Ness County Hospital

All Charges

Charge

Type

Setting

Price

KNEE IMMOBILIZER 19" MD

Facility

$60.00

Hospital Charge Code	2701029
Hospital Revenue Code	270
Min. Negotiated Rate	$27.72
Max. Negotiated Rate	$58.20
Rate for Payer: Cash Price	$45.00
Rate for Payer: Celtic Commercial/Exchange	$27.72
Rate for Payer: Health Partners Plans Commercial	$57.00
Rate for Payer: UnitedHealthcare Commercial	$58.20
Rate for Payer: WPPA Commercial	$50.40

KNEE IMMOBILIZER 19" MD

Facility

$60.00

Hospital Charge Code	2701029
Hospital Revenue Code	270
Min. Negotiated Rate	$49.20
Max. Negotiated Rate	$58.20
Rate for Payer: Cash Price	$45.00
Rate for Payer: Health Partners Plans Commercial	$57.00
Rate for Payer: UnitedHealthcare Commercial	$58.20
Rate for Payer: WPPA Commercial	$49.20

KNEE IMMOBILIZER 19" SM

Facility

$60.00

Hospital Charge Code	2701030
Hospital Revenue Code	270
Min. Negotiated Rate	$49.20
Max. Negotiated Rate	$58.20
Rate for Payer: Cash Price	$45.00
Rate for Payer: Health Partners Plans Commercial	$57.00
Rate for Payer: UnitedHealthcare Commercial	$58.20
Rate for Payer: WPPA Commercial	$49.20

KNEE IMMOBILIZER 19" SM

Facility

$60.00

Hospital Charge Code	2701030
Hospital Revenue Code	270
Min. Negotiated Rate	$27.72
Max. Negotiated Rate	$58.20
Rate for Payer: Cash Price	$45.00
Rate for Payer: Celtic Commercial/Exchange	$27.72
Rate for Payer: Health Partners Plans Commercial	$57.00
Rate for Payer: UnitedHealthcare Commercial	$58.20
Rate for Payer: WPPA Commercial	$50.40

KNEE IMMOBILIZER 19" XL

Facility

$60.00

Hospital Charge Code	2701031
Hospital Revenue Code	270
Min. Negotiated Rate	$27.72
Max. Negotiated Rate	$58.20
Rate for Payer: Cash Price	$45.00
Rate for Payer: Celtic Commercial/Exchange	$27.72
Rate for Payer: Health Partners Plans Commercial	$57.00
Rate for Payer: UnitedHealthcare Commercial	$58.20
Rate for Payer: WPPA Commercial	$50.40

KNEE IMMOBILIZER 19" XL

Facility

$60.00

Hospital Charge Code	2701031
Hospital Revenue Code	270
Min. Negotiated Rate	$49.20
Max. Negotiated Rate	$58.20
Rate for Payer: Cash Price	$45.00
Rate for Payer: Health Partners Plans Commercial	$57.00
Rate for Payer: UnitedHealthcare Commercial	$58.20
Rate for Payer: WPPA Commercial	$49.20

KNEE IMOBILIZER 12" SM

Facility

$60.00

Hospital Charge Code	2701032
Hospital Revenue Code	272
Min. Negotiated Rate	$27.72
Max. Negotiated Rate	$58.20
Rate for Payer: Cash Price	$45.00
Rate for Payer: Celtic Commercial/Exchange	$27.72
Rate for Payer: Health Partners Plans Commercial	$57.00
Rate for Payer: UnitedHealthcare Commercial	$58.20
Rate for Payer: WPPA Commercial	$50.40

KNEE IMOBILIZER 12" SM

Facility

$60.00

Hospital Charge Code	2701032
Hospital Revenue Code	272
Min. Negotiated Rate	$49.20
Max. Negotiated Rate	$58.20
Rate for Payer: Cash Price	$45.00
Rate for Payer: Health Partners Plans Commercial	$57.00
Rate for Payer: UnitedHealthcare Commercial	$58.20
Rate for Payer: WPPA Commercial	$49.20

KNEE LT 2V

Facility

$203.00

Service Code	HCPCS 73560 LT
Hospital Charge Code	3290017
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

KNEE LT 2V

Facility

$203.00

Service Code	HCPCS 73560 LT
Hospital Charge Code	3290017
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

KNEE LT 3V

Facility

$314.00

Service Code	HCPCS 73562 LT
Hospital Charge Code	3290050
Hospital Revenue Code	320
Min. Negotiated Rate	$145.07
Max. Negotiated Rate	$304.58
Rate for Payer: BCBS Commercial	$149.60
Rate for Payer: Cash Price	$235.50
Rate for Payer: Cash Price	$235.50
Rate for Payer: Celtic Commercial/Exchange	$145.07
Rate for Payer: Health Partners Plans Commercial	$298.30
Rate for Payer: UnitedHealthcare Commercial	$304.58
Rate for Payer: WPPA Commercial	$263.76

KNEE LT 3V

Facility

$314.00

Service Code	HCPCS 73562 LT
Hospital Charge Code	3290050
Hospital Revenue Code	320
Min. Negotiated Rate	$257.48
Max. Negotiated Rate	$304.58
Rate for Payer: Cash Price	$235.50
Rate for Payer: Health Partners Plans Commercial	$298.30
Rate for Payer: UnitedHealthcare Commercial	$304.58
Rate for Payer: WPPA Commercial	$257.48

KNEE LT 4+V

Facility

$344.00

Service Code	HCPCS 73564 LT
Hospital Charge Code	3290023
Hospital Revenue Code	320
Min. Negotiated Rate	$158.93
Max. Negotiated Rate	$333.68
Rate for Payer: BCBS Commercial	$216.50
Rate for Payer: Cash Price	$258.00
Rate for Payer: Cash Price	$258.00
Rate for Payer: Celtic Commercial/Exchange	$158.93
Rate for Payer: Health Partners Plans Commercial	$326.80
Rate for Payer: UnitedHealthcare Commercial	$333.68
Rate for Payer: WPPA Commercial	$288.96

KNEE LT 4+V

Facility

$344.00

Service Code	HCPCS 73564 LT
Hospital Charge Code	3290023
Hospital Revenue Code	320
Min. Negotiated Rate	$282.08
Max. Negotiated Rate	$333.68
Rate for Payer: Cash Price	$258.00
Rate for Payer: Health Partners Plans Commercial	$326.80
Rate for Payer: UnitedHealthcare Commercial	$333.68
Rate for Payer: WPPA Commercial	$282.08

KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC

Facility

$17,535.33

Service Code	MSDRG 488
Min. Negotiated Rate	$17,535.33
Max. Negotiated Rate	$17,535.33
Rate for Payer: BCBS Commercial	$17,535.33

KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC

Facility

$11,697.05

Service Code	MSDRG 489
Min. Negotiated Rate	$11,697.05
Max. Negotiated Rate	$11,697.05
Rate for Payer: BCBS Commercial	$11,697.05

KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC

Facility

$19,077.01

Service Code	MSDRG 486
Min. Negotiated Rate	$19,077.01
Max. Negotiated Rate	$19,077.01
Rate for Payer: BCBS Commercial	$19,077.01

KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC

Facility

$30,261.93

Service Code	MSDRG 485
Min. Negotiated Rate	$30,261.93
Max. Negotiated Rate	$30,261.93
Rate for Payer: BCBS Commercial	$30,261.93

KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC

Facility

$14,557.60

Service Code	MSDRG 487
Min. Negotiated Rate	$14,557.60
Max. Negotiated Rate	$14,557.60
Rate for Payer: BCBS Commercial	$14,557.60

KNEE RT 2V

Facility

$203.00

Service Code	HCPCS 73560 RT
Hospital Charge Code	3290016
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

KNEE RT 2V

Facility

$203.00

Service Code	HCPCS 73560 RT
Hospital Charge Code	3290016
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

KNEE RT 3V

Facility

$314.00

Service Code	HCPCS 73562 RT
Hospital Charge Code	3290018
Hospital Revenue Code	320
Min. Negotiated Rate	$145.07
Max. Negotiated Rate	$304.58
Rate for Payer: BCBS Commercial	$149.60
Rate for Payer: Cash Price	$235.50
Rate for Payer: Cash Price	$235.50
Rate for Payer: Celtic Commercial/Exchange	$145.07
Rate for Payer: Health Partners Plans Commercial	$298.30
Rate for Payer: UnitedHealthcare Commercial	$304.58
Rate for Payer: WPPA Commercial	$263.76

KNEE RT 3V

Facility

$314.00

Service Code	HCPCS 73562 RT
Hospital Charge Code	3290018
Hospital Revenue Code	320
Min. Negotiated Rate	$257.48
Max. Negotiated Rate	$304.58
Rate for Payer: Cash Price	$235.50
Rate for Payer: Health Partners Plans Commercial	$298.30
Rate for Payer: UnitedHealthcare Commercial	$304.58
Rate for Payer: WPPA Commercial	$257.48

KNEE RT 4+V

Facility

$344.00

Service Code	HCPCS 73564 RT
Hospital Charge Code	3290022
Hospital Revenue Code	320
Min. Negotiated Rate	$282.08
Max. Negotiated Rate	$333.68
Rate for Payer: Cash Price	$258.00
Rate for Payer: Health Partners Plans Commercial	$326.80
Rate for Payer: UnitedHealthcare Commercial	$333.68
Rate for Payer: WPPA Commercial	$282.08

KNEE RT 4+V

Facility

$344.00

Service Code	HCPCS 73564 RT
Hospital Charge Code	3290022
Hospital Revenue Code	320
Min. Negotiated Rate	$158.93
Max. Negotiated Rate	$333.68
Rate for Payer: BCBS Commercial	$216.50
Rate for Payer: Cash Price	$258.00
Rate for Payer: Cash Price	$258.00
Rate for Payer: Celtic Commercial/Exchange	$158.93
Rate for Payer: Health Partners Plans Commercial	$326.80
Rate for Payer: UnitedHealthcare Commercial	$333.68
Rate for Payer: WPPA Commercial	$288.96

Know your out-of-pocket cost for care.

All Charges