Ness County Hospital

All Charges

Charge

Type

Setting

Price

FIBRIN(OGEN)DEGRADATION(SPLIT)

Facility

$70.00

Service Code	HCPCS 85362
Hospital Charge Code	8536200
Hospital Revenue Code	305
Min. Negotiated Rate	$57.40
Max. Negotiated Rate	$67.90
Rate for Payer: Cash Price	$52.50
Rate for Payer: Health Partners Plans Commercial	$66.50
Rate for Payer: UnitedHealthcare Commercial	$67.90
Rate for Payer: WPPA Commercial	$57.40

FIBRN DEGRAD PROD,D-DIMER QUAL

Facility

$62.00

Service Code	HCPCS 85378
Hospital Charge Code	8537800
Hospital Revenue Code	305
Min. Negotiated Rate	$50.84
Max. Negotiated Rate	$60.14
Rate for Payer: Cash Price	$46.50
Rate for Payer: Health Partners Plans Commercial	$58.90
Rate for Payer: UnitedHealthcare Commercial	$60.14
Rate for Payer: WPPA Commercial	$50.84

FIBRN DEGRAD PROD,D-DIMER QUAL

Facility

$62.00

Service Code	HCPCS 85378
Hospital Charge Code	8537800
Hospital Revenue Code	305
Min. Negotiated Rate	$28.64
Max. Negotiated Rate	$60.14
Rate for Payer: BCBS Commercial	$48.30
Rate for Payer: Cash Price	$46.50
Rate for Payer: Cash Price	$46.50
Rate for Payer: Celtic Commercial/Exchange	$28.64
Rate for Payer: Health Partners Plans Commercial	$58.90
Rate for Payer: UnitedHealthcare Commercial	$60.14
Rate for Payer: WPPA Commercial	$52.08

FINE NEEDLE ASPIRATION W/IMAG

Facility

$450.00

Service Code	HCPCS 10022
Hospital Charge Code	1002200
Hospital Revenue Code	761
Min. Negotiated Rate	$369.00
Max. Negotiated Rate	$436.50
Rate for Payer: Cash Price	$337.50
Rate for Payer: Health Partners Plans Commercial	$427.50
Rate for Payer: UnitedHealthcare Commercial	$436.50
Rate for Payer: WPPA Commercial	$369.00

FINE NEEDLE ASPIRATION W/IMAG

Facility

$450.00

Service Code	HCPCS 10022
Hospital Charge Code	1002200
Hospital Revenue Code	761
Min. Negotiated Rate	$207.90
Max. Negotiated Rate	$436.50
Rate for Payer: Cash Price	$337.50
Rate for Payer: Celtic Commercial/Exchange	$207.90
Rate for Payer: Health Partners Plans Commercial	$427.50
Rate for Payer: UnitedHealthcare Commercial	$436.50
Rate for Payer: WPPA Commercial	$378.00

FINE NEEDLE ASPIRATION;W/O IMG

Facility

$380.00

Service Code	HCPCS 10021
Hospital Charge Code	1002100
Hospital Revenue Code	450
Min. Negotiated Rate	$311.60
Max. Negotiated Rate	$368.60
Rate for Payer: Cash Price	$285.00
Rate for Payer: Health Partners Plans Commercial	$361.00
Rate for Payer: UnitedHealthcare Commercial	$368.60
Rate for Payer: WPPA Commercial	$311.60

FINE NEEDLE ASPIRATION;W/O IMG

Facility

$380.00

Service Code	HCPCS 10021
Hospital Charge Code	1002100
Hospital Revenue Code	450
Min. Negotiated Rate	$175.56
Max. Negotiated Rate	$499.41
Rate for Payer: BCBS Commercial	$499.41
Rate for Payer: Cash Price	$285.00
Rate for Payer: Cash Price	$285.00
Rate for Payer: Celtic Commercial/Exchange	$175.56
Rate for Payer: Health Partners Plans Commercial	$361.00
Rate for Payer: UnitedHealthcare Commercial	$368.60
Rate for Payer: WPPA Commercial	$319.20

FINGERS LT

Facility

$203.00

Service Code	HCPCS 73140 LT
Hospital Charge Code	3280003
Hospital Revenue Code	320
Min. Negotiated Rate	$93.79
Max. Negotiated Rate	$196.91
Rate for Payer: BCBS Commercial	$110.06
Rate for Payer: Cash Price	$152.25
Rate for Payer: Cash Price	$152.25
Rate for Payer: Celtic Commercial/Exchange	$93.79
Rate for Payer: Health Partners Plans Commercial	$192.85
Rate for Payer: UnitedHealthcare Commercial	$196.91
Rate for Payer: WPPA Commercial	$170.52

FINGERS LT

Facility

$203.00

Service Code	HCPCS 73140 LT
Hospital Charge Code	3280003
Hospital Revenue Code	320
Min. Negotiated Rate	$166.46
Max. Negotiated Rate	$196.91
Rate for Payer: Cash Price	$152.25
Rate for Payer: Health Partners Plans Commercial	$192.85
Rate for Payer: UnitedHealthcare Commercial	$196.91
Rate for Payer: WPPA Commercial	$166.46

FINGER SPLINT 4 PRONG

Facility

$5.00

Hospital Charge Code	2701551
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

FINGER SPLINT 4 PRONG

Facility

$5.00

Hospital Charge Code	2701551
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

FINGER SPLINT 4 PRONG

Facility

$5.00

Hospital Charge Code	2701550
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

FINGER SPLINT 4 PRONG

Facility

$5.00

Hospital Charge Code	2701550
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

FINGER SPLINT BASEBALL LG

Facility

$10.00

Hospital Charge Code	2701456
Hospital Revenue Code	270
Min. Negotiated Rate	$8.20
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$8.06
Rate for Payer: Health Partners Plans Commercial	$9.50
Rate for Payer: UnitedHealthcare Commercial	$9.70
Rate for Payer: WPPA Commercial	$8.20

FINGER SPLINT BASEBALL LG

Facility

$10.00

Hospital Charge Code	2701456
Hospital Revenue Code	270
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$8.06
Rate for Payer: Celtic Commercial/Exchange	$4.62
Rate for Payer: Health Partners Plans Commercial	$9.50
Rate for Payer: UnitedHealthcare Commercial	$9.70
Rate for Payer: WPPA Commercial	$8.40

FINGER SPLINT BASEBALL MD

Facility

$10.00

Hospital Charge Code	2701423
Hospital Revenue Code	270
Min. Negotiated Rate	$8.20
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$8.06
Rate for Payer: Health Partners Plans Commercial	$9.50
Rate for Payer: UnitedHealthcare Commercial	$9.70
Rate for Payer: WPPA Commercial	$8.20

FINGER SPLINT BASEBALL MD

Facility

$10.00

Hospital Charge Code	2701423
Hospital Revenue Code	270
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$8.06
Rate for Payer: Celtic Commercial/Exchange	$4.62
Rate for Payer: Health Partners Plans Commercial	$9.50
Rate for Payer: UnitedHealthcare Commercial	$9.70
Rate for Payer: WPPA Commercial	$8.40

FINGER SPLINT BASEBALL SM

Facility

$10.00

Hospital Charge Code	2701553
Hospital Revenue Code	270
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$8.06
Rate for Payer: Celtic Commercial/Exchange	$4.62
Rate for Payer: Health Partners Plans Commercial	$9.50
Rate for Payer: UnitedHealthcare Commercial	$9.70
Rate for Payer: WPPA Commercial	$8.40

FINGER SPLINT BASEBALL SM

Facility

$10.00

Hospital Charge Code	2701553
Hospital Revenue Code	270
Min. Negotiated Rate	$8.20
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$8.06
Rate for Payer: Health Partners Plans Commercial	$9.50
Rate for Payer: UnitedHealthcare Commercial	$9.70
Rate for Payer: WPPA Commercial	$8.20

FINGER SPLINT COT

Facility

$10.00

Hospital Charge Code	2701549
Hospital Revenue Code	270
Min. Negotiated Rate	$8.20
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$7.50
Rate for Payer: Health Partners Plans Commercial	$9.50
Rate for Payer: UnitedHealthcare Commercial	$9.70
Rate for Payer: WPPA Commercial	$8.20

FINGER SPLINT COT

Facility

$10.00

Hospital Charge Code	2701549
Hospital Revenue Code	270
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$7.50
Rate for Payer: Celtic Commercial/Exchange	$4.62
Rate for Payer: Health Partners Plans Commercial	$9.50
Rate for Payer: UnitedHealthcare Commercial	$9.70
Rate for Payer: WPPA Commercial	$8.40

FINGER SPLINT FROG

Facility

$12.00

Hospital Charge Code	2701552
Hospital Revenue Code	270
Min. Negotiated Rate	$9.84
Max. Negotiated Rate	$11.64
Rate for Payer: Cash Price	$9.38
Rate for Payer: Health Partners Plans Commercial	$11.40
Rate for Payer: UnitedHealthcare Commercial	$11.64
Rate for Payer: WPPA Commercial	$9.84

FINGER SPLINT FROG

Facility

$12.00

Hospital Charge Code	2701552
Hospital Revenue Code	270
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$11.64
Rate for Payer: Cash Price	$9.38
Rate for Payer: Celtic Commercial/Exchange	$5.54
Rate for Payer: Health Partners Plans Commercial	$11.40
Rate for Payer: UnitedHealthcare Commercial	$11.64
Rate for Payer: WPPA Commercial	$10.08

FINGERS RT

Facility

$203.00

Service Code	HCPCS 73140 RT
Hospital Charge Code	3280002
Hospital Revenue Code	320
Min. Negotiated Rate	$166.46
Max. Negotiated Rate	$196.91
Rate for Payer: Cash Price	$152.25
Rate for Payer: Health Partners Plans Commercial	$192.85
Rate for Payer: UnitedHealthcare Commercial	$196.91
Rate for Payer: WPPA Commercial	$166.46

FINGERS RT

Facility

$203.00

Service Code	HCPCS 73140 RT
Hospital Charge Code	3280002
Hospital Revenue Code	320
Min. Negotiated Rate	$93.79
Max. Negotiated Rate	$196.91
Rate for Payer: BCBS Commercial	$110.06
Rate for Payer: Cash Price	$152.25
Rate for Payer: Cash Price	$152.25
Rate for Payer: Celtic Commercial/Exchange	$93.79
Rate for Payer: Health Partners Plans Commercial	$192.85
Rate for Payer: UnitedHealthcare Commercial	$196.91
Rate for Payer: WPPA Commercial	$170.52

Know your out-of-pocket cost for care.

All Charges