Ness County Hospital

All Charges

Charge

Type

Setting

Price

ARM SLING ENVELOPE W/PAD LG

Facility

$32.00

Hospital Charge Code	2700988
Hospital Revenue Code	270
Min. Negotiated Rate	$14.78
Max. Negotiated Rate	$31.04
Rate for Payer: Cash Price	$24.00
Rate for Payer: Celtic Commercial/Exchange	$14.78
Rate for Payer: Health Partners Plans Commercial	$30.40
Rate for Payer: UnitedHealthcare Commercial	$31.04
Rate for Payer: WPPA Commercial	$26.88

ARM SLING ENVELOPE W/PAD LG

Facility

$32.00

Hospital Charge Code	2700988
Hospital Revenue Code	270
Min. Negotiated Rate	$26.24
Max. Negotiated Rate	$31.04
Rate for Payer: Cash Price	$24.00
Rate for Payer: Health Partners Plans Commercial	$30.40
Rate for Payer: UnitedHealthcare Commercial	$31.04
Rate for Payer: WPPA Commercial	$26.24

ARM SLING ENVELOPE W/PAD MD

Facility

$12.00

Hospital Charge Code	2700989
Hospital Revenue Code	270
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$11.64
Rate for Payer: Cash Price	$9.00
Rate for Payer: Celtic Commercial/Exchange	$5.54
Rate for Payer: Health Partners Plans Commercial	$11.40
Rate for Payer: UnitedHealthcare Commercial	$11.64
Rate for Payer: WPPA Commercial	$10.08

ARM SLING ENVELOPE W/PAD MD

Facility

$12.00

Hospital Charge Code	2700989
Hospital Revenue Code	270
Min. Negotiated Rate	$9.84
Max. Negotiated Rate	$11.64
Rate for Payer: Cash Price	$9.00
Rate for Payer: Health Partners Plans Commercial	$11.40
Rate for Payer: UnitedHealthcare Commercial	$11.64
Rate for Payer: WPPA Commercial	$9.84

ARM SLING ENVELOPE W/PAD SM

Facility

$32.00

Hospital Charge Code	2700990
Hospital Revenue Code	270
Min. Negotiated Rate	$14.78
Max. Negotiated Rate	$31.04
Rate for Payer: Cash Price	$24.00
Rate for Payer: Celtic Commercial/Exchange	$14.78
Rate for Payer: Health Partners Plans Commercial	$30.40
Rate for Payer: UnitedHealthcare Commercial	$31.04
Rate for Payer: WPPA Commercial	$26.88

ARM SLING ENVELOPE W/PAD SM

Facility

$32.00

Hospital Charge Code	2700990
Hospital Revenue Code	270
Min. Negotiated Rate	$26.24
Max. Negotiated Rate	$31.04
Rate for Payer: Cash Price	$24.00
Rate for Payer: Health Partners Plans Commercial	$30.40
Rate for Payer: UnitedHealthcare Commercial	$31.04
Rate for Payer: WPPA Commercial	$26.24

ARM SLING ENVELOPE W/PAD XL

Facility

$32.00

Hospital Charge Code	2700991
Hospital Revenue Code	270
Min. Negotiated Rate	$26.24
Max. Negotiated Rate	$31.04
Rate for Payer: Cash Price	$24.00
Rate for Payer: Health Partners Plans Commercial	$30.40
Rate for Payer: UnitedHealthcare Commercial	$31.04
Rate for Payer: WPPA Commercial	$26.24

ARM SLING ENVELOPE W/PAD XL

Facility

$32.00

Hospital Charge Code	2700991
Hospital Revenue Code	270
Min. Negotiated Rate	$14.78
Max. Negotiated Rate	$31.04
Rate for Payer: Cash Price	$24.00
Rate for Payer: Celtic Commercial/Exchange	$14.78
Rate for Payer: Health Partners Plans Commercial	$30.40
Rate for Payer: UnitedHealthcare Commercial	$31.04
Rate for Payer: WPPA Commercial	$26.88

ARM SLING SPECIALTY II MD

Facility

$32.00

Hospital Charge Code	2700992
Hospital Revenue Code	270
Min. Negotiated Rate	$14.78
Max. Negotiated Rate	$31.04
Rate for Payer: Cash Price	$24.00
Rate for Payer: Celtic Commercial/Exchange	$14.78
Rate for Payer: Health Partners Plans Commercial	$30.40
Rate for Payer: UnitedHealthcare Commercial	$31.04
Rate for Payer: WPPA Commercial	$26.88

ARM SLING SPECIALTY II MD

Facility

$32.00

Hospital Charge Code	2700992
Hospital Revenue Code	270
Min. Negotiated Rate	$26.24
Max. Negotiated Rate	$31.04
Rate for Payer: Cash Price	$24.00
Rate for Payer: Health Partners Plans Commercial	$30.40
Rate for Payer: UnitedHealthcare Commercial	$31.04
Rate for Payer: WPPA Commercial	$26.24

ARM SLING ULTRASLING II LG

Facility

$155.00

Hospital Charge Code	2702382
Hospital Revenue Code	272
Min. Negotiated Rate	$71.61
Max. Negotiated Rate	$150.35
Rate for Payer: Cash Price	$116.25
Rate for Payer: Celtic Commercial/Exchange	$71.61
Rate for Payer: Health Partners Plans Commercial	$147.25
Rate for Payer: UnitedHealthcare Commercial	$150.35
Rate for Payer: WPPA Commercial	$130.20

ARM SLING ULTRASLING II LG

Facility

$155.00

Hospital Charge Code	2702382
Hospital Revenue Code	272
Min. Negotiated Rate	$127.10
Max. Negotiated Rate	$150.35
Rate for Payer: Cash Price	$116.25
Rate for Payer: Health Partners Plans Commercial	$147.25
Rate for Payer: UnitedHealthcare Commercial	$150.35
Rate for Payer: WPPA Commercial	$127.10

ARM SLING ULTRASLING II MD

Facility

$155.00

Hospital Charge Code	2702381
Hospital Revenue Code	272
Min. Negotiated Rate	$127.10
Max. Negotiated Rate	$150.35
Rate for Payer: Cash Price	$116.25
Rate for Payer: Health Partners Plans Commercial	$147.25
Rate for Payer: UnitedHealthcare Commercial	$150.35
Rate for Payer: WPPA Commercial	$127.10

ARM SLING ULTRASLING II MD

Facility

$155.00

Hospital Charge Code	2702381
Hospital Revenue Code	272
Min. Negotiated Rate	$71.61
Max. Negotiated Rate	$150.35
Rate for Payer: Cash Price	$116.25
Rate for Payer: Celtic Commercial/Exchange	$71.61
Rate for Payer: Health Partners Plans Commercial	$147.25
Rate for Payer: UnitedHealthcare Commercial	$150.35
Rate for Payer: WPPA Commercial	$130.20

ARM SLING ULTRASLING II SM

Facility

$155.00

Hospital Charge Code	2702380
Hospital Revenue Code	272
Min. Negotiated Rate	$127.10
Max. Negotiated Rate	$150.35
Rate for Payer: Cash Price	$116.25
Rate for Payer: Health Partners Plans Commercial	$147.25
Rate for Payer: UnitedHealthcare Commercial	$150.35
Rate for Payer: WPPA Commercial	$127.10

ARM SLING ULTRASLING II SM

Facility

$155.00

Hospital Charge Code	2702380
Hospital Revenue Code	272
Min. Negotiated Rate	$71.61
Max. Negotiated Rate	$150.35
Rate for Payer: Cash Price	$116.25
Rate for Payer: Celtic Commercial/Exchange	$71.61
Rate for Payer: Health Partners Plans Commercial	$147.25
Rate for Payer: UnitedHealthcare Commercial	$150.35
Rate for Payer: WPPA Commercial	$130.20

ARM SLING ULTRASLING II XLG

Facility

$155.00

Hospital Charge Code	2702383
Hospital Revenue Code	272
Min. Negotiated Rate	$127.10
Max. Negotiated Rate	$150.35
Rate for Payer: Cash Price	$116.25
Rate for Payer: Health Partners Plans Commercial	$147.25
Rate for Payer: UnitedHealthcare Commercial	$150.35
Rate for Payer: WPPA Commercial	$127.10

ARM SLING ULTRASLING II XLG

Facility

$155.00

Hospital Charge Code	2702383
Hospital Revenue Code	272
Min. Negotiated Rate	$71.61
Max. Negotiated Rate	$150.35
Rate for Payer: Cash Price	$116.25
Rate for Payer: Celtic Commercial/Exchange	$71.61
Rate for Payer: Health Partners Plans Commercial	$147.25
Rate for Payer: UnitedHealthcare Commercial	$150.35
Rate for Payer: WPPA Commercial	$130.20

ARM SPLINT 11"

Facility

$85.00

Hospital Charge Code	2700100
Hospital Revenue Code	270
Min. Negotiated Rate	$39.27
Max. Negotiated Rate	$82.45
Rate for Payer: Cash Price	$63.75
Rate for Payer: Celtic Commercial/Exchange	$39.27
Rate for Payer: Health Partners Plans Commercial	$80.75
Rate for Payer: UnitedHealthcare Commercial	$82.45
Rate for Payer: WPPA Commercial	$71.40

ARM SPLINT 11"

Facility

$85.00

Hospital Charge Code	2700100
Hospital Revenue Code	270
Min. Negotiated Rate	$69.70
Max. Negotiated Rate	$82.45
Rate for Payer: Cash Price	$63.75
Rate for Payer: Health Partners Plans Commercial	$80.75
Rate for Payer: UnitedHealthcare Commercial	$82.45
Rate for Payer: WPPA Commercial	$69.70

ARM SPLINT 8"

Facility

$75.00

Hospital Charge Code	2700101
Hospital Revenue Code	270
Min. Negotiated Rate	$34.65
Max. Negotiated Rate	$72.75
Rate for Payer: Cash Price	$56.25
Rate for Payer: Celtic Commercial/Exchange	$34.65
Rate for Payer: Health Partners Plans Commercial	$71.25
Rate for Payer: UnitedHealthcare Commercial	$72.75
Rate for Payer: WPPA Commercial	$63.00

ARM SPLINT 8"

Facility

$75.00

Hospital Charge Code	2700101
Hospital Revenue Code	270
Min. Negotiated Rate	$61.50
Max. Negotiated Rate	$72.75
Rate for Payer: Cash Price	$56.25
Rate for Payer: Health Partners Plans Commercial	$71.25
Rate for Payer: UnitedHealthcare Commercial	$72.75
Rate for Payer: WPPA Commercial	$61.50

ARSENIC

Facility

$65.00

Service Code	HCPCS 82175
Hospital Charge Code	8217500
Hospital Revenue Code	301
Min. Negotiated Rate	$30.03
Max. Negotiated Rate	$63.05
Rate for Payer: BCBS Commercial	$60.26
Rate for Payer: Cash Price	$48.75
Rate for Payer: Cash Price	$48.75
Rate for Payer: Celtic Commercial/Exchange	$30.03
Rate for Payer: Health Partners Plans Commercial	$61.75
Rate for Payer: UnitedHealthcare Commercial	$63.05
Rate for Payer: WPPA Commercial	$54.60

ARSENIC

Facility

$65.00

Service Code	HCPCS 82175
Hospital Charge Code	8217500
Hospital Revenue Code	301
Min. Negotiated Rate	$53.30
Max. Negotiated Rate	$63.05
Rate for Payer: Cash Price	$48.75
Rate for Payer: Health Partners Plans Commercial	$61.75
Rate for Payer: UnitedHealthcare Commercial	$63.05
Rate for Payer: WPPA Commercial	$53.30

ARTERIAL EXTREM STUDY 3+LEVELS

Facility

$700.00

Service Code	HCPCS 93923
Hospital Charge Code	3320041
Hospital Revenue Code	921
Min. Negotiated Rate	$323.40
Max. Negotiated Rate	$679.00
Rate for Payer: BCBS Commercial	$480.76
Rate for Payer: Cash Price	$525.00
Rate for Payer: Cash Price	$525.00
Rate for Payer: Celtic Commercial/Exchange	$323.40
Rate for Payer: Health Partners Plans Commercial	$665.00
Rate for Payer: UnitedHealthcare Commercial	$679.00
Rate for Payer: WPPA Commercial	$588.00

Know your out-of-pocket cost for care.

All Charges