Ness County Hospital

All Charges

Charge

Type

Setting

Price

OPEN TX DIST PHALANG FX W/WO F

Facility

$4,300.00

Service Code	HCPCS 26765
Hospital Charge Code	2676500
Hospital Revenue Code	450
Min. Negotiated Rate	$3,526.00
Max. Negotiated Rate	$4,171.00
Rate for Payer: Cash Price	$3,225.00
Rate for Payer: Health Partners Plans Commercial	$4,085.00
Rate for Payer: UnitedHealthcare Commercial	$4,171.00
Rate for Payer: WPPA Commercial	$3,526.00

OPEN TX FEM FX PROX END FIX/PR

Facility

$323.00

Service Code	HCPCS 27236
Hospital Charge Code	2723600
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

OPEN TX FEM FX PROX END FIX/PR

Facility

$323.00

Service Code	HCPCS 27236
Hospital Charge Code	2723600
Hospital Revenue Code	450
Min. Negotiated Rate	$149.23
Max. Negotiated Rate	$7,604.29
Rate for Payer: BCBS Commercial	$7,604.29
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

OPEN TX PHALANGEAL FX W/WO FIX

Facility

$4,300.00

Service Code	HCPCS 26735
Hospital Charge Code	2673500
Hospital Revenue Code	450
Min. Negotiated Rate	$1,986.60
Max. Negotiated Rate	$4,171.00
Rate for Payer: BCBS Commercial	$3,638.02
Rate for Payer: Cash Price	$3,225.00
Rate for Payer: Cash Price	$3,225.00
Rate for Payer: Celtic Commercial/Exchange	$1,986.60
Rate for Payer: Health Partners Plans Commercial	$4,085.00
Rate for Payer: UnitedHealthcare Commercial	$4,171.00
Rate for Payer: WPPA Commercial	$3,612.00

OPEN TX PHALANGEAL FX W/WO FIX

Facility

$4,300.00

Service Code	HCPCS 26735
Hospital Charge Code	2673500
Hospital Revenue Code	450
Min. Negotiated Rate	$3,526.00
Max. Negotiated Rate	$4,171.00
Rate for Payer: Cash Price	$3,225.00
Rate for Payer: Health Partners Plans Commercial	$4,085.00
Rate for Payer: UnitedHealthcare Commercial	$4,171.00
Rate for Payer: WPPA Commercial	$3,526.00

OP -EST PAT.-COMPREHENSIVE

Facility

$267.00

Service Code	HCPCS 99070
Hospital Charge Code	9921500
Hospital Revenue Code	761
Min. Negotiated Rate	$123.35
Max. Negotiated Rate	$258.99
Rate for Payer: Cash Price	$200.25
Rate for Payer: Celtic Commercial/Exchange	$123.35
Rate for Payer: Health Partners Plans Commercial	$253.65
Rate for Payer: UnitedHealthcare Commercial	$258.99
Rate for Payer: WPPA Commercial	$224.28

OP -EST PAT.-COMPREHENSIVE

Facility

$267.00

Service Code	HCPCS 99070
Hospital Charge Code	9921500
Hospital Revenue Code	761
Min. Negotiated Rate	$218.94
Max. Negotiated Rate	$258.99
Rate for Payer: Cash Price	$200.25
Rate for Payer: Health Partners Plans Commercial	$253.65
Rate for Payer: UnitedHealthcare Commercial	$258.99
Rate for Payer: WPPA Commercial	$218.94

OPIATES, 1 OR MORE

Facility

$147.00

Service Code	HCPCS 80361
Hospital Charge Code	8036100
Hospital Revenue Code	300
Min. Negotiated Rate	$120.54
Max. Negotiated Rate	$142.59
Rate for Payer: Cash Price	$110.25
Rate for Payer: Health Partners Plans Commercial	$139.65
Rate for Payer: UnitedHealthcare Commercial	$142.59
Rate for Payer: WPPA Commercial	$120.54

OPIATES, 1 OR MORE

Facility

$147.00

Service Code	HCPCS 80361
Hospital Charge Code	8036100
Hospital Revenue Code	300
Min. Negotiated Rate	$42.68
Max. Negotiated Rate	$142.59
Rate for Payer: BCBS Commercial	$42.68
Rate for Payer: Cash Price	$110.25
Rate for Payer: Cash Price	$110.25
Rate for Payer: Celtic Commercial/Exchange	$67.91
Rate for Payer: Health Partners Plans Commercial	$139.65
Rate for Payer: UnitedHealthcare Commercial	$142.59
Rate for Payer: WPPA Commercial	$123.48

OPIATES OXYCOD QN

Facility

$110.00

Service Code	HCPCS 80365
Hospital Charge Code	8036500
Hospital Revenue Code	300
Min. Negotiated Rate	$23.88
Max. Negotiated Rate	$106.70
Rate for Payer: BCBS Commercial	$23.88
Rate for Payer: Cash Price	$82.50
Rate for Payer: Cash Price	$82.50
Rate for Payer: Celtic Commercial/Exchange	$50.82
Rate for Payer: Health Partners Plans Commercial	$104.50
Rate for Payer: UnitedHealthcare Commercial	$106.70
Rate for Payer: WPPA Commercial	$92.40

OPIATES OXYCOD QN

Facility

$110.00

Service Code	HCPCS 80365
Hospital Charge Code	8036500
Hospital Revenue Code	300
Min. Negotiated Rate	$90.20
Max. Negotiated Rate	$106.70
Rate for Payer: Cash Price	$82.50
Rate for Payer: Health Partners Plans Commercial	$104.50
Rate for Payer: UnitedHealthcare Commercial	$106.70
Rate for Payer: WPPA Commercial	$90.20

OPIOID/OPIATE ANALOG 5+ SCRN

Facility

$271.00

Service Code	HCPCS 80364
Hospital Charge Code	8036400
Hospital Revenue Code	300
Min. Negotiated Rate	$222.22
Max. Negotiated Rate	$262.87
Rate for Payer: Cash Price	$203.25
Rate for Payer: Health Partners Plans Commercial	$257.45
Rate for Payer: UnitedHealthcare Commercial	$262.87
Rate for Payer: WPPA Commercial	$222.22

OPIOID/OPIATE ANALOG 5+ SCRN

Facility

$271.00

Service Code	HCPCS 80364
Hospital Charge Code	8036400
Hospital Revenue Code	300
Min. Negotiated Rate	$83.86
Max. Negotiated Rate	$262.87
Rate for Payer: BCBS Commercial	$83.86
Rate for Payer: Cash Price	$203.25
Rate for Payer: Cash Price	$203.25
Rate for Payer: Celtic Commercial/Exchange	$125.20
Rate for Payer: Health Partners Plans Commercial	$257.45
Rate for Payer: UnitedHealthcare Commercial	$262.87
Rate for Payer: WPPA Commercial	$227.64

OPIOIDS AND OPIATE ANALOGS; 1 OR 2

Facility

$81.00

Service Code	HCPCS 80362
Hospital Charge Code	8036200
Hospital Revenue Code	301
Min. Negotiated Rate	$66.42
Max. Negotiated Rate	$78.57
Rate for Payer: Cash Price	$60.75
Rate for Payer: Health Partners Plans Commercial	$76.95
Rate for Payer: UnitedHealthcare Commercial	$78.57
Rate for Payer: WPPA Commercial	$66.42

OPIOIDS AND OPIATE ANALOGS; 1 OR 2

Facility

$81.00

Service Code	HCPCS 80362
Hospital Charge Code	8036200
Hospital Revenue Code	301
Min. Negotiated Rate	$37.42
Max. Negotiated Rate	$78.57
Rate for Payer: BCBS Commercial	$55.90
Rate for Payer: Cash Price	$60.75
Rate for Payer: Cash Price	$60.75
Rate for Payer: Celtic Commercial/Exchange	$37.42
Rate for Payer: Health Partners Plans Commercial	$76.95
Rate for Payer: UnitedHealthcare Commercial	$78.57
Rate for Payer: WPPA Commercial	$68.04

OPIOIDS & OPIATES ANALOGS 3-4

Facility

$95.00

Service Code	HCPCS 80363
Hospital Charge Code	8036300
Hospital Revenue Code	300
Min. Negotiated Rate	$77.90
Max. Negotiated Rate	$92.15
Rate for Payer: Cash Price	$71.25
Rate for Payer: Health Partners Plans Commercial	$90.25
Rate for Payer: UnitedHealthcare Commercial	$92.15
Rate for Payer: WPPA Commercial	$77.90

OPIOIDS & OPIATES ANALOGS 3-4

Facility

$95.00

Service Code	HCPCS 80363
Hospital Charge Code	8036300
Hospital Revenue Code	300
Min. Negotiated Rate	$43.89
Max. Negotiated Rate	$92.15
Rate for Payer: BCBS Commercial	$69.89
Rate for Payer: Cash Price	$71.25
Rate for Payer: Cash Price	$71.25
Rate for Payer: Celtic Commercial/Exchange	$43.89
Rate for Payer: Health Partners Plans Commercial	$90.25
Rate for Payer: UnitedHealthcare Commercial	$92.15
Rate for Payer: WPPA Commercial	$79.80

OP-NEG PRES WND THER <=50 SQCM

Facility

$350.00

Service Code	HCPCS 97605
Hospital Charge Code	9760500
Hospital Revenue Code	761
Min. Negotiated Rate	$287.00
Max. Negotiated Rate	$339.50
Rate for Payer: Cash Price	$262.50
Rate for Payer: Health Partners Plans Commercial	$332.50
Rate for Payer: UnitedHealthcare Commercial	$339.50
Rate for Payer: WPPA Commercial	$287.00

OP-NEG PRES WND THER <=50 SQCM

Facility

$350.00

Service Code	HCPCS 97605
Hospital Charge Code	9760500
Hospital Revenue Code	761
Min. Negotiated Rate	$161.70
Max. Negotiated Rate	$339.50
Rate for Payer: BCBS Commercial	$223.75
Rate for Payer: Cash Price	$262.50
Rate for Payer: Cash Price	$262.50
Rate for Payer: Celtic Commercial/Exchange	$161.70
Rate for Payer: Health Partners Plans Commercial	$332.50
Rate for Payer: UnitedHealthcare Commercial	$339.50
Rate for Payer: WPPA Commercial	$294.00

OP-NEG PRES WND THER >50 SQ CM

Facility

$400.00

Service Code	HCPCS 97606
Hospital Charge Code	9760600
Hospital Revenue Code	761
Min. Negotiated Rate	$184.80
Max. Negotiated Rate	$388.00
Rate for Payer: BCBS Commercial	$331.25
Rate for Payer: Cash Price	$300.00
Rate for Payer: Cash Price	$300.00
Rate for Payer: Celtic Commercial/Exchange	$184.80
Rate for Payer: Health Partners Plans Commercial	$380.00
Rate for Payer: UnitedHealthcare Commercial	$388.00
Rate for Payer: WPPA Commercial	$336.00

OP-NEG PRES WND THER >50 SQ CM

Facility

$400.00

Service Code	HCPCS 97606
Hospital Charge Code	9760600
Hospital Revenue Code	761
Min. Negotiated Rate	$328.00
Max. Negotiated Rate	$388.00
Rate for Payer: Cash Price	$300.00
Rate for Payer: Health Partners Plans Commercial	$380.00
Rate for Payer: UnitedHealthcare Commercial	$388.00
Rate for Payer: WPPA Commercial	$328.00

OP PHYS-EST PAT.-PROB FOCUSED

Facility

$60.00

Service Code	HCPCS 99212 GF
Hospital Charge Code	9921200
Hospital Revenue Code	982
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

OP PHYS-EST PAT.-PROB FOCUSED

Facility

$60.00

Service Code	HCPCS 99212 GF
Hospital Charge Code	9921200
Hospital Revenue Code	982
Min. Negotiated Rate	$27.72
Max. Negotiated Rate	$85.38
Rate for Payer: BCBS Commercial	$85.38
Rate for Payer: Cash Price	$45.00
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

OP PODIATRY CLINIC-NEW PATIENT

Facility

$85.00

Service Code	HCPCS 99070
Hospital Charge Code	5100004
Hospital Revenue Code	761
Min. Negotiated Rate	$39.27
Max. Negotiated Rate	$82.45
Rate for Payer: Cash Price	$63.75
Rate for Payer: Celtic Commercial/Exchange	$39.27
Rate for Payer: Health Partners Plans Commercial	$80.75
Rate for Payer: UnitedHealthcare Commercial	$82.45
Rate for Payer: WPPA Commercial	$71.40

OP PODIATRY CLINIC-NEW PATIENT

Facility

$85.00

Service Code	HCPCS 99070
Hospital Charge Code	5100004
Hospital Revenue Code	761
Min. Negotiated Rate	$69.70
Max. Negotiated Rate	$82.45
Rate for Payer: Cash Price	$63.75
Rate for Payer: Health Partners Plans Commercial	$80.75
Rate for Payer: UnitedHealthcare Commercial	$82.45
Rate for Payer: WPPA Commercial	$69.70

Know your out-of-pocket cost for care.

All Charges