Ness County Hospital

All Charges

Charge

Type

Setting

Price

1 PIECE DRAINABLE OSTOMY POUCH

Facility

$6.00

Hospital Charge Code	2720378
Hospital Revenue Code	272
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

20FR 30CC CATHETER

Facility

$40.00

Hospital Charge Code	2720409LTC
Hospital Revenue Code	272
Min. Negotiated Rate	$18.48
Max. Negotiated Rate	$38.80
Rate for Payer: Cash Price	$30.00
Rate for Payer: Celtic Commercial/Exchange	$18.48
Rate for Payer: Health Partners Plans Commercial	$38.00
Rate for Payer: UnitedHealthcare Commercial	$38.80
Rate for Payer: WPPA Commercial	$33.60

20FR 30CC CATHETER

Facility

$40.00

Hospital Charge Code	2720409LTC
Hospital Revenue Code	272
Min. Negotiated Rate	$32.80
Max. Negotiated Rate	$38.80
Rate for Payer: Cash Price	$30.00
Rate for Payer: Health Partners Plans Commercial	$38.00
Rate for Payer: UnitedHealthcare Commercial	$38.80
Rate for Payer: WPPA Commercial	$32.80

21-30 ROUND TRIP MILES OF NC

Facility

$18.00

Hospital Charge Code	5710867
Hospital Revenue Code	990
Min. Negotiated Rate	$8.32
Max. Negotiated Rate	$17.46
Rate for Payer: Cash Price	$13.50
Rate for Payer: Celtic Commercial/Exchange	$8.32
Rate for Payer: Health Partners Plans Commercial	$17.10
Rate for Payer: UnitedHealthcare Commercial	$17.46
Rate for Payer: WPPA Commercial	$15.12

21-30 ROUND TRIP MILES OF NC

Facility

$18.00

Hospital Charge Code	5710867
Hospital Revenue Code	990
Min. Negotiated Rate	$14.76
Max. Negotiated Rate	$17.46
Rate for Payer: Cash Price	$13.50
Rate for Payer: Health Partners Plans Commercial	$17.10
Rate for Payer: UnitedHealthcare Commercial	$17.46
Rate for Payer: WPPA Commercial	$14.76

22 GA BUTTERFLY/HUBER NEEDLE

Facility

$39.00

Hospital Charge Code	2702249
Hospital Revenue Code	270
Min. Negotiated Rate	$18.02
Max. Negotiated Rate	$37.83
Rate for Payer: Cash Price	$29.44
Rate for Payer: Celtic Commercial/Exchange	$18.02
Rate for Payer: Health Partners Plans Commercial	$37.05
Rate for Payer: UnitedHealthcare Commercial	$37.83
Rate for Payer: WPPA Commercial	$32.76

22 GA BUTTERFLY/HUBER NEEDLE

Facility

$39.00

Hospital Charge Code	2702249
Hospital Revenue Code	270
Min. Negotiated Rate	$31.98
Max. Negotiated Rate	$37.83
Rate for Payer: Cash Price	$29.44
Rate for Payer: Health Partners Plans Commercial	$37.05
Rate for Payer: UnitedHealthcare Commercial	$37.83
Rate for Payer: WPPA Commercial	$31.98

2.6-7.5CMCOMPLEX WOUND REPAIR

Facility

$581.00

Service Code	HCPCS 13101
Hospital Charge Code	1310100
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

2.6-7.5CMCOMPLEX WOUND REPAIR

Facility

$581.00

Service Code	HCPCS 13101
Hospital Charge Code	1310100
Hospital Revenue Code	450
Min. Negotiated Rate	$268.42
Max. Negotiated Rate	$563.57
Rate for Payer: BCBS Commercial	$539.34
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

2" COBAN

Facility

$3.00

Hospital Charge Code	2722595
Hospital Revenue Code	270
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.74
Rate for Payer: Celtic Commercial/Exchange	$1.39
Rate for Payer: Health Partners Plans Commercial	$2.85
Rate for Payer: UnitedHealthcare Commercial	$2.91
Rate for Payer: WPPA Commercial	$2.52

2" COBAN

Facility

$9.00

Hospital Charge Code	2707611
Hospital Revenue Code	270
Min. Negotiated Rate	$7.38
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$6.75
Rate for Payer: Health Partners Plans Commercial	$8.55
Rate for Payer: UnitedHealthcare Commercial	$8.73
Rate for Payer: WPPA Commercial	$7.38

2" COBAN

Facility

$3.00

Hospital Charge Code	2722595
Hospital Revenue Code	270
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.74
Rate for Payer: Health Partners Plans Commercial	$2.85
Rate for Payer: UnitedHealthcare Commercial	$2.91
Rate for Payer: WPPA Commercial	$2.46

2" COBAN

Facility

$9.00

Hospital Charge Code	2707611
Hospital Revenue Code	270
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$6.75
Rate for Payer: Celtic Commercial/Exchange	$4.16
Rate for Payer: Health Partners Plans Commercial	$8.55
Rate for Payer: UnitedHealthcare Commercial	$8.73
Rate for Payer: WPPA Commercial	$7.56

2 PIECE OSTOMY

Facility

$9.00

Hospital Charge Code	2720379
Hospital Revenue Code	272
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$6.75
Rate for Payer: Celtic Commercial/Exchange	$4.16
Rate for Payer: Health Partners Plans Commercial	$8.55
Rate for Payer: UnitedHealthcare Commercial	$8.73
Rate for Payer: WPPA Commercial	$7.56

2 PIECE OSTOMY

Facility

$9.00

Hospital Charge Code	2720379
Hospital Revenue Code	272
Min. Negotiated Rate	$7.38
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$6.75
Rate for Payer: Health Partners Plans Commercial	$8.55
Rate for Payer: UnitedHealthcare Commercial	$8.73
Rate for Payer: WPPA Commercial	$7.38

31-40 ROUND TRIP MILES OF NC

Facility

$24.00

Hospital Charge Code	5710873
Hospital Revenue Code	990
Min. Negotiated Rate	$19.68
Max. Negotiated Rate	$23.28
Rate for Payer: Cash Price	$18.00
Rate for Payer: Health Partners Plans Commercial	$22.80
Rate for Payer: UnitedHealthcare Commercial	$23.28
Rate for Payer: WPPA Commercial	$19.68

31-40 ROUND TRIP MILES OF NC

Facility

$24.00

Hospital Charge Code	5710873
Hospital Revenue Code	990
Min. Negotiated Rate	$11.09
Max. Negotiated Rate	$23.28
Rate for Payer: Cash Price	$18.00
Rate for Payer: Celtic Commercial/Exchange	$11.09
Rate for Payer: Health Partners Plans Commercial	$22.80
Rate for Payer: UnitedHealthcare Commercial	$23.28
Rate for Payer: WPPA Commercial	$20.16

36" SAMS SPLINT

Facility

$26.00

Hospital Charge Code	2702011
Hospital Revenue Code	270
Min. Negotiated Rate	$21.32
Max. Negotiated Rate	$25.22
Rate for Payer: Cash Price	$19.50
Rate for Payer: Health Partners Plans Commercial	$24.70
Rate for Payer: UnitedHealthcare Commercial	$25.22
Rate for Payer: WPPA Commercial	$21.32

36" SAMS SPLINT

Facility

$26.00

Hospital Charge Code	2702011
Hospital Revenue Code	270
Min. Negotiated Rate	$12.01
Max. Negotiated Rate	$25.22
Rate for Payer: Cash Price	$19.50
Rate for Payer: Celtic Commercial/Exchange	$12.01
Rate for Payer: Health Partners Plans Commercial	$24.70
Rate for Payer: UnitedHealthcare Commercial	$25.22
Rate for Payer: WPPA Commercial	$21.84

3" COBAN

Facility

$4.00

Hospital Charge Code	2722597
Hospital Revenue Code	270
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$3.53
Rate for Payer: Celtic Commercial/Exchange	$1.85
Rate for Payer: Health Partners Plans Commercial	$3.80
Rate for Payer: UnitedHealthcare Commercial	$3.88
Rate for Payer: WPPA Commercial	$3.36

3" COBAN

Facility

$4.00

Hospital Charge Code	2722597
Hospital Revenue Code	270
Min. Negotiated Rate	$3.28
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$3.53
Rate for Payer: Health Partners Plans Commercial	$3.80
Rate for Payer: UnitedHealthcare Commercial	$3.88
Rate for Payer: WPPA Commercial	$3.28

3" COBAN KP

Facility

$9.00

Hospital Charge Code	2707789
Hospital Revenue Code	270
Min. Negotiated Rate	$7.38
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$6.75
Rate for Payer: Health Partners Plans Commercial	$8.55
Rate for Payer: UnitedHealthcare Commercial	$8.73
Rate for Payer: WPPA Commercial	$7.38

3" COBAN KP

Facility

$9.00

Hospital Charge Code	2707789
Hospital Revenue Code	270
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$6.75
Rate for Payer: Celtic Commercial/Exchange	$4.16
Rate for Payer: Health Partners Plans Commercial	$8.55
Rate for Payer: UnitedHealthcare Commercial	$8.73
Rate for Payer: WPPA Commercial	$7.56

3D BILATERAL DIAG MAMMOGRAM

Facility

$71.00

Service Code	HCPCS 77062
Hospital Charge Code	7706200
Hospital Revenue Code	401
Min. Negotiated Rate	$58.22
Max. Negotiated Rate	$68.87
Rate for Payer: Cash Price	$53.25
Rate for Payer: Health Partners Plans Commercial	$67.45
Rate for Payer: UnitedHealthcare Commercial	$68.87
Rate for Payer: WPPA Commercial	$58.22

3D BILATERAL DIAG MAMMOGRAM

Facility

$71.00

Service Code	HCPCS 77062
Hospital Charge Code	7706200
Hospital Revenue Code	401
Min. Negotiated Rate	$26.66
Max. Negotiated Rate	$68.87
Rate for Payer: BCBS Commercial	$26.66
Rate for Payer: Cash Price	$53.25
Rate for Payer: Cash Price	$53.25
Rate for Payer: Celtic Commercial/Exchange	$32.80
Rate for Payer: Health Partners Plans Commercial	$67.45
Rate for Payer: UnitedHealthcare Commercial	$68.87
Rate for Payer: WPPA Commercial	$59.64

Know your out-of-pocket cost for care.

All Charges