Ness County Hospital

All Charges

Charge

Type

Setting

Price

FRACT/DISLOCATION CLOSED TREAT

Facility

$1,075.00

Service Code	HCPCS 27246
Hospital Charge Code	2724600
Hospital Revenue Code	450
Min. Negotiated Rate	$496.65
Max. Negotiated Rate	$1,042.75
Rate for Payer: Cash Price	$806.25
Rate for Payer: Celtic Commercial/Exchange	$496.65
Rate for Payer: Health Partners Plans Commercial	$1,021.25
Rate for Payer: UnitedHealthcare Commercial	$1,042.75
Rate for Payer: WPPA Commercial	$903.00

FRACT/DISLOCATION WITH MANIPUL

Facility

$323.00

Service Code	HCPCS 26755
Hospital Charge Code	2675500
Hospital Revenue Code	450
Min. Negotiated Rate	$149.23
Max. Negotiated Rate	$541.36
Rate for Payer: BCBS Commercial	$541.36
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 WITH MANIPUL

Facility

$323.00

Service Code	HCPCS 26755
Hospital Charge Code	2675500
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

FRACTURE/DISLOCATION MANIPULAT

Facility

$1,530.00

Service Code	HCPCS 25565
Hospital Charge Code	2556500
Hospital Revenue Code	450
Min. Negotiated Rate	$1,254.60
Max. Negotiated Rate	$1,484.10
Rate for Payer: Cash Price	$1,147.50
Rate for Payer: Health Partners Plans Commercial	$1,453.50
Rate for Payer: UnitedHealthcare Commercial	$1,484.10
Rate for Payer: WPPA Commercial	$1,254.60

FRACTURE/DISLOCATION MANIPULAT

Facility

$1,530.00

Service Code	HCPCS 25565
Hospital Charge Code	2556500
Hospital Revenue Code	450
Min. Negotiated Rate	$706.86
Max. Negotiated Rate	$2,000.51
Rate for Payer: BCBS Commercial	$2,000.51
Rate for Payer: Cash Price	$1,147.50
Rate for Payer: Cash Price	$1,147.50
Rate for Payer: Celtic Commercial/Exchange	$706.86
Rate for Payer: Health Partners Plans Commercial	$1,453.50
Rate for Payer: UnitedHealthcare Commercial	$1,484.10
Rate for Payer: WPPA Commercial	$1,285.20

FRACTURES OF FEMUR WITH MCC

Facility

$16,096.37

Service Code	MSDRG 533
Min. Negotiated Rate	$16,096.37
Max. Negotiated Rate	$16,096.37
Rate for Payer: BCBS Commercial	$16,096.37

FRACTURES OF FEMUR WITHOUT MCC

Facility

$8,940.34

Service Code	MSDRG 534
Min. Negotiated Rate	$8,940.34
Max. Negotiated Rate	$8,940.34
Rate for Payer: BCBS Commercial	$8,940.34

FRACTURES OF HIP AND PELVIS WITH MCC

Facility

$11,053.58

Service Code	MSDRG 535
Min. Negotiated Rate	$11,053.58
Max. Negotiated Rate	$11,053.58
Rate for Payer: BCBS Commercial	$11,053.58

FRACTURES OF HIP AND PELVIS WITHOUT MCC

Facility

$7,048.58

Service Code	MSDRG 536
Min. Negotiated Rate	$7,048.58
Max. Negotiated Rate	$7,048.58
Rate for Payer: BCBS Commercial	$7,048.58

FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC

Facility

$12,658.54

Service Code	MSDRG 562
Min. Negotiated Rate	$12,658.54
Max. Negotiated Rate	$12,658.54
Rate for Payer: BCBS Commercial	$12,658.54

FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC

Facility

$7,741.20

Service Code	MSDRG 563
Min. Negotiated Rate	$7,741.20
Max. Negotiated Rate	$7,741.20
Rate for Payer: BCBS Commercial	$7,741.20

FRAGMIN 15,000 UNITS

Facility

$443.00

Hospital Charge Code	2519320
Hospital Revenue Code	250
Min. Negotiated Rate	$204.67
Max. Negotiated Rate	$429.71
Rate for Payer: Cash Price	$332.40
Rate for Payer: Celtic Commercial/Exchange	$204.67
Rate for Payer: Health Partners Plans Commercial	$420.85
Rate for Payer: UnitedHealthcare Commercial	$429.71
Rate for Payer: WPPA Commercial	$372.12

FRAGMIN 15,000 UNITS

Facility

$443.00

Hospital Charge Code	2519320
Hospital Revenue Code	250
Min. Negotiated Rate	$363.26
Max. Negotiated Rate	$429.71
Rate for Payer: Cash Price	$332.40
Rate for Payer: Health Partners Plans Commercial	$420.85
Rate for Payer: UnitedHealthcare Commercial	$429.71
Rate for Payer: WPPA Commercial	$363.26

FRAGMIN 18,000 UNITS/0.72 ML

Facility

$531.00

Hospital Charge Code	2519312
Hospital Revenue Code	250
Min. Negotiated Rate	$435.42
Max. Negotiated Rate	$515.07
Rate for Payer: Cash Price	$398.89
Rate for Payer: Health Partners Plans Commercial	$504.45
Rate for Payer: UnitedHealthcare Commercial	$515.07
Rate for Payer: WPPA Commercial	$435.42

FRAGMIN 18,000 UNITS/0.72 ML

Facility

$531.00

Hospital Charge Code	2519312
Hospital Revenue Code	250
Min. Negotiated Rate	$245.32
Max. Negotiated Rate	$515.07
Rate for Payer: Cash Price	$398.89
Rate for Payer: Celtic Commercial/Exchange	$245.32
Rate for Payer: Health Partners Plans Commercial	$504.45
Rate for Payer: UnitedHealthcare Commercial	$515.07
Rate for Payer: WPPA Commercial	$446.04

FRESH FROZEN PLASMA,8-24 HR

Facility

$73.00

Service Code	HCPCS 86945
Hospital Charge Code	P905900
Hospital Revenue Code	390
Min. Negotiated Rate	$33.73
Max. Negotiated Rate	$70.81
Rate for Payer: Cash Price	$54.75
Rate for Payer: Celtic Commercial/Exchange	$33.73
Rate for Payer: Health Partners Plans Commercial	$69.35
Rate for Payer: UnitedHealthcare Commercial	$70.81
Rate for Payer: WPPA Commercial	$61.32

FRESH FROZEN PLASMA,8-24 HR

Facility

$73.00

Service Code	HCPCS 86945
Hospital Charge Code	P905900
Hospital Revenue Code	390
Min. Negotiated Rate	$59.86
Max. Negotiated Rate	$70.81
Rate for Payer: Cash Price	$54.75
Rate for Payer: Health Partners Plans Commercial	$69.35
Rate for Payer: UnitedHealthcare Commercial	$70.81
Rate for Payer: WPPA Commercial	$59.86

FTA-ABS

Facility

$101.00

Service Code	HCPCS 86780
Hospital Charge Code	8678000
Hospital Revenue Code	302
Min. Negotiated Rate	$82.82
Max. Negotiated Rate	$97.97
Rate for Payer: Cash Price	$75.75
Rate for Payer: Health Partners Plans Commercial	$95.95
Rate for Payer: UnitedHealthcare Commercial	$97.97
Rate for Payer: WPPA Commercial	$82.82

FTA-ABS

Facility

$101.00

Service Code	HCPCS 86780
Hospital Charge Code	8678000
Hospital Revenue Code	302
Min. Negotiated Rate	$46.66
Max. Negotiated Rate	$97.97
Rate for Payer: BCBS Commercial	$53.11
Rate for Payer: Cash Price	$75.75
Rate for Payer: Cash Price	$75.75
Rate for Payer: Celtic Commercial/Exchange	$46.66
Rate for Payer: Health Partners Plans Commercial	$95.95
Rate for Payer: UnitedHealthcare Commercial	$97.97
Rate for Payer: WPPA Commercial	$84.84

FULL TERM NEONATE WITH MAJOR PROBLEMS

Facility

$37,071.94

Service Code	MSDRG 793
Min. Negotiated Rate	$37,071.94
Max. Negotiated Rate	$37,071.94
Rate for Payer: BCBS Commercial	$37,071.94

FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY

Facility

$17,402.59

Service Code	MSDRG 934
Min. Negotiated Rate	$17,402.59
Max. Negotiated Rate	$17,402.59
Rate for Payer: BCBS Commercial	$17,402.59

FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CC/MCC

Facility

$43,531.05

Service Code	MSDRG 928
Min. Negotiated Rate	$43,531.05
Max. Negotiated Rate	$43,531.05
Rate for Payer: BCBS Commercial	$43,531.05

FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CC/MCC

Facility

$18,881.23

Service Code	MSDRG 929
Min. Negotiated Rate	$18,881.23
Max. Negotiated Rate	$18,881.23
Rate for Payer: BCBS Commercial	$18,881.23

Fulphila (pegfilgrastim-jmdb) subQ syringe

Facility

$25,050.00

Service Code	NDC 67457083306
Hospital Charge Code	2512416
Hospital Revenue Code	250
Min. Negotiated Rate	$11,573.10
Max. Negotiated Rate	$24,298.50
Rate for Payer: Cash Price	$18,787.50
Rate for Payer: Celtic Commercial/Exchange	$11,573.10
Rate for Payer: Health Partners Plans Commercial	$23,797.50
Rate for Payer: UnitedHealthcare Commercial	$24,298.50
Rate for Payer: WPPA Commercial	$21,042.00

Fulphila (pegfilgrastim-jmdb) subQ syringe

Facility

$25,050.00

Service Code	NDC 67457083306
Hospital Charge Code	2512416
Hospital Revenue Code	250
Min. Negotiated Rate	$20,541.00
Max. Negotiated Rate	$24,298.50
Rate for Payer: Cash Price	$18,787.50
Rate for Payer: Health Partners Plans Commercial	$23,797.50
Rate for Payer: UnitedHealthcare Commercial	$24,298.50
Rate for Payer: WPPA Commercial	$20,541.00

Know your out-of-pocket cost for care.

All Charges