Ness County Hospital

All Charges

Charge

Type

Setting

Price

O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC

Facility

$19,711.61

Service Code	MSDRG 940
Min. Negotiated Rate	$19,711.61
Max. Negotiated Rate	$19,711.61
Rate for Payer: BCBS Commercial	$19,711.61

O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC

Facility

$29,951.30

Service Code	MSDRG 939
Min. Negotiated Rate	$29,951.30
Max. Negotiated Rate	$29,951.30
Rate for Payer: BCBS Commercial	$29,951.30

O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC

Facility

$17,068.49

Service Code	MSDRG 941
Min. Negotiated Rate	$17,068.49
Max. Negotiated Rate	$17,068.49
Rate for Payer: BCBS Commercial	$17,068.49

O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS

Facility

$26,864.08

Service Code	MSDRG 876
Min. Negotiated Rate	$26,864.08
Max. Negotiated Rate	$26,864.08
Rate for Payer: BCBS Commercial	$26,864.08

ORTHC/PROSTC MGMT SBSQ ENC

Facility

$140.00

Service Code	HCPCS 97763 GO
Hospital Charge Code	9776300
Hospital Revenue Code	430
Min. Negotiated Rate	$114.80
Max. Negotiated Rate	$135.80
Rate for Payer: Cash Price	$105.00
Rate for Payer: Health Partners Plans Commercial	$133.00
Rate for Payer: UnitedHealthcare Commercial	$135.80
Rate for Payer: WPPA Commercial	$114.80

ORTHC/PROSTC MGMT SBSQ ENC

Facility

$140.00

Service Code	HCPCS 97763 GO
Hospital Charge Code	9776300
Hospital Revenue Code	430
Min. Negotiated Rate	$29.21
Max. Negotiated Rate	$135.80
Rate for Payer: BCBS Commercial	$29.21
Rate for Payer: Cash Price	$105.00
Rate for Payer: Cash Price	$105.00
Rate for Payer: Celtic Commercial/Exchange	$64.68
Rate for Payer: Health Partners Plans Commercial	$133.00
Rate for Payer: UnitedHealthcare Commercial	$135.80
Rate for Payer: WPPA Commercial	$117.60

ORTHOTICS MGMT/TRAIN EA 15"

Facility

$81.00

Service Code	HCPCS 97760 GP
Hospital Charge Code	4201955
Hospital Revenue Code	420
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

ORTHOTICS MGMT/TRAIN EA 15"

Facility

$81.00

Service Code	HCPCS 97760 GP
Hospital Charge Code	4201955
Hospital Revenue Code	420
Min. Negotiated Rate	$37.42
Max. Negotiated Rate	$78.57
Rate for Payer: BCBS Commercial	$39.64
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

OS-CAL W/ VIT. D TAB 500 MG (OYSTER SHELL CALCIUM + D)

Facility

$1.00

Service Code	NDC 10006070038
Hospital Charge Code	2505188
Hospital Revenue Code	250
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.75
Rate for Payer: Health Partners Plans Commercial	$0.95
Rate for Payer: UnitedHealthcare Commercial	$0.97
Rate for Payer: WPPA Commercial	$0.82

OS-CAL W/ VIT. D TAB 500 MG (OYSTER SHELL CALCIUM + D)

Facility

$1.00

Service Code	NDC 10006070038
Hospital Charge Code	2505188
Hospital Revenue Code	250
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.75
Rate for Payer: Celtic Commercial/Exchange	$0.46
Rate for Payer: Health Partners Plans Commercial	$0.95
Rate for Payer: UnitedHealthcare Commercial	$0.97
Rate for Payer: WPPA Commercial	$0.84

OSMOLAITY-URINE

Facility

$87.00

Service Code	HCPCS 83935
Hospital Charge Code	8393500
Hospital Revenue Code	301
Min. Negotiated Rate	$31.23
Max. Negotiated Rate	$84.39
Rate for Payer: BCBS Commercial	$31.23
Rate for Payer: Cash Price	$65.25
Rate for Payer: Cash Price	$65.25
Rate for Payer: Celtic Commercial/Exchange	$40.19
Rate for Payer: Health Partners Plans Commercial	$82.65
Rate for Payer: UnitedHealthcare Commercial	$84.39
Rate for Payer: WPPA Commercial	$73.08

OSMOLAITY-URINE

Facility

$87.00

Service Code	HCPCS 83935
Hospital Charge Code	8393500
Hospital Revenue Code	301
Min. Negotiated Rate	$71.34
Max. Negotiated Rate	$84.39
Rate for Payer: Cash Price	$65.25
Rate for Payer: Health Partners Plans Commercial	$82.65
Rate for Payer: UnitedHealthcare Commercial	$84.39
Rate for Payer: WPPA Commercial	$71.34

OSMOLALITY BLOOD

Facility

$85.00

Service Code	HCPCS 83930
Hospital Charge Code	8393000
Hospital Revenue Code	301
Min. Negotiated Rate	$28.69
Max. Negotiated Rate	$82.45
Rate for Payer: BCBS Commercial	$28.69
Rate for Payer: Cash Price	$63.75
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

OSMOLALITY BLOOD

Facility

$85.00

Service Code	HCPCS 83930
Hospital Charge Code	8393000
Hospital Revenue Code	301
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

OSTEOMYELITIS WITH CC

Facility

$11,552.36

Service Code	MSDRG 540
Min. Negotiated Rate	$11,552.36
Max. Negotiated Rate	$11,552.36
Rate for Payer: BCBS Commercial	$11,552.36

OSTEOMYELITIS WITH MCC

Facility

$17,463.56

Service Code	MSDRG 539
Min. Negotiated Rate	$17,463.56
Max. Negotiated Rate	$17,463.56
Rate for Payer: BCBS Commercial	$17,463.56

OSTEOMYELITIS WITHOUT CC/MCC

Facility

$7,560.33

Service Code	MSDRG 541
Min. Negotiated Rate	$7,560.33
Max. Negotiated Rate	$7,560.33
Rate for Payer: BCBS Commercial	$7,560.33

OSTOMY 2 PIECE LTC

Facility

$9.00

Hospital Charge Code	2720379LTC
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

OSTOMY 2 PIECE LTC

Facility

$9.00

Hospital Charge Code	2720379LTC
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

OSTOMY DRAINABLE POUCH 2 PIECE

Facility

$12.00

Hospital Charge Code	2720380
Hospital Revenue Code	272
Min. Negotiated Rate	$9.84
Max. Negotiated Rate	$11.64
Rate for Payer: Cash Price	$9.00
Rate for Payer: Health Partners Plans Commercial	$11.40
Rate for Payer: UnitedHealthcare Commercial	$11.64
Rate for Payer: WPPA Commercial	$9.84

OSTOMY DRAINABLE POUCH 2 PIECE

Facility

$12.00

Hospital Charge Code	2720380
Hospital Revenue Code	272
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$11.64
Rate for Payer: Cash Price	$9.00
Rate for Payer: Celtic Commercial/Exchange	$5.54
Rate for Payer: Health Partners Plans Commercial	$11.40
Rate for Payer: UnitedHealthcare Commercial	$11.64
Rate for Payer: WPPA Commercial	$10.08

OSTOMY FLANGE 2 1/4

Facility

$3.00

Hospital Charge Code	2720377
Hospital Revenue Code	272
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.25
Rate for Payer: Health Partners Plans Commercial	$2.85
Rate for Payer: UnitedHealthcare Commercial	$2.91
Rate for Payer: WPPA Commercial	$2.46

OSTOMY FLANGE 2 1/4

Facility

$3.00

Hospital Charge Code	2720377
Hospital Revenue Code	272
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.25
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

Ostomy Flange LTC

Facility

$3.00

Hospital Charge Code	2720377LTC
Hospital Revenue Code	272
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.25
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

Ostomy Flange LTC

Facility

$3.00

Hospital Charge Code	2720377LTC
Hospital Revenue Code	272
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.25
Rate for Payer: Health Partners Plans Commercial	$2.85
Rate for Payer: UnitedHealthcare Commercial	$2.91
Rate for Payer: WPPA Commercial	$2.46

Know your out-of-pocket cost for care.

All Charges