

EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC

Facility

$22,513.61

Service Code	MSDRG 982
Min. Negotiated Rate	$22,513.61
Max. Negotiated Rate	$22,513.61
Rate for Payer: BCBS Commercial	$22,513.61

EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC

Facility

$41,374.77

Service Code	MSDRG 981
Min. Negotiated Rate	$41,374.77
Max. Negotiated Rate	$41,374.77
Rate for Payer: BCBS Commercial	$41,374.77

EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC

Facility

$15,272.98

Service Code	MSDRG 983
Min. Negotiated Rate	$15,272.98
Max. Negotiated Rate	$15,272.98
Rate for Payer: BCBS Commercial	$15,272.98

EXTRACRANIAL PROCEDURES WITH CC

Facility

$14,722.69

Service Code	MSDRG 038
Min. Negotiated Rate	$14,722.69
Max. Negotiated Rate	$14,722.69
Rate for Payer: BCBS Commercial	$14,722.69

EXTRACRANIAL PROCEDURES WITH MCC

Facility

$29,090.37

Service Code	MSDRG 037
Min. Negotiated Rate	$29,090.37
Max. Negotiated Rate	$29,090.37
Rate for Payer: BCBS Commercial	$29,090.37

EXTRACRANIAL PROCEDURES WITHOUT CC/MCC

Facility

$10,127.25

Service Code	MSDRG 039
Min. Negotiated Rate	$10,127.25
Max. Negotiated Rate	$10,127.25
Rate for Payer: BCBS Commercial	$10,127.25

EXTRAOCULAR PROCEDURES EXCEPT ORBIT

Facility

$10,336.78

Service Code	MSDRG 115
Min. Negotiated Rate	$10,336.78
Max. Negotiated Rate	$10,336.78
Rate for Payer: BCBS Commercial	$10,336.78

EXTRCT NUCLR ANTIGEN,ANY METHD

Facility

$368.00

Service Code	HCPCS 86235
Hospital Charge Code	8623500
Hospital Revenue Code	302
Min. Negotiated Rate	$52.26
Max. Negotiated Rate	$356.96
Rate for Payer: BCBS Commercial	$52.26
Rate for Payer: Cash Price	$276.00
Rate for Payer: Cash Price	$276.00
Rate for Payer: Celtic Commercial/Exchange	$170.02
Rate for Payer: Health Partners Plans Commercial	$349.60
Rate for Payer: UnitedHealthcare Commercial	$356.96
Rate for Payer: WPPA Commercial	$309.12

EXTRCT NUCLR ANTIGEN,ANY METHD

Facility

$368.00

Service Code	HCPCS 86235
Hospital Charge Code	8623500
Hospital Revenue Code	302
Min. Negotiated Rate	$301.76
Max. Negotiated Rate	$356.96
Rate for Payer: Cash Price	$276.00
Rate for Payer: Health Partners Plans Commercial	$349.60
Rate for Payer: UnitedHealthcare Commercial	$356.96
Rate for Payer: WPPA Commercial	$301.76

EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE

Facility

$50,857.49

Service Code	MSDRG 790
Min. Negotiated Rate	$50,857.49
Max. Negotiated Rate	$50,857.49
Rate for Payer: BCBS Commercial	$50,857.49

EXTREMITY NONVASCULAR

Facility

$467.00

Service Code	HCPCS 76882
Hospital Charge Code	7688200
Hospital Revenue Code	402
Min. Negotiated Rate	$132.93
Max. Negotiated Rate	$452.99
Rate for Payer: BCBS Commercial	$132.93
Rate for Payer: Cash Price	$350.25
Rate for Payer: Cash Price	$350.25
Rate for Payer: Celtic Commercial/Exchange	$215.75
Rate for Payer: Health Partners Plans Commercial	$443.65
Rate for Payer: UnitedHealthcare Commercial	$452.99
Rate for Payer: WPPA Commercial	$392.28

EXTREMITY NONVASCULAR

Facility

$467.00

Service Code	HCPCS 76882
Hospital Charge Code	7688200
Hospital Revenue Code	402
Min. Negotiated Rate	$382.94
Max. Negotiated Rate	$452.99
Rate for Payer: Cash Price	$350.25
Rate for Payer: Health Partners Plans Commercial	$443.65
Rate for Payer: UnitedHealthcare Commercial	$452.99
Rate for Payer: WPPA Commercial	$382.94

EYE WASH DEL SYSTEM

Facility

$18.00

Hospital Charge Code	2700029
Hospital Revenue Code	270
Min. Negotiated Rate	$8.32
Max. Negotiated Rate	$17.46
Rate for Payer: Cash Price	$13.69
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

EYE WASH DEL SYSTEM

Facility

$18.00

Hospital Charge Code	2700029
Hospital Revenue Code	270
Min. Negotiated Rate	$14.76
Max. Negotiated Rate	$17.46
Rate for Payer: Cash Price	$13.69
Rate for Payer: Health Partners Plans Commercial	$17.10
Rate for Payer: UnitedHealthcare Commercial	$17.46
Rate for Payer: WPPA Commercial	$14.76

EZ-IO ADULT NEEDLE

Facility

$474.00

Hospital Charge Code	2727168
Hospital Revenue Code	272
Min. Negotiated Rate	$388.68
Max. Negotiated Rate	$459.78
Rate for Payer: Cash Price	$355.50
Rate for Payer: Health Partners Plans Commercial	$450.30
Rate for Payer: UnitedHealthcare Commercial	$459.78
Rate for Payer: WPPA Commercial	$388.68

EZ-IO ADULT NEEDLE

Facility

$474.00

Hospital Charge Code	2727168
Hospital Revenue Code	272
Min. Negotiated Rate	$218.99
Max. Negotiated Rate	$459.78
Rate for Payer: Cash Price	$355.50
Rate for Payer: Celtic Commercial/Exchange	$218.99
Rate for Payer: Health Partners Plans Commercial	$450.30
Rate for Payer: UnitedHealthcare Commercial	$459.78
Rate for Payer: WPPA Commercial	$398.16

F2 PROTHROMBIN COAG FACTOR II

Facility

$245.00

Service Code	HCPCS 81240
Hospital Charge Code	8124000
Hospital Revenue Code	300
Min. Negotiated Rate	$113.19
Max. Negotiated Rate	$237.65
Rate for Payer: BCBS Commercial	$190.18
Rate for Payer: Cash Price	$183.75
Rate for Payer: Cash Price	$183.75
Rate for Payer: Celtic Commercial/Exchange	$113.19
Rate for Payer: Health Partners Plans Commercial	$232.75
Rate for Payer: UnitedHealthcare Commercial	$237.65
Rate for Payer: WPPA Commercial	$205.80

F2 PROTHROMBIN COAG FACTOR II

Facility

$245.00

Service Code	HCPCS 81240
Hospital Charge Code	8124000
Hospital Revenue Code	300
Min. Negotiated Rate	$200.90
Max. Negotiated Rate	$237.65
Rate for Payer: Cash Price	$183.75
Rate for Payer: Health Partners Plans Commercial	$232.75
Rate for Payer: UnitedHealthcare Commercial	$237.65
Rate for Payer: WPPA Commercial	$200.90

FACE TENT

Facility

$15.00

Hospital Charge Code	4100194
Hospital Revenue Code	270
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

FACE TENT

Facility

$15.00

Hospital Charge Code	4100194
Hospital Revenue Code	270
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

Know your out-of-pocket cost for care.

All Charges