Ness County Hospital

All Charges

Charge

Type

Setting

Price

LAYER CLOSURE OF WOUND7.6-12.5

Facility

$380.00

Service Code	HCPCS 12034
Hospital Charge Code	1203400
Hospital Revenue Code	450
Min. Negotiated Rate	$175.56
Max. Negotiated Rate	$1,548.33
Rate for Payer: BCBS Commercial	$1,548.33
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

LAYER CLOSURE OF WOUND7.6-12.5

Facility

$380.00

Service Code	HCPCS 12034
Hospital Charge Code	1203400
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

LAYER CLOSURE OF WOUNDS2.5 CM

Facility

$380.00

Service Code	HCPCS 12041
Hospital Charge Code	1204100
Hospital Revenue Code	450
Min. Negotiated Rate	$175.56
Max. Negotiated Rate	$532.27
Rate for Payer: BCBS Commercial	$532.27
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

LAYER CLOSURE OF WOUNDS2.5 CM

Facility

$380.00

Service Code	HCPCS 12041
Hospital Charge Code	1204100
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

LAYER CLOSURE-WNDS 2.6CM-7.5CM

Facility

$380.00

Service Code	HCPCS 12032
Hospital Charge Code	1203200
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

LAYER CLOSURE-WNDS 2.6CM-7.5CM

Facility

$380.00

Service Code	HCPCS 12032
Hospital Charge Code	1203200
Hospital Revenue Code	450
Min. Negotiated Rate	$175.56
Max. Negotiated Rate	$451.17
Rate for Payer: BCBS Commercial	$451.17
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

LAYER CLOSURE WOUND 7.6-12.5CM

Facility

$380.00

Service Code	HCPCS 12054
Hospital Charge Code	1205400
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

LAYER CLOSURE WOUND 7.6-12.5CM

Facility

$380.00

Service Code	HCPCS 12054
Hospital Charge Code	1205400
Hospital Revenue Code	450
Min. Negotiated Rate	$175.56
Max. Negotiated Rate	$1,060.50
Rate for Payer: BCBS Commercial	$1,060.50
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

LAYER CLOS WND/NECK,HANDS,FEET

Facility

$581.00

Service Code	HCPCS 12045
Hospital Charge Code	1204500
Hospital Revenue Code	450
Min. Negotiated Rate	$476.42
Max. Negotiated Rate	$563.57
Rate for Payer: Cash Price	$435.75
Rate for Payer: Health Partners Plans Commercial	$551.95
Rate for Payer: UnitedHealthcare Commercial	$563.57
Rate for Payer: WPPA Commercial	$476.42

LAYER CLOS WND/NECK,HANDS,FEET

Facility

$581.00

Service Code	HCPCS 12045
Hospital Charge Code	1204500
Hospital Revenue Code	450
Min. Negotiated Rate	$268.42
Max. Negotiated Rate	$1,086.76
Rate for Payer: BCBS Commercial	$1,086.76
Rate for Payer: Cash Price	$435.75
Rate for Payer: Cash Price	$435.75
Rate for Payer: Celtic Commercial/Exchange	$268.42
Rate for Payer: Health Partners Plans Commercial	$551.95
Rate for Payer: UnitedHealthcare Commercial	$563.57
Rate for Payer: WPPA Commercial	$488.04

LAYER CLOS WNDS,SCALP,AXILLAE,

Facility

$382.00

Service Code	HCPCS 12031
Hospital Charge Code	1203101
Hospital Revenue Code	981
Min. Negotiated Rate	$176.48
Max. Negotiated Rate	$451.17
Rate for Payer: BCBS Commercial	$451.17
Rate for Payer: Cash Price	$286.50
Rate for Payer: Cash Price	$286.50
Rate for Payer: Celtic Commercial/Exchange	$176.48
Rate for Payer: Health Partners Plans Commercial	$362.90
Rate for Payer: UnitedHealthcare Commercial	$370.54
Rate for Payer: WPPA Commercial	$320.88

LAYER CLOS WNDS,SCALP,AXILLAE,

Facility

$382.00

Service Code	HCPCS 12031
Hospital Charge Code	1203101
Hospital Revenue Code	981
Min. Negotiated Rate	$313.24
Max. Negotiated Rate	$370.54
Rate for Payer: Cash Price	$286.50
Rate for Payer: Health Partners Plans Commercial	$362.90
Rate for Payer: UnitedHealthcare Commercial	$370.54
Rate for Payer: WPPA Commercial	$313.24

LAYERED CLOSURE OF WOUNDS FACE

Facility

$380.00

Service Code	HCPCS 12053
Hospital Charge Code	1205300
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

LAYERED CLOSURE OF WOUNDS FACE

Facility

$380.00

Service Code	HCPCS 12053
Hospital Charge Code	1205300
Hospital Revenue Code	450
Min. Negotiated Rate	$175.56
Max. Negotiated Rate	$973.64
Rate for Payer: BCBS Commercial	$973.64
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

LD ISOENZYMES

Facility

$90.00

Service Code	HCPCS 83625
Hospital Charge Code	8362500
Hospital Revenue Code	301
Min. Negotiated Rate	$41.58
Max. Negotiated Rate	$87.30
Rate for Payer: BCBS Commercial	$47.08
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cash Price	$67.50
Rate for Payer: Celtic Commercial/Exchange	$41.58
Rate for Payer: Health Partners Plans Commercial	$85.50
Rate for Payer: UnitedHealthcare Commercial	$87.30
Rate for Payer: WPPA Commercial	$75.60

LD ISOENZYMES

Facility

$90.00

Service Code	HCPCS 83625
Hospital Charge Code	8362500
Hospital Revenue Code	301
Min. Negotiated Rate	$73.80
Max. Negotiated Rate	$87.30
Rate for Payer: Cash Price	$67.50
Rate for Payer: Health Partners Plans Commercial	$85.50
Rate for Payer: UnitedHealthcare Commercial	$87.30
Rate for Payer: WPPA Commercial	$73.80

LEAD

Facility

$57.00

Service Code	HCPCS 83655
Hospital Charge Code	8365500
Hospital Revenue Code	301
Min. Negotiated Rate	$24.36
Max. Negotiated Rate	$55.29
Rate for Payer: BCBS Commercial	$24.36
Rate for Payer: Cash Price	$42.75
Rate for Payer: Cash Price	$42.75
Rate for Payer: Celtic Commercial/Exchange	$26.33
Rate for Payer: Health Partners Plans Commercial	$54.15
Rate for Payer: UnitedHealthcare Commercial	$55.29
Rate for Payer: WPPA Commercial	$47.88

LEAD

Facility

$57.00

Service Code	HCPCS 83655
Hospital Charge Code	8365500
Hospital Revenue Code	301
Min. Negotiated Rate	$46.74
Max. Negotiated Rate	$55.29
Rate for Payer: Cash Price	$42.75
Rate for Payer: Health Partners Plans Commercial	$54.15
Rate for Payer: UnitedHealthcare Commercial	$55.29
Rate for Payer: WPPA Commercial	$46.74

LEG BAG W/TUBING

Facility

$14.00

Hospital Charge Code	2726687
Hospital Revenue Code	270
Min. Negotiated Rate	$6.47
Max. Negotiated Rate	$13.58
Rate for Payer: Cash Price	$10.50
Rate for Payer: Celtic Commercial/Exchange	$6.47
Rate for Payer: Health Partners Plans Commercial	$13.30
Rate for Payer: UnitedHealthcare Commercial	$13.58
Rate for Payer: WPPA Commercial	$11.76

LEG BAG W/TUBING

Facility

$14.00

Hospital Charge Code	2726687
Hospital Revenue Code	270
Min. Negotiated Rate	$11.48
Max. Negotiated Rate	$13.58
Rate for Payer: Cash Price	$10.50
Rate for Payer: Health Partners Plans Commercial	$13.30
Rate for Payer: UnitedHealthcare Commercial	$13.58
Rate for Payer: WPPA Commercial	$11.48

LEGIONELLA ANTIGEN, EIA, URINE

Facility

$150.00

Service Code	HCPCS 87449
Hospital Charge Code	8744902
Hospital Revenue Code	306
Min. Negotiated Rate	$54.84
Max. Negotiated Rate	$145.50
Rate for Payer: BCBS Commercial	$54.84
Rate for Payer: Cash Price	$112.50
Rate for Payer: Cash Price	$112.50
Rate for Payer: Celtic Commercial/Exchange	$69.30
Rate for Payer: Health Partners Plans Commercial	$142.50
Rate for Payer: UnitedHealthcare Commercial	$145.50
Rate for Payer: WPPA Commercial	$126.00

LEGIONELLA ANTIGEN, EIA, URINE

Facility

$150.00

Service Code	HCPCS 87449
Hospital Charge Code	8744902
Hospital Revenue Code	306
Min. Negotiated Rate	$123.00
Max. Negotiated Rate	$145.50
Rate for Payer: Cash Price	$112.50
Rate for Payer: Health Partners Plans Commercial	$142.50
Rate for Payer: UnitedHealthcare Commercial	$145.50
Rate for Payer: WPPA Commercial	$123.00

LEG SPLINT INFLATABLE FULL ADU

Facility

$35.00

Hospital Charge Code	2701081
Hospital Revenue Code	272
Min. Negotiated Rate	$16.17
Max. Negotiated Rate	$33.95
Rate for Payer: Cash Price	$26.25
Rate for Payer: Celtic Commercial/Exchange	$16.17
Rate for Payer: Health Partners Plans Commercial	$33.25
Rate for Payer: UnitedHealthcare Commercial	$33.95
Rate for Payer: WPPA Commercial	$29.40

LEG SPLINT INFLATABLE FULL ADU

Facility

$35.00

Hospital Charge Code	2701081
Hospital Revenue Code	272
Min. Negotiated Rate	$28.70
Max. Negotiated Rate	$33.95
Rate for Payer: Cash Price	$26.25
Rate for Payer: Health Partners Plans Commercial	$33.25
Rate for Payer: UnitedHealthcare Commercial	$33.95
Rate for Payer: WPPA Commercial	$28.70

LESION DIAMETER 06 TO 1.0 CM

Facility

$353.00

Service Code	HCPCS 11401
Hospital Charge Code	1140100
Hospital Revenue Code	450
Min. Negotiated Rate	$289.46
Max. Negotiated Rate	$342.41
Rate for Payer: Cash Price	$264.75
Rate for Payer: Health Partners Plans Commercial	$335.35
Rate for Payer: UnitedHealthcare Commercial	$342.41
Rate for Payer: WPPA Commercial	$289.46

Know your out-of-pocket cost for care.

All Charges