Ness County Hospital

All Charges

Charge

Type

Setting

Price

WHEELCHAIR FOOTREST EXTENDER

Facility

$90.00

Hospital Charge Code	2700446
Hospital Revenue Code	272
Min. Negotiated Rate	$41.58
Max. Negotiated Rate	$87.30
Rate for Payer: Cash Price	$67.50
Rate for Payer: Celtic Commercial/Exchange	$41.58
Rate for Payer: Health Partners Plans Commercial	$85.50
Rate for Payer: UnitedHealthcare Commercial	$87.30
Rate for Payer: WPPA Commercial	$75.60

WHEELCHAIR FOOTREST EXTENDER

Facility

$90.00

Hospital Charge Code	2700446
Hospital Revenue Code	272
Min. Negotiated Rate	$73.80
Max. Negotiated Rate	$87.30
Rate for Payer: Cash Price	$67.50
Rate for Payer: Health Partners Plans Commercial	$85.50
Rate for Payer: UnitedHealthcare Commercial	$87.30
Rate for Payer: WPPA Commercial	$73.80

WHIRLPOOL

Facility

$94.00

Service Code	HCPCS 97022 GP
Hospital Charge Code	4200853
Hospital Revenue Code	420
Min. Negotiated Rate	$77.08
Max. Negotiated Rate	$91.18
Rate for Payer: Cash Price	$70.50
Rate for Payer: Health Partners Plans Commercial	$89.30
Rate for Payer: UnitedHealthcare Commercial	$91.18
Rate for Payer: WPPA Commercial	$77.08

WHIRLPOOL

Facility

$94.00

Service Code	HCPCS 97022 GP
Hospital Charge Code	4200853
Hospital Revenue Code	420
Min. Negotiated Rate	$33.33
Max. Negotiated Rate	$91.18
Rate for Payer: BCBS Commercial	$33.33
Rate for Payer: Cash Price	$70.50
Rate for Payer: Cash Price	$70.50
Rate for Payer: Celtic Commercial/Exchange	$43.43
Rate for Payer: Health Partners Plans Commercial	$89.30
Rate for Payer: UnitedHealthcare Commercial	$91.18
Rate for Payer: WPPA Commercial	$78.96

WND VAC CANNISTER 500ml w/o gel, per day

Facility

$70.00

Hospital Charge Code	2725016
Hospital Revenue Code	272
Min. Negotiated Rate	$32.34
Max. Negotiated Rate	$67.90
Rate for Payer: Cash Price	$52.50
Rate for Payer: Celtic Commercial/Exchange	$32.34
Rate for Payer: Health Partners Plans Commercial	$66.50
Rate for Payer: UnitedHealthcare Commercial	$67.90
Rate for Payer: WPPA Commercial	$58.80

WND VAC CANNISTER 500ml w/o gel, per day

Facility

$70.00

Hospital Charge Code	2725016
Hospital Revenue Code	272
Min. Negotiated Rate	$57.40
Max. Negotiated Rate	$67.90
Rate for Payer: Cash Price	$52.50
Rate for Payer: Health Partners Plans Commercial	$66.50
Rate for Payer: UnitedHealthcare Commercial	$67.90
Rate for Payer: WPPA Commercial	$57.40

WND VAC INFOV.A.C 1000ML CANNISTER, per day

Facility

$80.00

Hospital Charge Code	2725631
Hospital Revenue Code	272
Min. Negotiated Rate	$36.96
Max. Negotiated Rate	$77.60
Rate for Payer: Cash Price	$60.00
Rate for Payer: Celtic Commercial/Exchange	$36.96
Rate for Payer: Health Partners Plans Commercial	$76.00
Rate for Payer: UnitedHealthcare Commercial	$77.60
Rate for Payer: WPPA Commercial	$67.20

WND VAC INFOV.A.C 1000ML CANNISTER, per day

Facility

$80.00

Hospital Charge Code	2725631
Hospital Revenue Code	272
Min. Negotiated Rate	$65.60
Max. Negotiated Rate	$77.60
Rate for Payer: Cash Price	$60.00
Rate for Payer: Health Partners Plans Commercial	$76.00
Rate for Payer: UnitedHealthcare Commercial	$77.60
Rate for Payer: WPPA Commercial	$65.60

WOUND CLOSURE 2.6-7.5 CM

Facility

$380.00

Service Code	HCPCS 12042
Hospital Charge Code	1204200
Hospital Revenue Code	450
Min. Negotiated Rate	$311.60
Max. Negotiated Rate	$368.60
Rate for Payer: Cash Price	$285.00
Rate for Payer: Health Partners Plans Commercial	$361.00
Rate for Payer: UnitedHealthcare Commercial	$368.60
Rate for Payer: WPPA Commercial	$311.60

WOUND CLOSURE 2.6-7.5 CM

Facility

$380.00

Service Code	HCPCS 12042
Hospital Charge Code	1204200
Hospital Revenue Code	450
Min. Negotiated Rate	$175.56
Max. Negotiated Rate	$707.00
Rate for Payer: BCBS Commercial	$707.00
Rate for Payer: Cash Price	$285.00
Rate for Payer: Cash Price	$285.00
Rate for Payer: Celtic Commercial/Exchange	$175.56
Rate for Payer: Health Partners Plans Commercial	$361.00
Rate for Payer: UnitedHealthcare Commercial	$368.60
Rate for Payer: WPPA Commercial	$319.20

WOUND CLOSURE BY ADHESIVE

Facility

$108.00

Service Code	HCPCS G0168
Hospital Charge Code	G016800
Hospital Revenue Code	450
Min. Negotiated Rate	$49.90
Max. Negotiated Rate	$141.40
Rate for Payer: BCBS Commercial	$141.40
Rate for Payer: Cash Price	$81.00
Rate for Payer: Cash Price	$81.00
Rate for Payer: Celtic Commercial/Exchange	$49.90
Rate for Payer: Health Partners Plans Commercial	$102.60
Rate for Payer: UnitedHealthcare Commercial	$104.76
Rate for Payer: WPPA Commercial	$90.72

WOUND CLOSURE BY ADHESIVE

Facility

$108.00

Service Code	HCPCS G0168
Hospital Charge Code	G016800
Hospital Revenue Code	450
Min. Negotiated Rate	$88.56
Max. Negotiated Rate	$104.76
Rate for Payer: Cash Price	$81.00
Rate for Payer: Health Partners Plans Commercial	$102.60
Rate for Payer: UnitedHealthcare Commercial	$104.76
Rate for Payer: WPPA Commercial	$88.56

WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC

Facility

$28,621.76

Service Code	MSDRG 464
Min. Negotiated Rate	$28,621.76
Max. Negotiated Rate	$28,621.76
Rate for Payer: BCBS Commercial	$28,621.76

WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC

Facility

$47,664.15

Service Code	MSDRG 463
Min. Negotiated Rate	$47,664.15
Max. Negotiated Rate	$47,664.15
Rate for Payer: BCBS Commercial	$47,664.15

WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC

Facility

$20,312.20

Service Code	MSDRG 465
Min. Negotiated Rate	$20,312.20
Max. Negotiated Rate	$20,312.20
Rate for Payer: BCBS Commercial	$20,312.20

WOUND DEBRIDEMENTS FOR INJURIES WITH CC

Facility

$17,434.15

Service Code	MSDRG 902
Min. Negotiated Rate	$17,434.15
Max. Negotiated Rate	$17,434.15
Rate for Payer: BCBS Commercial	$17,434.15

WOUND DEBRIDEMENTS FOR INJURIES WITH MCC

Facility

$38,274.23

Service Code	MSDRG 901
Min. Negotiated Rate	$38,274.23
Max. Negotiated Rate	$38,274.23
Rate for Payer: BCBS Commercial	$38,274.23

WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC

Facility

$9,036.66

Service Code	MSDRG 903
Min. Negotiated Rate	$9,036.66
Max. Negotiated Rate	$9,036.66
Rate for Payer: BCBS Commercial	$9,036.66

WOUND DEBRIDMENT-PRACTITIONER

Facility

$279.00

Service Code	HCPCS 97597
Hospital Charge Code	9759700
Hospital Revenue Code	761
Min. Negotiated Rate	$228.78
Max. Negotiated Rate	$270.63
Rate for Payer: Cash Price	$209.25
Rate for Payer: Health Partners Plans Commercial	$265.05
Rate for Payer: UnitedHealthcare Commercial	$270.63
Rate for Payer: WPPA Commercial	$228.78

WOUND DEBRIDMENT-PRACTITIONER

Facility

$279.00

Service Code	HCPCS 97597
Hospital Charge Code	9759700
Hospital Revenue Code	761
Min. Negotiated Rate	$128.90
Max. Negotiated Rate	$278.76
Rate for Payer: BCBS Commercial	$278.76
Rate for Payer: Cash Price	$209.25
Rate for Payer: Cash Price	$209.25
Rate for Payer: Celtic Commercial/Exchange	$128.90
Rate for Payer: Health Partners Plans Commercial	$265.05
Rate for Payer: UnitedHealthcare Commercial	$270.63
Rate for Payer: WPPA Commercial	$234.36

WOUND/SIMPLE REPAIR/BODY 2.5<

Facility

$474.00

Service Code	HCPCS 12001
Hospital Charge Code	1200100
Hospital Revenue Code	761
Min. Negotiated Rate	$218.99
Max. Negotiated Rate	$459.78
Rate for Payer: BCBS Commercial	$382.79
Rate for Payer: Cash Price	$355.50
Rate for Payer: Cash Price	$355.50
Rate for Payer: Celtic Commercial/Exchange	$218.99
Rate for Payer: Health Partners Plans Commercial	$450.30
Rate for Payer: UnitedHealthcare Commercial	$459.78
Rate for Payer: WPPA Commercial	$398.16

WOUND/SIMPLE REPAIR/BODY 2.5<

Facility

$474.00

Service Code	HCPCS 12001
Hospital Charge Code	1200100
Hospital Revenue Code	761
Min. Negotiated Rate	$388.68
Max. Negotiated Rate	$459.78
Rate for Payer: Cash Price	$355.50
Rate for Payer: Health Partners Plans Commercial	$450.30
Rate for Payer: UnitedHealthcare Commercial	$459.78
Rate for Payer: WPPA Commercial	$388.68

WOUND/SIM REP-FACE,EN,LIP 2.5<

Facility

$250.00

Service Code	HCPCS 12011
Hospital Charge Code	1201101
Hospital Revenue Code	981
Min. Negotiated Rate	$115.50
Max. Negotiated Rate	$475.71
Rate for Payer: BCBS Commercial	$475.71
Rate for Payer: Cash Price	$187.50
Rate for Payer: Cash Price	$187.50
Rate for Payer: Celtic Commercial/Exchange	$115.50
Rate for Payer: Health Partners Plans Commercial	$237.50
Rate for Payer: UnitedHealthcare Commercial	$242.50
Rate for Payer: WPPA Commercial	$210.00

WOUND/SIM REP-FACE,EN,LIP 2.5<

Facility

$250.00

Service Code	HCPCS 12011
Hospital Charge Code	1201101
Hospital Revenue Code	981
Min. Negotiated Rate	$205.00
Max. Negotiated Rate	$242.50
Rate for Payer: Cash Price	$187.50
Rate for Payer: Health Partners Plans Commercial	$237.50
Rate for Payer: UnitedHealthcare Commercial	$242.50
Rate for Payer: WPPA Commercial	$205.00

WOUND/SIM REP-SCALP/NECK 2.5<

Facility

$185.00

Service Code	HCPCS 12001
Hospital Charge Code	1200101
Hospital Revenue Code	981
Min. Negotiated Rate	$85.47
Max. Negotiated Rate	$382.79
Rate for Payer: BCBS Commercial	$382.79
Rate for Payer: Cash Price	$138.75
Rate for Payer: Cash Price	$138.75
Rate for Payer: Celtic Commercial/Exchange	$85.47
Rate for Payer: Health Partners Plans Commercial	$175.75
Rate for Payer: UnitedHealthcare Commercial	$179.45
Rate for Payer: WPPA Commercial	$155.40

Know your out-of-pocket cost for care.

All Charges