Ness County Hospital

All Charges

Charge

Type

Setting

Price

APPLICATION OF FINGER SPLINT

Facility

$326.00

Service Code	HCPCS 29130
Hospital Charge Code	2913000
Hospital Revenue Code	761
Min. Negotiated Rate	$150.61
Max. Negotiated Rate	$316.22
Rate for Payer: BCBS Commercial	$230.28
Rate for Payer: Cash Price	$244.50
Rate for Payer: Cash Price	$244.50
Rate for Payer: Celtic Commercial/Exchange	$150.61
Rate for Payer: Health Partners Plans Commercial	$309.70
Rate for Payer: UnitedHealthcare Commercial	$316.22
Rate for Payer: WPPA Commercial	$273.84

APPLICATION OF FINGER SPLINT

Facility

$326.00

Service Code	HCPCS 29130
Hospital Charge Code	2913000
Hospital Revenue Code	761
Min. Negotiated Rate	$267.32
Max. Negotiated Rate	$316.22
Rate for Payer: Cash Price	$244.50
Rate for Payer: Health Partners Plans Commercial	$309.70
Rate for Payer: UnitedHealthcare Commercial	$316.22
Rate for Payer: WPPA Commercial	$267.32

APPLICATION OF LONG ARM SPLINT

Facility

$298.00

Service Code	HCPCS 29105
Hospital Charge Code	2910500
Hospital Revenue Code	761
Min. Negotiated Rate	$137.68
Max. Negotiated Rate	$289.06
Rate for Payer: BCBS Commercial	$230.28
Rate for Payer: Cash Price	$223.50
Rate for Payer: Cash Price	$223.50
Rate for Payer: Celtic Commercial/Exchange	$137.68
Rate for Payer: Health Partners Plans Commercial	$283.10
Rate for Payer: UnitedHealthcare Commercial	$289.06
Rate for Payer: WPPA Commercial	$250.32

APPLICATION OF LONG ARM SPLINT

Facility

$298.00

Service Code	HCPCS 29105
Hospital Charge Code	2910500
Hospital Revenue Code	761
Min. Negotiated Rate	$244.36
Max. Negotiated Rate	$289.06
Rate for Payer: Cash Price	$223.50
Rate for Payer: Health Partners Plans Commercial	$283.10
Rate for Payer: UnitedHealthcare Commercial	$289.06
Rate for Payer: WPPA Commercial	$244.36

APPLICATION OF LONG LEG SPLINT

Facility

$377.00

Service Code	HCPCS 29505
Hospital Charge Code	2950500
Hospital Revenue Code	761
Min. Negotiated Rate	$309.14
Max. Negotiated Rate	$365.69
Rate for Payer: Cash Price	$282.75
Rate for Payer: Health Partners Plans Commercial	$358.15
Rate for Payer: UnitedHealthcare Commercial	$365.69
Rate for Payer: WPPA Commercial	$309.14

APPLICATION OF LONG LEG SPLINT

Facility

$377.00

Service Code	HCPCS 29505
Hospital Charge Code	2950500
Hospital Revenue Code	761
Min. Negotiated Rate	$174.17
Max. Negotiated Rate	$365.69
Rate for Payer: BCBS Commercial	$230.28
Rate for Payer: Cash Price	$282.75
Rate for Payer: Cash Price	$282.75
Rate for Payer: Celtic Commercial/Exchange	$174.17
Rate for Payer: Health Partners Plans Commercial	$358.15
Rate for Payer: UnitedHealthcare Commercial	$365.69
Rate for Payer: WPPA Commercial	$316.68

Application of Multi-Layer Compression System to Lower Leg, including ankle and foot

Facility

$350.00

Service Code	HCPCS 29581 GO
Hospital Charge Code	2958100
Hospital Revenue Code	430
Min. Negotiated Rate	$161.70
Max. Negotiated Rate	$339.50
Rate for Payer: BCBS Commercial	$277.75
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

Application of Multi-Layer Compression System to Lower Leg, including ankle and foot

Facility

$350.00

Service Code	HCPCS 29581 GO
Hospital Charge Code	2958100
Hospital Revenue Code	430
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

APPLICATION SHORT LEG CAST

Facility

$300.00

Service Code	HCPCS 29515
Hospital Charge Code	2951523
Hospital Revenue Code	761
Min. Negotiated Rate	$138.60
Max. Negotiated Rate	$291.00
Rate for Payer: BCBS Commercial	$230.28
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

APPLICATION SHORT LEG CAST

Facility

$300.00

Service Code	HCPCS 29515
Hospital Charge Code	2951523
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

APPLICATION SHORT LEG SPLINT

Facility

$294.00

Service Code	HCPCS 29515
Hospital Charge Code	2951500
Hospital Revenue Code	761
Min. Negotiated Rate	$241.08
Max. Negotiated Rate	$285.18
Rate for Payer: Cash Price	$220.50
Rate for Payer: Health Partners Plans Commercial	$279.30
Rate for Payer: UnitedHealthcare Commercial	$285.18
Rate for Payer: WPPA Commercial	$241.08

APPLICATION SHORT LEG SPLINT

Facility

$294.00

Service Code	HCPCS 29515
Hospital Charge Code	2951500
Hospital Revenue Code	761
Min. Negotiated Rate	$135.83
Max. Negotiated Rate	$285.18
Rate for Payer: BCBS Commercial	$230.28
Rate for Payer: Cash Price	$220.50
Rate for Payer: Cash Price	$220.50
Rate for Payer: Celtic Commercial/Exchange	$135.83
Rate for Payer: Health Partners Plans Commercial	$279.30
Rate for Payer: UnitedHealthcare Commercial	$285.18
Rate for Payer: WPPA Commercial	$246.96

APPLICATON SHORT LEG CAST

Facility

$484.00

Service Code	HCPCS 29405
Hospital Charge Code	2940500
Hospital Revenue Code	761
Min. Negotiated Rate	$396.88
Max. Negotiated Rate	$469.48
Rate for Payer: Cash Price	$363.00
Rate for Payer: Health Partners Plans Commercial	$459.80
Rate for Payer: UnitedHealthcare Commercial	$469.48
Rate for Payer: WPPA Commercial	$396.88

APPLICATON SHORT LEG CAST

Facility

$484.00

Service Code	HCPCS 29405
Hospital Charge Code	2940500
Hospital Revenue Code	761
Min. Negotiated Rate	$223.61
Max. Negotiated Rate	$469.48
Rate for Payer: BCBS Commercial	$277.75
Rate for Payer: Cash Price	$363.00
Rate for Payer: Cash Price	$363.00
Rate for Payer: Celtic Commercial/Exchange	$223.61
Rate for Payer: Health Partners Plans Commercial	$459.80
Rate for Payer: UnitedHealthcare Commercial	$469.48
Rate for Payer: WPPA Commercial	$406.56

APPL SHORT ARM SPLINT DYNAMIC

Facility

$246.00

Service Code	HCPCS 29126
Hospital Charge Code	2912600
Hospital Revenue Code	450
Min. Negotiated Rate	$201.72
Max. Negotiated Rate	$238.62
Rate for Payer: Cash Price	$184.50
Rate for Payer: Health Partners Plans Commercial	$233.70
Rate for Payer: UnitedHealthcare Commercial	$238.62
Rate for Payer: WPPA Commercial	$201.72

APPL SHORT ARM SPLINT DYNAMIC

Facility

$246.00

Service Code	HCPCS 29126
Hospital Charge Code	2912600
Hospital Revenue Code	450
Min. Negotiated Rate	$113.65
Max. Negotiated Rate	$238.62
Rate for Payer: BCBS Commercial	$230.28
Rate for Payer: Cash Price	$184.50
Rate for Payer: Cash Price	$184.50
Rate for Payer: Celtic Commercial/Exchange	$113.65
Rate for Payer: Health Partners Plans Commercial	$233.70
Rate for Payer: UnitedHealthcare Commercial	$238.62
Rate for Payer: WPPA Commercial	$206.64

APPL SKIN CHILD F/N/HF/G+100CM

Facility

$750.00

Service Code	HCPCS 15278
Hospital Charge Code	1527823
Hospital Revenue Code	761
Min. Negotiated Rate	$615.00
Max. Negotiated Rate	$727.50
Rate for Payer: Cash Price	$562.50
Rate for Payer: Health Partners Plans Commercial	$712.50
Rate for Payer: UnitedHealthcare Commercial	$727.50
Rate for Payer: WPPA Commercial	$615.00

APPL SKIN CHILD F/N/HF/G+100CM

Facility

$114.00

Service Code	HCPCS 15278 GF
Hospital Charge Code	15278WC
Hospital Revenue Code	983
Min. Negotiated Rate	$52.67
Max. Negotiated Rate	$110.58
Rate for Payer: Cash Price	$85.50
Rate for Payer: Celtic Commercial/Exchange	$52.67
Rate for Payer: Health Partners Plans Commercial	$108.30
Rate for Payer: UnitedHealthcare Commercial	$110.58
Rate for Payer: WPPA Commercial	$95.76

APPL SKIN CHILD F/N/HF/G+100CM

Facility

$114.00

Service Code	HCPCS 15278 GF
Hospital Charge Code	15278WC
Hospital Revenue Code	983
Min. Negotiated Rate	$93.48
Max. Negotiated Rate	$110.58
Rate for Payer: Cash Price	$85.50
Rate for Payer: Health Partners Plans Commercial	$108.30
Rate for Payer: UnitedHealthcare Commercial	$110.58
Rate for Payer: WPPA Commercial	$93.48

APPL SKIN CHILD F/N/HF/G+100CM

Facility

$750.00

Service Code	HCPCS 15278
Hospital Charge Code	1527823
Hospital Revenue Code	761
Min. Negotiated Rate	$346.50
Max. Negotiated Rate	$727.50
Rate for Payer: Cash Price	$562.50
Rate for Payer: Celtic Commercial/Exchange	$346.50
Rate for Payer: Health Partners Plans Commercial	$712.50
Rate for Payer: UnitedHealthcare Commercial	$727.50
Rate for Payer: WPPA Commercial	$630.00

APPL SKIN CHILD F/N/HF/G<100CM

Facility

$410.00

Service Code	HCPCS 15277 GF
Hospital Charge Code	15277WC
Hospital Revenue Code	983
Min. Negotiated Rate	$189.42
Max. Negotiated Rate	$809.01
Rate for Payer: BCBS Commercial	$809.01
Rate for Payer: Cash Price	$307.50
Rate for Payer: Cash Price	$307.50
Rate for Payer: Celtic Commercial/Exchange	$189.42
Rate for Payer: Health Partners Plans Commercial	$389.50
Rate for Payer: UnitedHealthcare Commercial	$397.70
Rate for Payer: WPPA Commercial	$344.40

APPL SKIN CHILD F/N/HF/G<100CM

Facility

$410.00

Service Code	HCPCS 15277 GF
Hospital Charge Code	15277WC
Hospital Revenue Code	983
Min. Negotiated Rate	$336.20
Max. Negotiated Rate	$397.70
Rate for Payer: Cash Price	$307.50
Rate for Payer: Health Partners Plans Commercial	$389.50
Rate for Payer: UnitedHealthcare Commercial	$397.70
Rate for Payer: WPPA Commercial	$336.20

APPL SKIN CHILD F/N/HF/G>100CM

Facility

$3,000.00

Service Code	HCPCS 15277
Hospital Charge Code	1527723
Hospital Revenue Code	761
Min. Negotiated Rate	$809.01
Max. Negotiated Rate	$2,910.00
Rate for Payer: BCBS Commercial	$809.01
Rate for Payer: Cash Price	$2,250.00
Rate for Payer: Cash Price	$2,250.00
Rate for Payer: Celtic Commercial/Exchange	$1,386.00
Rate for Payer: Health Partners Plans Commercial	$2,850.00
Rate for Payer: UnitedHealthcare Commercial	$2,910.00
Rate for Payer: WPPA Commercial	$2,520.00

APPL SKIN CHILD F/N/HF/G>100CM

Facility

$3,000.00

Service Code	HCPCS 15277
Hospital Charge Code	1527723
Hospital Revenue Code	761
Min. Negotiated Rate	$2,460.00
Max. Negotiated Rate	$2,910.00
Rate for Payer: Cash Price	$2,250.00
Rate for Payer: Health Partners Plans Commercial	$2,850.00
Rate for Payer: UnitedHealthcare Commercial	$2,910.00
Rate for Payer: WPPA Commercial	$2,460.00

APPL SKIN CHILD T/A/L +100CM

Facility

$770.00

Service Code	HCPCS 15274
Hospital Charge Code	1527423
Hospital Revenue Code	761
Min. Negotiated Rate	$631.40
Max. Negotiated Rate	$746.90
Rate for Payer: Cash Price	$577.50
Rate for Payer: Health Partners Plans Commercial	$731.50
Rate for Payer: UnitedHealthcare Commercial	$746.90
Rate for Payer: WPPA Commercial	$631.40

Know your out-of-pocket cost for care.

All Charges