Ness County Hospital

All Charges

Charge

Type

Setting

Price

FOLIC ACID SERUM

Facility

$139.00

Service Code	HCPCS 82746
Hospital Charge Code	8274600
Hospital Revenue Code	301
Min. Negotiated Rate	$61.81
Max. Negotiated Rate	$134.83
Rate for Payer: BCBS Commercial	$61.81
Rate for Payer: Cash Price	$104.25
Rate for Payer: Cash Price	$104.25
Rate for Payer: Celtic Commercial/Exchange	$64.22
Rate for Payer: Health Partners Plans Commercial	$132.05
Rate for Payer: UnitedHealthcare Commercial	$134.83
Rate for Payer: WPPA Commercial	$116.76

FOOT LT 2V

Facility

$160.00

Service Code	HCPCS 73620 LT
Hospital Charge Code	3290005
Hospital Revenue Code	320
Min. Negotiated Rate	$73.92
Max. Negotiated Rate	$155.20
Rate for Payer: BCBS Commercial	$110.06
Rate for Payer: Cash Price	$120.45
Rate for Payer: Cash Price	$120.45
Rate for Payer: Celtic Commercial/Exchange	$73.92
Rate for Payer: Health Partners Plans Commercial	$152.00
Rate for Payer: UnitedHealthcare Commercial	$155.20
Rate for Payer: WPPA Commercial	$134.40

FOOT LT 2V

Facility

$160.00

Service Code	HCPCS 73620 LT
Hospital Charge Code	3290005
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

FOOT LT 3V

Facility

$284.00

Service Code	HCPCS 73630 LT
Hospital Charge Code	3290007
Hospital Revenue Code	320
Min. Negotiated Rate	$131.21
Max. Negotiated Rate	$275.48
Rate for Payer: BCBS Commercial	$134.73
Rate for Payer: Cash Price	$213.00
Rate for Payer: Cash Price	$213.00
Rate for Payer: Celtic Commercial/Exchange	$131.21
Rate for Payer: Health Partners Plans Commercial	$269.80
Rate for Payer: UnitedHealthcare Commercial	$275.48
Rate for Payer: WPPA Commercial	$238.56

FOOT LT 3V

Facility

$284.00

Service Code	HCPCS 73630 LT
Hospital Charge Code	3290007
Hospital Revenue Code	320
Min. Negotiated Rate	$232.88
Max. Negotiated Rate	$275.48
Rate for Payer: Cash Price	$213.00
Rate for Payer: Health Partners Plans Commercial	$269.80
Rate for Payer: UnitedHealthcare Commercial	$275.48
Rate for Payer: WPPA Commercial	$232.88

FOOT PROCEDURES WITH CC

Facility

$15,754.02

Service Code	MSDRG 504
Min. Negotiated Rate	$15,754.02
Max. Negotiated Rate	$15,754.02
Rate for Payer: BCBS Commercial	$15,754.02

FOOT PROCEDURES WITH MCC

Facility

$18,876.40

Service Code	MSDRG 503
Min. Negotiated Rate	$18,876.40
Max. Negotiated Rate	$18,876.40
Rate for Payer: BCBS Commercial	$18,876.40

FOOT PROCEDURES WITHOUT CC/MCC

Facility

$15,754.02

Service Code	MSDRG 505
Min. Negotiated Rate	$15,754.02
Max. Negotiated Rate	$15,754.02
Rate for Payer: BCBS Commercial	$15,754.02

FOOT RT 2V

Facility

$209.00

Service Code	HCPCS 73620 RT
Hospital Charge Code	3290004
Hospital Revenue Code	320
Min. Negotiated Rate	$96.56
Max. Negotiated Rate	$202.73
Rate for Payer: BCBS Commercial	$110.06
Rate for Payer: Cash Price	$156.75
Rate for Payer: Cash Price	$156.75
Rate for Payer: Celtic Commercial/Exchange	$96.56
Rate for Payer: Health Partners Plans Commercial	$198.55
Rate for Payer: UnitedHealthcare Commercial	$202.73
Rate for Payer: WPPA Commercial	$175.56

FOOT RT 2V

Facility

$209.00

Service Code	HCPCS 73620 RT
Hospital Charge Code	3290004
Hospital Revenue Code	320
Min. Negotiated Rate	$171.38
Max. Negotiated Rate	$202.73
Rate for Payer: Cash Price	$156.75
Rate for Payer: Health Partners Plans Commercial	$198.55
Rate for Payer: UnitedHealthcare Commercial	$202.73
Rate for Payer: WPPA Commercial	$171.38

FOOT RT 3V

Facility

$284.00

Service Code	HCPCS 73630 RT
Hospital Charge Code	3290006
Hospital Revenue Code	320
Min. Negotiated Rate	$131.21
Max. Negotiated Rate	$275.48
Rate for Payer: BCBS Commercial	$134.73
Rate for Payer: Cash Price	$213.00
Rate for Payer: Cash Price	$213.00
Rate for Payer: Celtic Commercial/Exchange	$131.21
Rate for Payer: Health Partners Plans Commercial	$269.80
Rate for Payer: UnitedHealthcare Commercial	$275.48
Rate for Payer: WPPA Commercial	$238.56

FOOT RT 3V

Facility

$284.00

Service Code	HCPCS 73630 RT
Hospital Charge Code	3290006
Hospital Revenue Code	320
Min. Negotiated Rate	$232.88
Max. Negotiated Rate	$275.48
Rate for Payer: Cash Price	$213.00
Rate for Payer: Health Partners Plans Commercial	$269.80
Rate for Payer: UnitedHealthcare Commercial	$275.48
Rate for Payer: WPPA Commercial	$232.88

FOREARM LT

Facility

$231.00

Service Code	HCPCS 73090 LT
Hospital Charge Code	3280013
Hospital Revenue Code	320
Min. Negotiated Rate	$106.72
Max. Negotiated Rate	$224.07
Rate for Payer: BCBS Commercial	$124.51
Rate for Payer: Cash Price	$173.25
Rate for Payer: Cash Price	$173.25
Rate for Payer: Celtic Commercial/Exchange	$106.72
Rate for Payer: Health Partners Plans Commercial	$219.45
Rate for Payer: UnitedHealthcare Commercial	$224.07
Rate for Payer: WPPA Commercial	$194.04

FOREARM LT

Facility

$231.00

Service Code	HCPCS 73090 LT
Hospital Charge Code	3280013
Hospital Revenue Code	320
Min. Negotiated Rate	$189.42
Max. Negotiated Rate	$224.07
Rate for Payer: Cash Price	$173.25
Rate for Payer: Health Partners Plans Commercial	$219.45
Rate for Payer: UnitedHealthcare Commercial	$224.07
Rate for Payer: WPPA Commercial	$189.42

FOREARM RT

Facility

$231.00

Service Code	HCPCS 73090 RT
Hospital Charge Code	3280012
Hospital Revenue Code	320
Min. Negotiated Rate	$189.42
Max. Negotiated Rate	$224.07
Rate for Payer: Cash Price	$173.25
Rate for Payer: Health Partners Plans Commercial	$219.45
Rate for Payer: UnitedHealthcare Commercial	$224.07
Rate for Payer: WPPA Commercial	$189.42

FOREARM RT

Facility

$231.00

Service Code	HCPCS 73090 RT
Hospital Charge Code	3280012
Hospital Revenue Code	320
Min. Negotiated Rate	$106.72
Max. Negotiated Rate	$224.07
Rate for Payer: BCBS Commercial	$124.51
Rate for Payer: Cash Price	$173.25
Rate for Payer: Cash Price	$173.25
Rate for Payer: Celtic Commercial/Exchange	$106.72
Rate for Payer: Health Partners Plans Commercial	$219.45
Rate for Payer: UnitedHealthcare Commercial	$224.07
Rate for Payer: WPPA Commercial	$194.04

FOREIGN BODY CHILD 1V FULL BOD

Facility

$160.00

Service Code	HCPCS 76010
Hospital Charge Code	3250014
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

FOREIGN BODY CHILD 1V FULL BOD

Facility

$160.00

Service Code	HCPCS 76010
Hospital Charge Code	3250014
Hospital Revenue Code	320
Min. Negotiated Rate	$73.92
Max. Negotiated Rate	$155.20
Rate for Payer: BCBS Commercial	$112.43
Rate for Payer: Cash Price	$120.45
Rate for Payer: Cash Price	$120.45
Rate for Payer: Celtic Commercial/Exchange	$73.92
Rate for Payer: Health Partners Plans Commercial	$152.00
Rate for Payer: UnitedHealthcare Commercial	$155.20
Rate for Payer: WPPA Commercial	$134.40

FORTAZ 1 GM DUPLEX

Facility

$58.00

Hospital Charge Code	2519551
Hospital Revenue Code	250
Min. Negotiated Rate	$26.80
Max. Negotiated Rate	$56.26
Rate for Payer: Cash Price	$43.91
Rate for Payer: Celtic Commercial/Exchange	$26.80
Rate for Payer: Health Partners Plans Commercial	$55.10
Rate for Payer: UnitedHealthcare Commercial	$56.26
Rate for Payer: WPPA Commercial	$48.72

FORTAZ 1 GM DUPLEX

Facility

$58.00

Hospital Charge Code	2519551
Hospital Revenue Code	250
Min. Negotiated Rate	$47.56
Max. Negotiated Rate	$56.26
Rate for Payer: Cash Price	$43.91
Rate for Payer: Health Partners Plans Commercial	$55.10
Rate for Payer: UnitedHealthcare Commercial	$56.26
Rate for Payer: WPPA Commercial	$47.56

Fortaz 1 gm INJ (ceftazidime/tazicef)

Facility

$21.00

Service Code	NDC 44567023525
Hospital Charge Code	2502482
Hospital Revenue Code	636
Min. Negotiated Rate	$9.70
Max. Negotiated Rate	$20.37
Rate for Payer: Cash Price	$16.09
Rate for Payer: Celtic Commercial/Exchange	$9.70
Rate for Payer: Health Partners Plans Commercial	$19.95
Rate for Payer: UnitedHealthcare Commercial	$20.37
Rate for Payer: WPPA Commercial	$17.64

Fortaz 1 gm INJ (ceftazidime/tazicef)

Facility

$21.00

Service Code	NDC 44567023525
Hospital Charge Code	2502482
Hospital Revenue Code	636
Min. Negotiated Rate	$17.22
Max. Negotiated Rate	$20.37
Rate for Payer: Cash Price	$16.09
Rate for Payer: Health Partners Plans Commercial	$19.95
Rate for Payer: UnitedHealthcare Commercial	$20.37
Rate for Payer: WPPA Commercial	$17.22

FRAC/DISLOCAT WITH MANIP

Facility

$323.00

Service Code	HCPCS 26725
Hospital Charge Code	2672500
Hospital Revenue Code	450
Min. Negotiated Rate	$264.86
Max. Negotiated Rate	$313.31
Rate for Payer: Cash Price	$242.25
Rate for Payer: Health Partners Plans Commercial	$306.85
Rate for Payer: UnitedHealthcare Commercial	$313.31
Rate for Payer: WPPA Commercial	$264.86

FRAC/DISLOCAT WITH MANIP

Facility

$323.00

Service Code	HCPCS 26725
Hospital Charge Code	2672500
Hospital Revenue Code	450
Min. Negotiated Rate	$149.23
Max. Negotiated Rate	$1,137.26
Rate for Payer: BCBS Commercial	$1,137.26
Rate for Payer: Cash Price	$242.25
Rate for Payer: Cash Price	$242.25
Rate for Payer: Celtic Commercial/Exchange	$149.23
Rate for Payer: Health Partners Plans Commercial	$306.85
Rate for Payer: UnitedHealthcare Commercial	$313.31
Rate for Payer: WPPA Commercial	$271.32

FRACT/DISLOCATION CLOSED TREAT

Facility

$1,075.00

Service Code	HCPCS 27246
Hospital Charge Code	2724600
Hospital Revenue Code	450
Min. Negotiated Rate	$881.50
Max. Negotiated Rate	$1,042.75
Rate for Payer: Cash Price	$806.25
Rate for Payer: Health Partners Plans Commercial	$1,021.25
Rate for Payer: UnitedHealthcare Commercial	$1,042.75
Rate for Payer: WPPA Commercial	$881.50

Know your out-of-pocket cost for care.

All Charges