Ness County Hospital

All Charges

Charge

Type

Setting

Price

REPAIR COMPLEX TRUNK 1.1-2.5CM

Facility

$645.00

Service Code	HCPCS 13100
Hospital Charge Code	1310000
Hospital Revenue Code	450
Min. Negotiated Rate	$297.99
Max. Negotiated Rate	$625.65
Rate for Payer: BCBS Commercial	$310.07
Rate for Payer: Cash Price	$483.75
Rate for Payer: Cash Price	$483.75
Rate for Payer: Celtic Commercial/Exchange	$297.99
Rate for Payer: Health Partners Plans Commercial	$612.75
Rate for Payer: UnitedHealthcare Commercial	$625.65
Rate for Payer: WPPA Commercial	$541.80

REPAIR EXTENSOR TENDON FINGER

Facility

$2,150.00

Service Code	HCPCS 26418
Hospital Charge Code	2641800
Hospital Revenue Code	450
Min. Negotiated Rate	$993.30
Max. Negotiated Rate	$3,017.88
Rate for Payer: BCBS Commercial	$3,017.88
Rate for Payer: Cash Price	$1,612.50
Rate for Payer: Cash Price	$1,612.50
Rate for Payer: Celtic Commercial/Exchange	$993.30
Rate for Payer: Health Partners Plans Commercial	$2,042.50
Rate for Payer: UnitedHealthcare Commercial	$2,085.50
Rate for Payer: WPPA Commercial	$1,806.00

REPAIR EXTENSOR TENDON FINGER

Facility

$2,150.00

Service Code	HCPCS 26418
Hospital Charge Code	2641800
Hospital Revenue Code	450
Min. Negotiated Rate	$1,763.00
Max. Negotiated Rate	$2,085.50
Rate for Payer: Cash Price	$1,612.50
Rate for Payer: Health Partners Plans Commercial	$2,042.50
Rate for Payer: UnitedHealthcare Commercial	$2,085.50
Rate for Payer: WPPA Commercial	$1,763.00

REPAIR NAIL BED

Facility

$581.00

Service Code	HCPCS 11760
Hospital Charge Code	1176000
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

REPAIR NAIL BED

Facility

$581.00

Service Code	HCPCS 11760
Hospital Charge Code	1176000
Hospital Revenue Code	450
Min. Negotiated Rate	$268.42
Max. Negotiated Rate	$563.57
Rate for Payer: BCBS Commercial	$371.68
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

REPAIR SUPERFIC WND 2.6-7.5 CM

Facility

$300.00

Service Code	HCPCS 12002
Hospital Charge Code	1200223
Hospital Revenue Code	761
Min. Negotiated Rate	$138.60
Max. Negotiated Rate	$457.53
Rate for Payer: BCBS Commercial	$457.53
Rate for Payer: Cash Price	$225.00
Rate for Payer: Cash Price	$225.00
Rate for Payer: Celtic Commercial/Exchange	$138.60
Rate for Payer: Health Partners Plans Commercial	$285.00
Rate for Payer: UnitedHealthcare Commercial	$291.00
Rate for Payer: WPPA Commercial	$252.00

REPAIR SUPERFIC WND 2.6-7.5 CM

Facility

$300.00

Service Code	HCPCS 12002
Hospital Charge Code	1200223
Hospital Revenue Code	761
Min. Negotiated Rate	$246.00
Max. Negotiated Rate	$291.00
Rate for Payer: Cash Price	$225.00
Rate for Payer: Health Partners Plans Commercial	$285.00
Rate for Payer: UnitedHealthcare Commercial	$291.00
Rate for Payer: WPPA Commercial	$246.00

REPAIR SUPERFIC WND =OR<2.5 CM

Facility

$250.00

Service Code	HCPCS 12001
Hospital Charge Code	1200123
Hospital Revenue Code	761
Min. Negotiated Rate	$205.00
Max. Negotiated Rate	$242.50
Rate for Payer: Cash Price	$187.50
Rate for Payer: Health Partners Plans Commercial	$237.50
Rate for Payer: UnitedHealthcare Commercial	$242.50
Rate for Payer: WPPA Commercial	$205.00

REPAIR SUPERFIC WND =OR<2.5 CM

Facility

$250.00

Service Code	HCPCS 12001
Hospital Charge Code	1200123
Hospital Revenue Code	761
Min. Negotiated Rate	$115.50
Max. Negotiated Rate	$382.79
Rate for Payer: BCBS Commercial	$382.79
Rate for Payer: Cash Price	$187.50
Rate for Payer: Cash Price	$187.50
Rate for Payer: Celtic Commercial/Exchange	$115.50
Rate for Payer: Health Partners Plans Commercial	$237.50
Rate for Payer: UnitedHealthcare Commercial	$242.50
Rate for Payer: WPPA Commercial	$210.00

REPLACE GTUBE WO GTRC REVISION

Facility

$712.00

Service Code	HCPCS 43762
Hospital Charge Code	4376200
Hospital Revenue Code	761
Min. Negotiated Rate	$583.84
Max. Negotiated Rate	$690.64
Rate for Payer: Cash Price	$534.00
Rate for Payer: Health Partners Plans Commercial	$676.40
Rate for Payer: UnitedHealthcare Commercial	$690.64
Rate for Payer: WPPA Commercial	$583.84

REPLACE GTUBE WO GTRC REVISION

Facility

$712.00

Service Code	HCPCS 43762
Hospital Charge Code	4376200
Hospital Revenue Code	761
Min. Negotiated Rate	$328.94
Max. Negotiated Rate	$690.64
Rate for Payer: BCBS Commercial	$462.58
Rate for Payer: Cash Price	$534.00
Rate for Payer: Cash Price	$534.00
Rate for Payer: Celtic Commercial/Exchange	$328.94
Rate for Payer: Health Partners Plans Commercial	$676.40
Rate for Payer: UnitedHealthcare Commercial	$690.64
Rate for Payer: WPPA Commercial	$598.08

REPR CMPLX FORHEAD/FT EA ADD 5

Facility

$215.00

Service Code	HCPCS 13133
Hospital Charge Code	1313300
Hospital Revenue Code	450
Min. Negotiated Rate	$176.30
Max. Negotiated Rate	$208.55
Rate for Payer: Cash Price	$161.25
Rate for Payer: Health Partners Plans Commercial	$204.25
Rate for Payer: UnitedHealthcare Commercial	$208.55
Rate for Payer: WPPA Commercial	$176.30

REPR CMPLX FORHEAD/FT EA ADD 5

Facility

$215.00

Service Code	HCPCS 13133
Hospital Charge Code	1313300
Hospital Revenue Code	450
Min. Negotiated Rate	$99.33
Max. Negotiated Rate	$208.55
Rate for Payer: Cash Price	$161.25
Rate for Payer: Celtic Commercial/Exchange	$99.33
Rate for Payer: Health Partners Plans Commercial	$204.25
Rate for Payer: UnitedHealthcare Commercial	$208.55
Rate for Payer: WPPA Commercial	$180.60

REPR CMPLX FRHD,FACE,HANDS,FT

Facility

$581.00

Service Code	HCPCS 13132
Hospital Charge Code	1313200
Hospital Revenue Code	450
Min. Negotiated Rate	$268.42
Max. Negotiated Rate	$1,008.99
Rate for Payer: BCBS Commercial	$1,008.99
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

REPR CMPLX FRHD,FACE,HANDS,FT

Facility

$581.00

Service Code	HCPCS 13132
Hospital Charge Code	1313200
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

REPR CMPLX SCLP/ARM/LEG1.1-2.5

Facility

$581.00

Service Code	HCPCS 13120
Hospital Charge Code	1312000
Hospital Revenue Code	450
Min. Negotiated Rate	$268.42
Max. Negotiated Rate	$563.57
Rate for Payer: BCBS Commercial	$310.07
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

REPR CMPLX SCLP/ARM/LEG1.1-2.5

Facility

$581.00

Service Code	HCPCS 13120
Hospital Charge Code	1312000
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

REPR CMPLX SCLP/ARM/LEG2.6-7.5

Facility

$581.00

Service Code	HCPCS 13121
Hospital Charge Code	1312100
Hospital Revenue Code	761
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

REPR CMPLX SCLP/ARM/LEG2.6-7.5

Facility

$581.00

Service Code	HCPCS 13121
Hospital Charge Code	1312100
Hospital Revenue Code	761
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

REPR LAC 2.5CM/LESS ANT 2/3 TO

Facility

$378.00

Service Code	HCPCS 41250
Hospital Charge Code	4125000
Hospital Revenue Code	450
Min. Negotiated Rate	$309.96
Max. Negotiated Rate	$366.66
Rate for Payer: Cash Price	$283.50
Rate for Payer: Health Partners Plans Commercial	$359.10
Rate for Payer: UnitedHealthcare Commercial	$366.66
Rate for Payer: WPPA Commercial	$309.96

REPR LAC 2.5CM/LESS ANT 2/3 TO

Facility

$378.00

Service Code	HCPCS 41250
Hospital Charge Code	4125000
Hospital Revenue Code	450
Min. Negotiated Rate	$174.64
Max. Negotiated Rate	$498.80
Rate for Payer: BCBS Commercial	$498.80
Rate for Payer: Cash Price	$283.50
Rate for Payer: Cash Price	$283.50
Rate for Payer: Celtic Commercial/Exchange	$174.64
Rate for Payer: Health Partners Plans Commercial	$359.10
Rate for Payer: UnitedHealthcare Commercial	$366.66
Rate for Payer: WPPA Commercial	$317.52

REQUIP 0.25 MG TAB (ROPINIROLE)

Facility

$7.00

Service Code	NDC 60687057711
Hospital Charge Code	2515831
Hospital Revenue Code	250
Min. Negotiated Rate	$3.23
Max. Negotiated Rate	$6.79
Rate for Payer: Cash Price	$5.66
Rate for Payer: Celtic Commercial/Exchange	$3.23
Rate for Payer: Health Partners Plans Commercial	$6.65
Rate for Payer: UnitedHealthcare Commercial	$6.79
Rate for Payer: WPPA Commercial	$5.88

REQUIP 0.25 MG TAB (ROPINIROLE)

Facility

$7.00

Service Code	NDC 60687057711
Hospital Charge Code	2515831
Hospital Revenue Code	250
Min. Negotiated Rate	$5.74
Max. Negotiated Rate	$6.79
Rate for Payer: Cash Price	$5.66
Rate for Payer: Health Partners Plans Commercial	$6.65
Rate for Payer: UnitedHealthcare Commercial	$6.79
Rate for Payer: WPPA Commercial	$5.74

RESPIRATORY CARE-ONE ON ONE

Facility

$93.00

Service Code	HCPCS G0237
Hospital Charge Code	G023700
Hospital Revenue Code	410
Min. Negotiated Rate	$76.26
Max. Negotiated Rate	$90.21
Rate for Payer: Cash Price	$69.75
Rate for Payer: Health Partners Plans Commercial	$88.35
Rate for Payer: UnitedHealthcare Commercial	$90.21
Rate for Payer: WPPA Commercial	$76.26

RESPIRATORY CARE-ONE ON ONE

Facility

$93.00

Service Code	HCPCS G0237
Hospital Charge Code	G023700
Hospital Revenue Code	410
Min. Negotiated Rate	$42.97
Max. Negotiated Rate	$90.21
Rate for Payer: BCBS Commercial	$47.47
Rate for Payer: Cash Price	$69.75
Rate for Payer: Cash Price	$69.75
Rate for Payer: Celtic Commercial/Exchange	$42.97
Rate for Payer: Health Partners Plans Commercial	$88.35
Rate for Payer: UnitedHealthcare Commercial	$90.21
Rate for Payer: WPPA Commercial	$78.12

Know your out-of-pocket cost for care.

All Charges