Ness County Hospital

All Charges

Charge

Type

Setting

Price

SPLENIC PROCEDURES WITH MCC

Facility

$45,685.79

Service Code	MSDRG 799
Min. Negotiated Rate	$45,685.79
Max. Negotiated Rate	$45,685.79
Rate for Payer: BCBS Commercial	$45,685.79

SPLENIC PROCEDURES WITHOUT CC/MCC

Facility

$17,207.19

Service Code	MSDRG 801
Min. Negotiated Rate	$17,207.19
Max. Negotiated Rate	$17,207.19
Rate for Payer: BCBS Commercial	$17,207.19

SPLINT-OCL-ARM PEDS

Facility

$55.00

Hospital Charge Code	2702082
Hospital Revenue Code	270
Min. Negotiated Rate	$45.10
Max. Negotiated Rate	$53.35
Rate for Payer: Cash Price	$41.25
Rate for Payer: Health Partners Plans Commercial	$52.25
Rate for Payer: UnitedHealthcare Commercial	$53.35
Rate for Payer: WPPA Commercial	$45.10

SPLINT-OCL-ARM PEDS

Facility

$55.00

Hospital Charge Code	2702082
Hospital Revenue Code	270
Min. Negotiated Rate	$25.41
Max. Negotiated Rate	$53.35
Rate for Payer: Cash Price	$41.25
Rate for Payer: Celtic Commercial/Exchange	$25.41
Rate for Payer: Health Partners Plans Commercial	$52.25
Rate for Payer: UnitedHealthcare Commercial	$53.35
Rate for Payer: WPPA Commercial	$46.20

SPLINT-OCL-FULL ARM

Facility

$98.00

Hospital Charge Code	2702066
Hospital Revenue Code	270
Min. Negotiated Rate	$45.28
Max. Negotiated Rate	$95.06
Rate for Payer: Cash Price	$74.06
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

SPLINT-OCL-FULL ARM

Facility

$98.00

Hospital Charge Code	2702066
Hospital Revenue Code	270
Min. Negotiated Rate	$80.36
Max. Negotiated Rate	$95.06
Rate for Payer: Cash Price	$74.06
Rate for Payer: Health Partners Plans Commercial	$93.10
Rate for Payer: UnitedHealthcare Commercial	$95.06
Rate for Payer: WPPA Commercial	$80.36

SPLINT-OCL FULL LEG

Facility

$128.00

Hospital Charge Code	2702041
Hospital Revenue Code	270
Min. Negotiated Rate	$59.14
Max. Negotiated Rate	$124.16
Rate for Payer: Cash Price	$96.56
Rate for Payer: Celtic Commercial/Exchange	$59.14
Rate for Payer: Health Partners Plans Commercial	$121.60
Rate for Payer: UnitedHealthcare Commercial	$124.16
Rate for Payer: WPPA Commercial	$107.52

SPLINT-OCL FULL LEG

Facility

$128.00

Hospital Charge Code	2702041
Hospital Revenue Code	270
Min. Negotiated Rate	$104.96
Max. Negotiated Rate	$124.16
Rate for Payer: Cash Price	$96.56
Rate for Payer: Health Partners Plans Commercial	$121.60
Rate for Payer: UnitedHealthcare Commercial	$124.16
Rate for Payer: WPPA Commercial	$104.96

SPLINT-OCL-LOWER ARM

Facility

$67.00

Hospital Charge Code	2702074
Hospital Revenue Code	270
Min. Negotiated Rate	$54.94
Max. Negotiated Rate	$64.99
Rate for Payer: Cash Price	$50.44
Rate for Payer: Health Partners Plans Commercial	$63.65
Rate for Payer: UnitedHealthcare Commercial	$64.99
Rate for Payer: WPPA Commercial	$54.94

SPLINT-OCL-LOWER ARM

Facility

$67.00

Hospital Charge Code	2702074
Hospital Revenue Code	270
Min. Negotiated Rate	$30.95
Max. Negotiated Rate	$64.99
Rate for Payer: Cash Price	$50.44
Rate for Payer: Celtic Commercial/Exchange	$30.95
Rate for Payer: Health Partners Plans Commercial	$63.65
Rate for Payer: UnitedHealthcare Commercial	$64.99
Rate for Payer: WPPA Commercial	$56.28

SPLINT- OCL-LOWER LEG

Facility

$77.00

Hospital Charge Code	2702058
Hospital Revenue Code	270
Min. Negotiated Rate	$63.14
Max. Negotiated Rate	$74.69
Rate for Payer: Cash Price	$58.12
Rate for Payer: Health Partners Plans Commercial	$73.15
Rate for Payer: UnitedHealthcare Commercial	$74.69
Rate for Payer: WPPA Commercial	$63.14

SPLINT- OCL-LOWER LEG

Facility

$77.00

Hospital Charge Code	2702058
Hospital Revenue Code	270
Min. Negotiated Rate	$35.57
Max. Negotiated Rate	$74.69
Rate for Payer: Cash Price	$58.12
Rate for Payer: Celtic Commercial/Exchange	$35.57
Rate for Payer: Health Partners Plans Commercial	$73.15
Rate for Payer: UnitedHealthcare Commercial	$74.69
Rate for Payer: WPPA Commercial	$64.68

SPLIT DRESSING

Facility

$9.00

Hospital Charge Code	2722691
Hospital Revenue Code	270
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

SPLIT DRESSING

Facility

$9.00

Hospital Charge Code	2722691
Hospital Revenue Code	270
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

SPLT AUTOGRFT,TRNK/ARM,LG 100S

Facility

$2,450.00

Service Code	HCPCS 15100
Hospital Charge Code	1510023
Hospital Revenue Code	761
Min. Negotiated Rate	$1,131.90
Max. Negotiated Rate	$3,746.09
Rate for Payer: BCBS Commercial	$3,746.09
Rate for Payer: Cash Price	$1,837.50
Rate for Payer: Cash Price	$1,837.50
Rate for Payer: Celtic Commercial/Exchange	$1,131.90
Rate for Payer: Health Partners Plans Commercial	$2,327.50
Rate for Payer: UnitedHealthcare Commercial	$2,376.50
Rate for Payer: WPPA Commercial	$2,058.00

SPLT AUTOGRFT,TRNK/ARM,LG 100S

Facility

$2,450.00

Service Code	HCPCS 15100
Hospital Charge Code	1510023
Hospital Revenue Code	761
Min. Negotiated Rate	$2,009.00
Max. Negotiated Rate	$2,376.50
Rate for Payer: Cash Price	$1,837.50
Rate for Payer: Health Partners Plans Commercial	$2,327.50
Rate for Payer: UnitedHealthcare Commercial	$2,376.50
Rate for Payer: WPPA Commercial	$2,009.00

SPLT THCKNS AUTOGRFT,F/H/FT100

Facility

$3,597.00

Service Code	HCPCS 15120
Hospital Charge Code	1512023
Hospital Revenue Code	761
Min. Negotiated Rate	$1,661.81
Max. Negotiated Rate	$3,840.02
Rate for Payer: BCBS Commercial	$3,840.02
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

SPLT THCKNS AUTOGRFT,F/H/FT100

Facility

$3,597.00

Service Code	HCPCS 15120
Hospital Charge Code	1512023
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

SPO2 NEO ADHESIVE

Facility

$45.00

Hospital Charge Code	2700909
Hospital Revenue Code	272
Min. Negotiated Rate	$36.90
Max. Negotiated Rate	$43.65
Rate for Payer: Cash Price	$33.75
Rate for Payer: Health Partners Plans Commercial	$42.75
Rate for Payer: UnitedHealthcare Commercial	$43.65
Rate for Payer: WPPA Commercial	$36.90

SPO2 NEO ADHESIVE

Facility

$45.00

Hospital Charge Code	2700909
Hospital Revenue Code	272
Min. Negotiated Rate	$20.79
Max. Negotiated Rate	$43.65
Rate for Payer: Cash Price	$33.75
Rate for Payer: Celtic Commercial/Exchange	$20.79
Rate for Payer: Health Partners Plans Commercial	$42.75
Rate for Payer: UnitedHealthcare Commercial	$43.65
Rate for Payer: WPPA Commercial	$37.80

SPONGE DRAIN 4" X 4 2S

Facility

$9.00

Hospital Charge Code	2720797
Hospital Revenue Code	270
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

SPONGE DRAIN 4" X 4 2S

Facility

$9.00

Hospital Charge Code	2720797
Hospital Revenue Code	270
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

SPONGE DRAIN 4" X 4 ST

Facility

$9.00

Hospital Charge Code	2720795LTC
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

SPONGE DRAIN 4" X 4 ST

Facility

$9.00

Hospital Charge Code	2720795LTC
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

SPONGE IV 2" X 2"

Facility

$9.00

Hospital Charge Code	2720796
Hospital Revenue Code	270
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

Know your out-of-pocket cost for care.

All Charges