Ness County Hospital

All Charges

Charge

Type

Setting

Price

UNIVERSAL SHOULDER IMMOBILIZER

Facility

$81.00

Hospital Charge Code	2701399
Hospital Revenue Code	270
Min. Negotiated Rate	$66.42
Max. Negotiated Rate	$78.57
Rate for Payer: Cash Price	$60.94
Rate for Payer: Health Partners Plans Commercial	$76.95
Rate for Payer: UnitedHealthcare Commercial	$78.57
Rate for Payer: WPPA Commercial	$66.42

UNIVERSAL SHOULDER IMMOBILIZER

Facility

$81.00

Hospital Charge Code	2701399
Hospital Revenue Code	270
Min. Negotiated Rate	$37.42
Max. Negotiated Rate	$78.57
Rate for Payer: Cash Price	$60.94
Rate for Payer: Celtic Commercial/Exchange	$37.42
Rate for Payer: Health Partners Plans Commercial	$76.95
Rate for Payer: UnitedHealthcare Commercial	$78.57
Rate for Payer: WPPA Commercial	$68.04

UNIVERSAL WRIST SPLINT 11"

Facility

$55.00

Hospital Charge Code	2701001
Hospital Revenue Code	292
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

UNIVERSAL WRIST SPLINT 11"

Facility

$55.00

Hospital Charge Code	2701001
Hospital Revenue Code	292
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

UNIVER WRIST SPLINT 6&8"

Facility

$47.00

Hospital Charge Code	2701019
Hospital Revenue Code	270
Min. Negotiated Rate	$21.71
Max. Negotiated Rate	$45.59
Rate for Payer: Cash Price	$35.44
Rate for Payer: Celtic Commercial/Exchange	$21.71
Rate for Payer: Health Partners Plans Commercial	$44.65
Rate for Payer: UnitedHealthcare Commercial	$45.59
Rate for Payer: WPPA Commercial	$39.48

UNIVER WRIST SPLINT 6&8"

Facility

$47.00

Hospital Charge Code	2701019
Hospital Revenue Code	270
Min. Negotiated Rate	$38.54
Max. Negotiated Rate	$45.59
Rate for Payer: Cash Price	$35.44
Rate for Payer: Health Partners Plans Commercial	$44.65
Rate for Payer: UnitedHealthcare Commercial	$45.59
Rate for Payer: WPPA Commercial	$38.54

UNIV. FINGER SPLINTS 3/4 X 18"

Facility

$13.00

Hospital Charge Code	2701415
Hospital Revenue Code	270
Min. Negotiated Rate	$6.01
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$10.31
Rate for Payer: Celtic Commercial/Exchange	$6.01
Rate for Payer: Health Partners Plans Commercial	$12.35
Rate for Payer: UnitedHealthcare Commercial	$12.61
Rate for Payer: WPPA Commercial	$10.92

UNIV. FINGER SPLINTS 3/4 X 18"

Facility

$13.00

Hospital Charge Code	2701415
Hospital Revenue Code	270
Min. Negotiated Rate	$10.66
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$10.31
Rate for Payer: Health Partners Plans Commercial	$12.35
Rate for Payer: UnitedHealthcare Commercial	$12.61
Rate for Payer: WPPA Commercial	$10.66

UNIV. POST OP KNEE IMMOBILIZER

Facility

$150.00

Hospital Charge Code	2701027
Hospital Revenue Code	270
Min. Negotiated Rate	$69.30
Max. Negotiated Rate	$145.50
Rate for Payer: Cash Price	$112.69
Rate for Payer: Celtic Commercial/Exchange	$69.30
Rate for Payer: Health Partners Plans Commercial	$142.50
Rate for Payer: UnitedHealthcare Commercial	$145.50
Rate for Payer: WPPA Commercial	$126.00

UNIV. POST OP KNEE IMMOBILIZER

Facility

$150.00

Hospital Charge Code	2701027
Hospital Revenue Code	270
Min. Negotiated Rate	$123.00
Max. Negotiated Rate	$145.50
Rate for Payer: Cash Price	$112.69
Rate for Payer: Health Partners Plans Commercial	$142.50
Rate for Payer: UnitedHealthcare Commercial	$145.50
Rate for Payer: WPPA Commercial	$123.00

UNLISTED CHEMISTRY PROCEDURE

Facility

$84.00

Service Code	HCPCS 84999
Hospital Charge Code	8499900
Hospital Revenue Code	301
Min. Negotiated Rate	$68.88
Max. Negotiated Rate	$81.48
Rate for Payer: Cash Price	$63.00
Rate for Payer: Health Partners Plans Commercial	$79.80
Rate for Payer: UnitedHealthcare Commercial	$81.48
Rate for Payer: WPPA Commercial	$68.88

UNLISTED CHEMISTRY PROCEDURE

Facility

$84.00

Service Code	HCPCS 84999
Hospital Charge Code	8499900
Hospital Revenue Code	301
Min. Negotiated Rate	$38.81
Max. Negotiated Rate	$81.48
Rate for Payer: Cash Price	$63.00
Rate for Payer: Celtic Commercial/Exchange	$38.81
Rate for Payer: Health Partners Plans Commercial	$79.80
Rate for Payer: UnitedHealthcare Commercial	$81.48
Rate for Payer: WPPA Commercial	$70.56

UNLISTED PROC, DENTOALVEOLAR

Facility

$234.00

Service Code	HCPCS 41899
Hospital Charge Code	4189900
Hospital Revenue Code	450
Min. Negotiated Rate	$108.11
Max. Negotiated Rate	$2,859.31
Rate for Payer: BCBS Commercial	$2,859.31
Rate for Payer: Cash Price	$175.50
Rate for Payer: Cash Price	$175.50
Rate for Payer: Celtic Commercial/Exchange	$108.11
Rate for Payer: Health Partners Plans Commercial	$222.30
Rate for Payer: UnitedHealthcare Commercial	$226.98
Rate for Payer: WPPA Commercial	$196.56

UNLISTED PROC, DENTOALVEOLAR

Facility

$234.00

Service Code	HCPCS 41899
Hospital Charge Code	4189900
Hospital Revenue Code	450
Min. Negotiated Rate	$191.88
Max. Negotiated Rate	$226.98
Rate for Payer: Cash Price	$175.50
Rate for Payer: Health Partners Plans Commercial	$222.30
Rate for Payer: UnitedHealthcare Commercial	$226.98
Rate for Payer: WPPA Commercial	$191.88

UNLISTED PROCEDURE, LIPS

Facility

$234.00

Service Code	HCPCS 40799
Hospital Charge Code	4079900
Hospital Revenue Code	450
Min. Negotiated Rate	$191.88
Max. Negotiated Rate	$226.98
Rate for Payer: Cash Price	$175.50
Rate for Payer: Health Partners Plans Commercial	$222.30
Rate for Payer: UnitedHealthcare Commercial	$226.98
Rate for Payer: WPPA Commercial	$191.88

UNLISTED PROCEDURE, LIPS

Facility

$234.00

Service Code	HCPCS 40799
Hospital Charge Code	4079900
Hospital Revenue Code	450
Min. Negotiated Rate	$108.11
Max. Negotiated Rate	$226.98
Rate for Payer: Cash Price	$175.50
Rate for Payer: Celtic Commercial/Exchange	$108.11
Rate for Payer: Health Partners Plans Commercial	$222.30
Rate for Payer: UnitedHealthcare Commercial	$226.98
Rate for Payer: WPPA Commercial	$196.56

UNLISTED REHAB SVC OR PROC.

Facility

$36.00

Service Code	HCPCS 97799 GP
Hospital Charge Code	4202094
Hospital Revenue Code	420
Min. Negotiated Rate	$29.52
Max. Negotiated Rate	$34.92
Rate for Payer: Cash Price	$27.38
Rate for Payer: Health Partners Plans Commercial	$34.20
Rate for Payer: UnitedHealthcare Commercial	$34.92
Rate for Payer: WPPA Commercial	$29.52

UNLISTED REHAB SVC OR PROC.

Facility

$36.00

Service Code	HCPCS 97799 GP
Hospital Charge Code	4202094
Hospital Revenue Code	420
Min. Negotiated Rate	$10.10
Max. Negotiated Rate	$34.92
Rate for Payer: BCBS Commercial	$10.10
Rate for Payer: Cash Price	$27.38
Rate for Payer: Cash Price	$27.38
Rate for Payer: Celtic Commercial/Exchange	$16.63
Rate for Payer: Health Partners Plans Commercial	$34.20
Rate for Payer: UnitedHealthcare Commercial	$34.92
Rate for Payer: WPPA Commercial	$30.24

UNNA BOOT

Facility

$350.00

Service Code	HCPCS 29580
Hospital Charge Code	2958023
Hospital Revenue Code	761
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

UNNA BOOT

Facility

$350.00

Service Code	HCPCS 29580
Hospital Charge Code	2958023
Hospital Revenue Code	761
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

UNNA BOOT ZINC

Facility

$47.00

Hospital Charge Code	2725057
Hospital Revenue Code	272
Min. Negotiated Rate	$21.71
Max. Negotiated Rate	$45.59
Rate for Payer: Cash Price	$35.25
Rate for Payer: Celtic Commercial/Exchange	$21.71
Rate for Payer: Health Partners Plans Commercial	$44.65
Rate for Payer: UnitedHealthcare Commercial	$45.59
Rate for Payer: WPPA Commercial	$39.48

UNNA BOOT ZINC

Facility

$47.00

Hospital Charge Code	2725057
Hospital Revenue Code	272
Min. Negotiated Rate	$38.54
Max. Negotiated Rate	$45.59
Rate for Payer: Cash Price	$35.25
Rate for Payer: Health Partners Plans Commercial	$44.65
Rate for Payer: UnitedHealthcare Commercial	$45.59
Rate for Payer: WPPA Commercial	$38.54

UOVENOX 140MG/1.4ML

Facility

$416.00

Hospital Charge Code	2509972
Hospital Revenue Code	250
Min. Negotiated Rate	$192.19
Max. Negotiated Rate	$403.52
Rate for Payer: Cash Price	$312.60
Rate for Payer: Celtic Commercial/Exchange	$192.19
Rate for Payer: Health Partners Plans Commercial	$395.20
Rate for Payer: UnitedHealthcare Commercial	$403.52
Rate for Payer: WPPA Commercial	$349.44

UOVENOX 140MG/1.4ML

Facility

$416.00

Hospital Charge Code	2509972
Hospital Revenue Code	250
Min. Negotiated Rate	$341.12
Max. Negotiated Rate	$403.52
Rate for Payer: Cash Price	$312.60
Rate for Payer: Health Partners Plans Commercial	$395.20
Rate for Payer: UnitedHealthcare Commercial	$403.52
Rate for Payer: WPPA Commercial	$341.12

UPPER EXT. INFANT 2 VIEW MIN

Facility

$160.00

Service Code	HCPCS 73092
Hospital Charge Code	3280014
Hospital Revenue Code	320
Min. Negotiated Rate	$73.92
Max. Negotiated Rate	$155.20
Rate for Payer: BCBS Commercial	$132.93
Rate for Payer: Cash Price	$120.45
Rate for Payer: Cash Price	$120.45
Rate for Payer: Celtic Commercial/Exchange	$73.92
Rate for Payer: Health Partners Plans Commercial	$152.00
Rate for Payer: UnitedHealthcare Commercial	$155.20
Rate for Payer: WPPA Commercial	$134.40

Know your out-of-pocket cost for care.

All Charges