Ness County Hospital

All Charges

Charge

Type

Setting

Price

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	$355.74
Max. Negotiated Rate	$746.90
Rate for Payer: Cash Price	$577.50
Rate for Payer: Celtic Commercial/Exchange	$355.74
Rate for Payer: Health Partners Plans Commercial	$731.50
Rate for Payer: UnitedHealthcare Commercial	$746.90
Rate for Payer: WPPA Commercial	$646.80

APPL SKIN CHILD T/A/L +100CM

Facility

$98.00

Service Code	HCPCS 15274 GF
Hospital Charge Code	15274WC
Hospital Revenue Code	983
Min. Negotiated Rate	$80.36
Max. Negotiated Rate	$95.06
Rate for Payer: Cash Price	$73.50
Rate for Payer: Health Partners Plans Commercial	$93.10
Rate for Payer: UnitedHealthcare Commercial	$95.06
Rate for Payer: WPPA Commercial	$80.36

APPL SKIN CHILD T/A/L +100CM

Facility

$98.00

Service Code	HCPCS 15274 GF
Hospital Charge Code	15274WC
Hospital Revenue Code	983
Min. Negotiated Rate	$45.28
Max. Negotiated Rate	$95.06
Rate for Payer: Cash Price	$73.50
Rate for Payer: Celtic Commercial/Exchange	$45.28
Rate for Payer: Health Partners Plans Commercial	$93.10
Rate for Payer: UnitedHealthcare Commercial	$95.06
Rate for Payer: WPPA Commercial	$82.32

APPL SKIN CHILD T/A/L =>100CM

Facility

$3,597.00

Service Code	HCPCS 15273
Hospital Charge Code	1527323
Hospital Revenue Code	761
Min. Negotiated Rate	$1,661.81
Max. Negotiated Rate	$3,489.09
Rate for Payer: BCBS Commercial	$2,471.47
Rate for Payer: Cash Price	$2,697.75
Rate for Payer: Cash Price	$2,697.75
Rate for Payer: Celtic Commercial/Exchange	$1,661.81
Rate for Payer: Health Partners Plans Commercial	$3,417.15
Rate for Payer: UnitedHealthcare Commercial	$3,489.09
Rate for Payer: WPPA Commercial	$3,021.48

APPL SKIN CHILD T/A/L =>100CM

Facility

$3,597.00

Service Code	HCPCS 15273
Hospital Charge Code	1527323
Hospital Revenue Code	761
Min. Negotiated Rate	$2,949.54
Max. Negotiated Rate	$3,489.09
Rate for Payer: Cash Price	$2,697.75
Rate for Payer: Health Partners Plans Commercial	$3,417.15
Rate for Payer: UnitedHealthcare Commercial	$3,489.09
Rate for Payer: WPPA Commercial	$2,949.54

APPL SKIN CHILD T/A/L=100CM

Facility

$373.00

Service Code	HCPCS 15273 GF
Hospital Charge Code	15273WC
Hospital Revenue Code	983
Min. Negotiated Rate	$305.86
Max. Negotiated Rate	$361.81
Rate for Payer: Cash Price	$279.75
Rate for Payer: Health Partners Plans Commercial	$354.35
Rate for Payer: UnitedHealthcare Commercial	$361.81
Rate for Payer: WPPA Commercial	$305.86

APPL SKIN CHILD T/A/L=100CM

Facility

$373.00

Service Code	HCPCS 15273 GF
Hospital Charge Code	15273WC
Hospital Revenue Code	983
Min. Negotiated Rate	$172.33
Max. Negotiated Rate	$2,471.47
Rate for Payer: BCBS Commercial	$2,471.47
Rate for Payer: Cash Price	$279.75
Rate for Payer: Cash Price	$279.75
Rate for Payer: Celtic Commercial/Exchange	$172.33
Rate for Payer: Health Partners Plans Commercial	$354.35
Rate for Payer: UnitedHealthcare Commercial	$361.81
Rate for Payer: WPPA Commercial	$313.32

APPL SKIN FC/NK/HF/GN=<25CM

Facility

$190.00

Service Code	HCPCS 15275 GF
Hospital Charge Code	15275WC
Hospital Revenue Code	983
Min. Negotiated Rate	$155.80
Max. Negotiated Rate	$184.30
Rate for Payer: Cash Price	$142.50
Rate for Payer: Health Partners Plans Commercial	$180.50
Rate for Payer: UnitedHealthcare Commercial	$184.30
Rate for Payer: WPPA Commercial	$155.80

APPL SKIN FC/NK/HF/GN=<25CM

Facility

$190.00

Service Code	HCPCS 15275 GF
Hospital Charge Code	15275WC
Hospital Revenue Code	983
Min. Negotiated Rate	$87.78
Max. Negotiated Rate	$4,483.39
Rate for Payer: BCBS Commercial	$4,483.39
Rate for Payer: Cash Price	$142.50
Rate for Payer: Cash Price	$142.50
Rate for Payer: Celtic Commercial/Exchange	$87.78
Rate for Payer: Health Partners Plans Commercial	$180.50
Rate for Payer: UnitedHealthcare Commercial	$184.30
Rate for Payer: WPPA Commercial	$159.60

APPL SKIN FC/NK/HF/GN ADD 25CM

Facility

$575.00

Service Code	HCPCS 15276
Hospital Charge Code	1527623
Hospital Revenue Code	761
Min. Negotiated Rate	$265.65
Max. Negotiated Rate	$557.75
Rate for Payer: Cash Price	$431.25
Rate for Payer: Celtic Commercial/Exchange	$265.65
Rate for Payer: Health Partners Plans Commercial	$546.25
Rate for Payer: UnitedHealthcare Commercial	$557.75
Rate for Payer: WPPA Commercial	$483.00

APPL SKIN FC/NK/HF/GN ADD 25CM

Facility

$39.00

Service Code	HCPCS 15276 GF
Hospital Charge Code	15276WC
Hospital Revenue Code	983
Min. Negotiated Rate	$31.98
Max. Negotiated Rate	$37.83
Rate for Payer: Cash Price	$29.25
Rate for Payer: Health Partners Plans Commercial	$37.05
Rate for Payer: UnitedHealthcare Commercial	$37.83
Rate for Payer: WPPA Commercial	$31.98

APPL SKIN FC/NK/HF/GN ADD 25CM

Facility

$39.00

Service Code	HCPCS 15276 GF
Hospital Charge Code	15276WC
Hospital Revenue Code	983
Min. Negotiated Rate	$18.02
Max. Negotiated Rate	$37.83
Rate for Payer: Cash Price	$29.25
Rate for Payer: Celtic Commercial/Exchange	$18.02
Rate for Payer: Health Partners Plans Commercial	$37.05
Rate for Payer: UnitedHealthcare Commercial	$37.83
Rate for Payer: WPPA Commercial	$32.76

APPL SKIN FC/NK/HF/GN ADD 25CM

Facility

$575.00

Service Code	HCPCS 15276
Hospital Charge Code	1527623
Hospital Revenue Code	761
Min. Negotiated Rate	$471.50
Max. Negotiated Rate	$557.75
Rate for Payer: Cash Price	$431.25
Rate for Payer: Health Partners Plans Commercial	$546.25
Rate for Payer: UnitedHealthcare Commercial	$557.75
Rate for Payer: WPPA Commercial	$471.50

APPL SKIN T/A/L =<25CM

Facility

$183.00

Service Code	HCPCS 15271 GF
Hospital Charge Code	15271WC
Hospital Revenue Code	983
Min. Negotiated Rate	$150.06
Max. Negotiated Rate	$177.51
Rate for Payer: Cash Price	$137.25
Rate for Payer: Health Partners Plans Commercial	$173.85
Rate for Payer: UnitedHealthcare Commercial	$177.51
Rate for Payer: WPPA Commercial	$150.06

APPL SKIN T/A/L =<25CM

Facility

$183.00

Service Code	HCPCS 15271 GF
Hospital Charge Code	15271WC
Hospital Revenue Code	983
Min. Negotiated Rate	$84.55
Max. Negotiated Rate	$3,014.85
Rate for Payer: BCBS Commercial	$3,014.85
Rate for Payer: Cash Price	$137.25
Rate for Payer: Cash Price	$137.25
Rate for Payer: Celtic Commercial/Exchange	$84.55
Rate for Payer: Health Partners Plans Commercial	$173.85
Rate for Payer: UnitedHealthcare Commercial	$177.51
Rate for Payer: WPPA Commercial	$153.72

APPL SKIN T/A/L =<25CM

Facility

$3,225.00

Service Code	HCPCS 15271
Hospital Charge Code	1527123
Hospital Revenue Code	761
Min. Negotiated Rate	$1,489.95
Max. Negotiated Rate	$3,128.25
Rate for Payer: BCBS Commercial	$3,014.85
Rate for Payer: Cash Price	$2,418.75
Rate for Payer: Cash Price	$2,418.75
Rate for Payer: Celtic Commercial/Exchange	$1,489.95
Rate for Payer: Health Partners Plans Commercial	$3,063.75
Rate for Payer: UnitedHealthcare Commercial	$3,128.25
Rate for Payer: WPPA Commercial	$2,709.00

APPL SKIN T/A/L =<25CM

Facility

$3,225.00

Service Code	HCPCS 15271
Hospital Charge Code	1527123
Hospital Revenue Code	761
Min. Negotiated Rate	$2,644.50
Max. Negotiated Rate	$3,128.25
Rate for Payer: Cash Price	$2,418.75
Rate for Payer: Health Partners Plans Commercial	$3,063.75
Rate for Payer: UnitedHealthcare Commercial	$3,128.25
Rate for Payer: WPPA Commercial	$2,644.50

APPL SKIN T/A/L ADD 25CM

Facility

$510.00

Service Code	HCPCS 15272
Hospital Charge Code	1527223
Hospital Revenue Code	761
Min. Negotiated Rate	$235.62
Max. Negotiated Rate	$494.70
Rate for Payer: Cash Price	$382.50
Rate for Payer: Celtic Commercial/Exchange	$235.62
Rate for Payer: Health Partners Plans Commercial	$484.50
Rate for Payer: UnitedHealthcare Commercial	$494.70
Rate for Payer: WPPA Commercial	$428.40

APPL SKIN T/A/L ADD 25CM

Facility

$30.00

Service Code	HCPCS 15272 GF
Hospital Charge Code	15272WC
Hospital Revenue Code	983
Min. Negotiated Rate	$13.86
Max. Negotiated Rate	$29.10
Rate for Payer: Cash Price	$22.50
Rate for Payer: Celtic Commercial/Exchange	$13.86
Rate for Payer: Health Partners Plans Commercial	$28.50
Rate for Payer: UnitedHealthcare Commercial	$29.10
Rate for Payer: WPPA Commercial	$25.20

APPL SKIN T/A/L ADD 25CM

Facility

$510.00

Service Code	HCPCS 15272
Hospital Charge Code	1527223
Hospital Revenue Code	761
Min. Negotiated Rate	$418.20
Max. Negotiated Rate	$494.70
Rate for Payer: Cash Price	$382.50
Rate for Payer: Health Partners Plans Commercial	$484.50
Rate for Payer: UnitedHealthcare Commercial	$494.70
Rate for Payer: WPPA Commercial	$418.20

APPL SKIN T/A/L ADD 25CM

Facility

$30.00

Service Code	HCPCS 15272 GF
Hospital Charge Code	15272WC
Hospital Revenue Code	983
Min. Negotiated Rate	$24.60
Max. Negotiated Rate	$29.10
Rate for Payer: Cash Price	$22.50
Rate for Payer: Health Partners Plans Commercial	$28.50
Rate for Payer: UnitedHealthcare Commercial	$29.10
Rate for Payer: WPPA Commercial	$24.60

APPLY CAST SHORT LEG

Facility

$473.00

Service Code	HCPCS 29425
Hospital Charge Code	2942500
Hospital Revenue Code	450
Min. Negotiated Rate	$387.86
Max. Negotiated Rate	$458.81
Rate for Payer: Cash Price	$354.75
Rate for Payer: Health Partners Plans Commercial	$449.35
Rate for Payer: UnitedHealthcare Commercial	$458.81
Rate for Payer: WPPA Commercial	$387.86

APPLY CAST SHORT LEG

Facility

$473.00

Service Code	HCPCS 29425
Hospital Charge Code	2942500
Hospital Revenue Code	450
Min. Negotiated Rate	$218.53
Max. Negotiated Rate	$458.81
Rate for Payer: BCBS Commercial	$277.75
Rate for Payer: Cash Price	$354.75
Rate for Payer: Cash Price	$354.75
Rate for Payer: Celtic Commercial/Exchange	$218.53
Rate for Payer: Health Partners Plans Commercial	$449.35
Rate for Payer: UnitedHealthcare Commercial	$458.81
Rate for Payer: WPPA Commercial	$397.32

APP SHORT ARM SPLINT-STATIC DY

Facility

$333.00

Service Code	HCPCS 29125
Hospital Charge Code	2912500
Hospital Revenue Code	761
Min. Negotiated Rate	$273.06
Max. Negotiated Rate	$323.01
Rate for Payer: Cash Price	$249.75
Rate for Payer: Health Partners Plans Commercial	$316.35
Rate for Payer: UnitedHealthcare Commercial	$323.01
Rate for Payer: WPPA Commercial	$273.06

APP SHORT ARM SPLINT-STATIC DY

Facility

$333.00

Service Code	HCPCS 29125
Hospital Charge Code	2912500
Hospital Revenue Code	761
Min. Negotiated Rate	$153.85
Max. Negotiated Rate	$323.01
Rate for Payer: BCBS Commercial	$230.28
Rate for Payer: Cash Price	$249.75
Rate for Payer: Cash Price	$249.75
Rate for Payer: Celtic Commercial/Exchange	$153.85
Rate for Payer: Health Partners Plans Commercial	$316.35
Rate for Payer: UnitedHealthcare Commercial	$323.01
Rate for Payer: WPPA Commercial	$279.72

Know your out-of-pocket cost for care.

All Charges