Ness County Hospital

All Charges

Charge

Type

Setting

Price

HANDLING FEE-SPECIMAN-REF LAB

Facility

$20.00

Service Code	HCPCS 99000
Hospital Charge Code	9900000
Hospital Revenue Code	309
Min. Negotiated Rate	$9.24
Max. Negotiated Rate	$19.40
Rate for Payer: BCBS Commercial	$10.85
Rate for Payer: Cash Price	$15.00
Rate for Payer: Cash Price	$15.00
Rate for Payer: Celtic Commercial/Exchange	$9.24
Rate for Payer: Health Partners Plans Commercial	$19.00
Rate for Payer: UnitedHealthcare Commercial	$19.40
Rate for Payer: WPPA Commercial	$16.80

HAND LT 2V

Facility

$264.00

Service Code	HCPCS 73120 LT
Hospital Charge Code	3280005
Hospital Revenue Code	320
Min. Negotiated Rate	$121.97
Max. Negotiated Rate	$256.08
Rate for Payer: BCBS Commercial	$132.93
Rate for Payer: Cash Price	$198.00
Rate for Payer: Cash Price	$198.00
Rate for Payer: Celtic Commercial/Exchange	$121.97
Rate for Payer: Health Partners Plans Commercial	$250.80
Rate for Payer: UnitedHealthcare Commercial	$256.08
Rate for Payer: WPPA Commercial	$221.76

HAND LT 2V

Facility

$264.00

Service Code	HCPCS 73120 LT
Hospital Charge Code	3280005
Hospital Revenue Code	320
Min. Negotiated Rate	$216.48
Max. Negotiated Rate	$256.08
Rate for Payer: Cash Price	$198.00
Rate for Payer: Health Partners Plans Commercial	$250.80
Rate for Payer: UnitedHealthcare Commercial	$256.08
Rate for Payer: WPPA Commercial	$216.48

HAND LT 3V

Facility

$274.00

Service Code	HCPCS 73130 LT
Hospital Charge Code	3280007
Hospital Revenue Code	320
Min. Negotiated Rate	$126.59
Max. Negotiated Rate	$265.78
Rate for Payer: BCBS Commercial	$136.59
Rate for Payer: Cash Price	$205.50
Rate for Payer: Cash Price	$205.50
Rate for Payer: Celtic Commercial/Exchange	$126.59
Rate for Payer: Health Partners Plans Commercial	$260.30
Rate for Payer: UnitedHealthcare Commercial	$265.78
Rate for Payer: WPPA Commercial	$230.16

HAND LT 3V

Facility

$274.00

Service Code	HCPCS 73130 LT
Hospital Charge Code	3280007
Hospital Revenue Code	320
Min. Negotiated Rate	$224.68
Max. Negotiated Rate	$265.78
Rate for Payer: Cash Price	$205.50
Rate for Payer: Health Partners Plans Commercial	$260.30
Rate for Payer: UnitedHealthcare Commercial	$265.78
Rate for Payer: WPPA Commercial	$224.68

HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC

Facility

$13,952.28

Service Code	MSDRG 513
Min. Negotiated Rate	$13,952.28
Max. Negotiated Rate	$13,952.28
Rate for Payer: BCBS Commercial	$13,952.28

HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC

Facility

$7,276.19

Service Code	MSDRG 514
Min. Negotiated Rate	$7,276.19
Max. Negotiated Rate	$7,276.19
Rate for Payer: BCBS Commercial	$7,276.19

HAND PROCEDURES FOR INJURIES

Facility

$11,014.34

Service Code	MSDRG 906
Min. Negotiated Rate	$11,014.34
Max. Negotiated Rate	$11,014.34
Rate for Payer: BCBS Commercial	$11,014.34

HAND RT 2V

Facility

$264.00

Service Code	HCPCS 73120 RT
Hospital Charge Code	3280004
Hospital Revenue Code	320
Min. Negotiated Rate	$216.48
Max. Negotiated Rate	$256.08
Rate for Payer: Cash Price	$198.00
Rate for Payer: Health Partners Plans Commercial	$250.80
Rate for Payer: UnitedHealthcare Commercial	$256.08
Rate for Payer: WPPA Commercial	$216.48

HAND RT 2V

Facility

$264.00

Service Code	HCPCS 73120 RT
Hospital Charge Code	3280004
Hospital Revenue Code	320
Min. Negotiated Rate	$121.97
Max. Negotiated Rate	$256.08
Rate for Payer: BCBS Commercial	$132.93
Rate for Payer: Cash Price	$198.00
Rate for Payer: Cash Price	$198.00
Rate for Payer: Celtic Commercial/Exchange	$121.97
Rate for Payer: Health Partners Plans Commercial	$250.80
Rate for Payer: UnitedHealthcare Commercial	$256.08
Rate for Payer: WPPA Commercial	$221.76

HAND RT 3V

Facility

$274.00

Service Code	HCPCS 73130 RT
Hospital Charge Code	3280006
Hospital Revenue Code	320
Min. Negotiated Rate	$224.68
Max. Negotiated Rate	$265.78
Rate for Payer: Cash Price	$205.50
Rate for Payer: Health Partners Plans Commercial	$260.30
Rate for Payer: UnitedHealthcare Commercial	$265.78
Rate for Payer: WPPA Commercial	$224.68

HAND RT 3V

Facility

$274.00

Service Code	HCPCS 73130 RT
Hospital Charge Code	3280006
Hospital Revenue Code	320
Min. Negotiated Rate	$126.59
Max. Negotiated Rate	$265.78
Rate for Payer: BCBS Commercial	$136.59
Rate for Payer: Cash Price	$205.50
Rate for Payer: Cash Price	$205.50
Rate for Payer: Celtic Commercial/Exchange	$126.59
Rate for Payer: Health Partners Plans Commercial	$260.30
Rate for Payer: UnitedHealthcare Commercial	$265.78
Rate for Payer: WPPA Commercial	$230.16

Hand Thumb Comfyprene Orthosis Adult

Facility

$190.00

Hospital Charge Code	2700102
Hospital Revenue Code	270
Min. Negotiated Rate	$155.80
Max. Negotiated Rate	$184.30
Rate for Payer: Cash Price	$142.50
Rate for Payer: Health Partners Plans Commercial	$180.50
Rate for Payer: UnitedHealthcare Commercial	$184.30
Rate for Payer: WPPA Commercial	$155.80

Hand Thumb Comfyprene Orthosis Adult

Facility

$190.00

Hospital Charge Code	2700102
Hospital Revenue Code	270
Min. Negotiated Rate	$87.78
Max. Negotiated Rate	$184.30
Rate for Payer: Cash Price	$142.50
Rate for Payer: Celtic Commercial/Exchange	$87.78
Rate for Payer: Health Partners Plans Commercial	$180.50
Rate for Payer: UnitedHealthcare Commercial	$184.30
Rate for Payer: WPPA Commercial	$159.60

HAPTOGLOBIN QUANTITATIVE

Facility

$135.00

Service Code	HCPCS 83010
Hospital Charge Code	8301000
Hospital Revenue Code	301
Min. Negotiated Rate	$52.09
Max. Negotiated Rate	$130.95
Rate for Payer: BCBS Commercial	$52.09
Rate for Payer: Cash Price	$101.25
Rate for Payer: Cash Price	$101.25
Rate for Payer: Celtic Commercial/Exchange	$62.37
Rate for Payer: Health Partners Plans Commercial	$128.25
Rate for Payer: UnitedHealthcare Commercial	$130.95
Rate for Payer: WPPA Commercial	$113.40

HAPTOGLOBIN QUANTITATIVE

Facility

$135.00

Service Code	HCPCS 83010
Hospital Charge Code	8301000
Hospital Revenue Code	301
Min. Negotiated Rate	$110.70
Max. Negotiated Rate	$130.95
Rate for Payer: Cash Price	$101.25
Rate for Payer: Health Partners Plans Commercial	$128.25
Rate for Payer: UnitedHealthcare Commercial	$130.95
Rate for Payer: WPPA Commercial	$110.70

HBA1/HBA2 GENE ANALYSIS, FOR

Facility

$485.00

Service Code	HCPCS 81257
Hospital Charge Code	8125700
Hospital Revenue Code	300
Min. Negotiated Rate	$397.70
Max. Negotiated Rate	$470.45
Rate for Payer: Cash Price	$363.75
Rate for Payer: Health Partners Plans Commercial	$460.75
Rate for Payer: UnitedHealthcare Commercial	$470.45
Rate for Payer: WPPA Commercial	$397.70

HBA1/HBA2 GENE ANALYSIS, FOR

Facility

$485.00

Service Code	HCPCS 81257
Hospital Charge Code	8125700
Hospital Revenue Code	300
Min. Negotiated Rate	$224.07
Max. Negotiated Rate	$470.45
Rate for Payer: BCBS Commercial	$371.14
Rate for Payer: Cash Price	$363.75
Rate for Payer: Cash Price	$363.75
Rate for Payer: Celtic Commercial/Exchange	$224.07
Rate for Payer: Health Partners Plans Commercial	$460.75
Rate for Payer: UnitedHealthcare Commercial	$470.45
Rate for Payer: WPPA Commercial	$407.40

HCBS NON-MEDICAL LEV 1 1/4 HR

Facility

$6.00

Service Code	HCPCS S5130
Hospital Charge Code	8300000
Hospital Revenue Code	271
Min. Negotiated Rate	$4.92
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$4.50
Rate for Payer: Health Partners Plans Commercial	$5.70
Rate for Payer: UnitedHealthcare Commercial	$5.82
Rate for Payer: WPPA Commercial	$4.92

HCBS NON-MEDICAL LEV 1 1/4 HR

Facility

$6.00

Service Code	HCPCS S5130
Hospital Charge Code	8300000
Hospital Revenue Code	271
Min. Negotiated Rate	$2.77
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$4.50
Rate for Payer: Celtic Commercial/Exchange	$2.77
Rate for Payer: Health Partners Plans Commercial	$5.70
Rate for Payer: UnitedHealthcare Commercial	$5.82
Rate for Payer: WPPA Commercial	$5.04

HCBS NON MEDICAL LEV 2- 1/4 HR

Facility

$6.00

Service Code	HCPCS S5125
Hospital Charge Code	8300001
Hospital Revenue Code	990
Min. Negotiated Rate	$2.77
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$4.50
Rate for Payer: Celtic Commercial/Exchange	$2.77
Rate for Payer: Health Partners Plans Commercial	$5.70
Rate for Payer: UnitedHealthcare Commercial	$5.82
Rate for Payer: WPPA Commercial	$5.04

HCBS NON MEDICAL LEV 2- 1/4 HR

Facility

$6.00

Service Code	HCPCS S5125
Hospital Charge Code	8300001
Hospital Revenue Code	990
Min. Negotiated Rate	$4.92
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$4.50
Rate for Payer: Health Partners Plans Commercial	$5.70
Rate for Payer: UnitedHealthcare Commercial	$5.82
Rate for Payer: WPPA Commercial	$4.92

HCBS-PD PERSONAL SERVICES

Facility

$6.00

Service Code	HCPCS S5125
Hospital Charge Code	8300003
Hospital Revenue Code	271
Min. Negotiated Rate	$2.77
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$4.50
Rate for Payer: Celtic Commercial/Exchange	$2.77
Rate for Payer: Health Partners Plans Commercial	$5.70
Rate for Payer: UnitedHealthcare Commercial	$5.82
Rate for Payer: WPPA Commercial	$5.04

HCBS-PD PERSONAL SERVICES

Facility

$6.00

Service Code	HCPCS S5125
Hospital Charge Code	8300003
Hospital Revenue Code	271
Min. Negotiated Rate	$4.92
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$4.50
Rate for Payer: Health Partners Plans Commercial	$5.70
Rate for Payer: UnitedHealthcare Commercial	$5.82
Rate for Payer: WPPA Commercial	$4.92

HCBS (TBI) PERSONAL SERVICES

Facility

$13.00

Hospital Charge Code	8300029
Hospital Revenue Code	271
Min. Negotiated Rate	$6.01
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$9.94
Rate for Payer: Celtic Commercial/Exchange	$6.01
Rate for Payer: Health Partners Plans Commercial	$12.35
Rate for Payer: UnitedHealthcare Commercial	$12.61
Rate for Payer: WPPA Commercial	$10.92

Know your out-of-pocket cost for care.

All Charges