Ness County Hospital

All Charges

Charge

Type

Setting

Price

SILVERGEL

Facility

$49.00

Hospital Charge Code	2720784
Hospital Revenue Code	272
Min. Negotiated Rate	$22.64
Max. Negotiated Rate	$47.53
Rate for Payer: Cash Price	$36.75
Rate for Payer: Celtic Commercial/Exchange	$22.64
Rate for Payer: Health Partners Plans Commercial	$46.55
Rate for Payer: UnitedHealthcare Commercial	$47.53
Rate for Payer: WPPA Commercial	$41.16

SILVERGEL

Facility

$49.00

Hospital Charge Code	2720784
Hospital Revenue Code	272
Min. Negotiated Rate	$40.18
Max. Negotiated Rate	$47.53
Rate for Payer: Cash Price	$36.75
Rate for Payer: Health Partners Plans Commercial	$46.55
Rate for Payer: UnitedHealthcare Commercial	$47.53
Rate for Payer: WPPA Commercial	$40.18

SILVER NITRATE STICKS ( ARZOL SILVER NITRATE APPLICATORS)

Facility

$4.00

Service Code	NDC 12870000102
Hospital Charge Code	2506343
Hospital Revenue Code	250
Min. Negotiated Rate	$3.28
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$3.00
Rate for Payer: Health Partners Plans Commercial	$3.80
Rate for Payer: UnitedHealthcare Commercial	$3.88
Rate for Payer: WPPA Commercial	$3.28

SILVER NITRATE STICKS ( ARZOL SILVER NITRATE APPLICATORS)

Facility

$4.00

Service Code	NDC 12870000102
Hospital Charge Code	2506343
Hospital Revenue Code	250
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$3.00
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

SIMPLE CLOSURE TREATMENT

Facility

$581.00

Service Code	HCPCS 12020
Hospital Charge Code	1202000
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

SIMPLE CLOSURE TREATMENT

Facility

$581.00

Service Code	HCPCS 12020
Hospital Charge Code	1202000
Hospital Revenue Code	450
Min. Negotiated Rate	$216.14
Max. Negotiated Rate	$563.57
Rate for Payer: BCBS Commercial	$216.14
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

SIMPLE CLOSURE WND DESHISCENCE

Facility

$581.00

Service Code	HCPCS 12020
Hospital Charge Code	1202023
Hospital Revenue Code	761
Min. Negotiated Rate	$216.14
Max. Negotiated Rate	$563.57
Rate for Payer: BCBS Commercial	$216.14
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

SIMPLE CLOSURE WND DESHISCENCE

Facility

$581.00

Service Code	HCPCS 12020
Hospital Charge Code	1202023
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

SIMPLE PNEUMONIA AND PLEURISY WITH CC

Facility

$9,085.55

Service Code	MSDRG 194
Min. Negotiated Rate	$9,085.55
Max. Negotiated Rate	$9,085.55
Rate for Payer: BCBS Commercial	$9,085.55

SIMPLE PNEUMONIA AND PLEURISY WITH MCC

Facility

$12,323.75

Service Code	MSDRG 193
Min. Negotiated Rate	$12,323.75
Max. Negotiated Rate	$12,323.75
Rate for Payer: BCBS Commercial	$12,323.75

SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC

Facility

$6,943.18

Service Code	MSDRG 195
Min. Negotiated Rate	$6,943.18
Max. Negotiated Rate	$6,943.18
Rate for Payer: BCBS Commercial	$6,943.18

SIMPLE REPAIR 2.5CMOR LESS

Facility

$476.00

Service Code	HCPCS 12011
Hospital Charge Code	1201100
Hospital Revenue Code	761
Min. Negotiated Rate	$219.91
Max. Negotiated Rate	$475.71
Rate for Payer: BCBS Commercial	$475.71
Rate for Payer: Cash Price	$357.00
Rate for Payer: Cash Price	$357.00
Rate for Payer: Celtic Commercial/Exchange	$219.91
Rate for Payer: Health Partners Plans Commercial	$452.20
Rate for Payer: UnitedHealthcare Commercial	$461.72
Rate for Payer: WPPA Commercial	$399.84

SIMPLE REPAIR 2.5CMOR LESS

Facility

$476.00

Service Code	HCPCS 12011
Hospital Charge Code	1201100
Hospital Revenue Code	761
Min. Negotiated Rate	$390.32
Max. Negotiated Rate	$461.72
Rate for Payer: Cash Price	$357.00
Rate for Payer: Health Partners Plans Commercial	$452.20
Rate for Payer: UnitedHealthcare Commercial	$461.72
Rate for Payer: WPPA Commercial	$390.32

SIMPLE REPAIR2.6-7.5CM ANATOMI

Facility

$477.00

Service Code	HCPCS 12002
Hospital Charge Code	1200200
Hospital Revenue Code	761
Min. Negotiated Rate	$391.14
Max. Negotiated Rate	$462.69
Rate for Payer: Cash Price	$357.75
Rate for Payer: Health Partners Plans Commercial	$453.15
Rate for Payer: UnitedHealthcare Commercial	$462.69
Rate for Payer: WPPA Commercial	$391.14

SIMPLE REPAIR2.6-7.5CM ANATOMI

Facility

$477.00

Service Code	HCPCS 12002
Hospital Charge Code	1200200
Hospital Revenue Code	761
Min. Negotiated Rate	$220.37
Max. Negotiated Rate	$462.69
Rate for Payer: BCBS Commercial	$457.53
Rate for Payer: Cash Price	$357.75
Rate for Payer: Cash Price	$357.75
Rate for Payer: Celtic Commercial/Exchange	$220.37
Rate for Payer: Health Partners Plans Commercial	$453.15
Rate for Payer: UnitedHealthcare Commercial	$462.69
Rate for Payer: WPPA Commercial	$400.68

SIMPLE REPAIR 2.6CM TO 7.5 CM

Facility

$215.00

Service Code	HCPCS 12002
Hospital Charge Code	1200202
Hospital Revenue Code	450
Min. Negotiated Rate	$99.33
Max. Negotiated Rate	$457.53
Rate for Payer: BCBS Commercial	$457.53
Rate for Payer: Cash Price	$161.25
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

SIMPLE REPAIR 2.6CM TO 7.5 CM

Facility

$215.00

Service Code	HCPCS 12002
Hospital Charge Code	1200202
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

SIMPLE REPAIR FACE ECT7.6-12.5

Facility

$269.00

Service Code	HCPCS 12015
Hospital Charge Code	1201500
Hospital Revenue Code	450
Min. Negotiated Rate	$124.28
Max. Negotiated Rate	$809.01
Rate for Payer: BCBS Commercial	$809.01
Rate for Payer: Cash Price	$201.75
Rate for Payer: Cash Price	$201.75
Rate for Payer: Celtic Commercial/Exchange	$124.28
Rate for Payer: Health Partners Plans Commercial	$255.55
Rate for Payer: UnitedHealthcare Commercial	$260.93
Rate for Payer: WPPA Commercial	$225.96

SIMPLE REPAIR FACE ECT7.6-12.5

Facility

$269.00

Service Code	HCPCS 12015
Hospital Charge Code	1201500
Hospital Revenue Code	450
Min. Negotiated Rate	$220.58
Max. Negotiated Rate	$260.93
Rate for Payer: Cash Price	$201.75
Rate for Payer: Health Partners Plans Commercial	$255.55
Rate for Payer: UnitedHealthcare Commercial	$260.93
Rate for Payer: WPPA Commercial	$220.58

SIMPLE REPAIR-SUPERFICIAL WNDS

Facility

$185.00

Service Code	HCPCS 12002
Hospital Charge Code	1200201
Hospital Revenue Code	981
Min. Negotiated Rate	$151.70
Max. Negotiated Rate	$179.45
Rate for Payer: Cash Price	$138.75
Rate for Payer: Health Partners Plans Commercial	$175.75
Rate for Payer: UnitedHealthcare Commercial	$179.45
Rate for Payer: WPPA Commercial	$151.70

SIMPLE REPAIR-SUPERFICIAL WNDS

Facility

$185.00

Service Code	HCPCS 12002
Hospital Charge Code	1200201
Hospital Revenue Code	981
Min. Negotiated Rate	$85.47
Max. Negotiated Rate	$457.53
Rate for Payer: BCBS Commercial	$457.53
Rate for Payer: Cash Price	$138.75
Rate for Payer: Cash Price	$138.75
Rate for Payer: Celtic Commercial/Exchange	$85.47
Rate for Payer: Health Partners Plans Commercial	$175.75
Rate for Payer: UnitedHealthcare Commercial	$179.45
Rate for Payer: WPPA Commercial	$155.40

SIMPLE REPAIR SUPRFIC WND>20.0

Facility

$404.00

Service Code	HCPCS 12006
Hospital Charge Code	1200600
Hospital Revenue Code	450
Min. Negotiated Rate	$331.28
Max. Negotiated Rate	$391.88
Rate for Payer: Cash Price	$303.00
Rate for Payer: Health Partners Plans Commercial	$383.80
Rate for Payer: UnitedHealthcare Commercial	$391.88
Rate for Payer: WPPA Commercial	$331.28

SIMPLE REPAIR SUPRFIC WND>20.0

Facility

$404.00

Service Code	HCPCS 12006
Hospital Charge Code	1200600
Hospital Revenue Code	450
Min. Negotiated Rate	$186.65
Max. Negotiated Rate	$1,538.23
Rate for Payer: BCBS Commercial	$1,538.23
Rate for Payer: Cash Price	$303.00
Rate for Payer: Cash Price	$303.00
Rate for Payer: Celtic Commercial/Exchange	$186.65
Rate for Payer: Health Partners Plans Commercial	$383.80
Rate for Payer: UnitedHealthcare Commercial	$391.88
Rate for Payer: WPPA Commercial	$339.36

SIMPL REPR FACE/MUCOUS 2.6-5.0

Facility

$476.00

Service Code	HCPCS 12013
Hospital Charge Code	1201300
Hospital Revenue Code	761
Min. Negotiated Rate	$219.91
Max. Negotiated Rate	$475.71
Rate for Payer: BCBS Commercial	$475.71
Rate for Payer: Cash Price	$357.00
Rate for Payer: Cash Price	$357.00
Rate for Payer: Celtic Commercial/Exchange	$219.91
Rate for Payer: Health Partners Plans Commercial	$452.20
Rate for Payer: UnitedHealthcare Commercial	$461.72
Rate for Payer: WPPA Commercial	$399.84

SIMPL REPR FACE/MUCOUS 2.6-5.0

Facility

$476.00

Service Code	HCPCS 12013
Hospital Charge Code	1201300
Hospital Revenue Code	761
Min. Negotiated Rate	$390.32
Max. Negotiated Rate	$461.72
Rate for Payer: Cash Price	$357.00
Rate for Payer: Health Partners Plans Commercial	$452.20
Rate for Payer: UnitedHealthcare Commercial	$461.72
Rate for Payer: WPPA Commercial	$390.32

Know your out-of-pocket cost for care.

All Charges