Ness County Hospital

All Charges

Charge

Type

Setting

Price

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	$151.70
Max. Negotiated Rate	$179.45
Rate for Payer: Cash Price	$138.75
Rate for Payer: Health Partners Plans Commercial	$175.75
Rate for Payer: UnitedHealthcare Commercial	$179.45
Rate for Payer: WPPA Commercial	$151.70

WOUND VAC EXTRA LG GRANUFOAM, per day

Facility

$149.00

Hospital Charge Code	2725022
Hospital Revenue Code	272
Min. Negotiated Rate	$122.18
Max. Negotiated Rate	$144.53
Rate for Payer: Cash Price	$111.75
Rate for Payer: Health Partners Plans Commercial	$141.55
Rate for Payer: UnitedHealthcare Commercial	$144.53
Rate for Payer: WPPA Commercial	$122.18

WOUND VAC EXTRA LG GRANUFOAM, per day

Facility

$149.00

Hospital Charge Code	2725022
Hospital Revenue Code	272
Min. Negotiated Rate	$68.84
Max. Negotiated Rate	$144.53
Rate for Payer: Cash Price	$111.75
Rate for Payer: Celtic Commercial/Exchange	$68.84
Rate for Payer: Health Partners Plans Commercial	$141.55
Rate for Payer: UnitedHealthcare Commercial	$144.53
Rate for Payer: WPPA Commercial	$125.16

WOUND VAC LG GRANUFOAM, per day

Facility

$79.00

Hospital Charge Code	2725021
Hospital Revenue Code	272
Min. Negotiated Rate	$36.50
Max. Negotiated Rate	$76.63
Rate for Payer: Cash Price	$59.70
Rate for Payer: Celtic Commercial/Exchange	$36.50
Rate for Payer: Health Partners Plans Commercial	$75.05
Rate for Payer: UnitedHealthcare Commercial	$76.63
Rate for Payer: WPPA Commercial	$66.36

WOUND VAC LG GRANUFOAM, per day

Facility

$79.00

Hospital Charge Code	2725021
Hospital Revenue Code	272
Min. Negotiated Rate	$64.78
Max. Negotiated Rate	$76.63
Rate for Payer: Cash Price	$59.70
Rate for Payer: Health Partners Plans Commercial	$75.05
Rate for Payer: UnitedHealthcare Commercial	$76.63
Rate for Payer: WPPA Commercial	$64.78

WOUND VAC MED GRANUFOAM, per day

Facility

$50.00

Hospital Charge Code	2725020
Hospital Revenue Code	272
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$48.50
Rate for Payer: Cash Price	$37.50
Rate for Payer: Celtic Commercial/Exchange	$23.10
Rate for Payer: Health Partners Plans Commercial	$47.50
Rate for Payer: UnitedHealthcare Commercial	$48.50
Rate for Payer: WPPA Commercial	$42.00

WOUND VAC MED GRANUFOAM, per day

Facility

$50.00

Hospital Charge Code	2725020
Hospital Revenue Code	272
Min. Negotiated Rate	$41.00
Max. Negotiated Rate	$48.50
Rate for Payer: Cash Price	$37.50
Rate for Payer: Health Partners Plans Commercial	$47.50
Rate for Payer: UnitedHealthcare Commercial	$48.50
Rate for Payer: WPPA Commercial	$41.00

WOUND VAC-SENSATRAC PAD/TUBING

Facility

$25.00

Hospital Charge Code	2725023
Hospital Revenue Code	272
Min. Negotiated Rate	$11.55
Max. Negotiated Rate	$24.25
Rate for Payer: Cash Price	$18.75
Rate for Payer: Celtic Commercial/Exchange	$11.55
Rate for Payer: Health Partners Plans Commercial	$23.75
Rate for Payer: UnitedHealthcare Commercial	$24.25
Rate for Payer: WPPA Commercial	$21.00

WOUND VAC-SENSATRAC PAD/TUBING

Facility

$25.00

Hospital Charge Code	2725023
Hospital Revenue Code	272
Min. Negotiated Rate	$20.50
Max. Negotiated Rate	$24.25
Rate for Payer: Cash Price	$18.75
Rate for Payer: Health Partners Plans Commercial	$23.75
Rate for Payer: UnitedHealthcare Commercial	$24.25
Rate for Payer: WPPA Commercial	$20.50

WOUND VAC SM GRANUFOAM, per day

Facility

$25.00

Hospital Charge Code	2725018
Hospital Revenue Code	272
Min. Negotiated Rate	$11.55
Max. Negotiated Rate	$24.25
Rate for Payer: Cash Price	$18.75
Rate for Payer: Celtic Commercial/Exchange	$11.55
Rate for Payer: Health Partners Plans Commercial	$23.75
Rate for Payer: UnitedHealthcare Commercial	$24.25
Rate for Payer: WPPA Commercial	$21.00

WOUND VAC SM GRANUFOAM, per day

Facility

$25.00

Hospital Charge Code	2725018
Hospital Revenue Code	272
Min. Negotiated Rate	$20.50
Max. Negotiated Rate	$24.25
Rate for Payer: Cash Price	$18.75
Rate for Payer: Health Partners Plans Commercial	$23.75
Rate for Payer: UnitedHealthcare Commercial	$24.25
Rate for Payer: WPPA Commercial	$20.50

WOUND WASH SALINE

Facility

$4.00

Hospital Charge Code	2713702
Hospital Revenue Code	272
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$3.00
Rate for Payer: Celtic Commercial/Exchange	$1.85
Rate for Payer: Health Partners Plans Commercial	$3.80
Rate for Payer: UnitedHealthcare Commercial	$3.88
Rate for Payer: WPPA Commercial	$3.36

WOUND WASH SALINE

Facility

$4.00

Hospital Charge Code	2713702
Hospital Revenue Code	272
Min. Negotiated Rate	$3.28
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$3.00
Rate for Payer: Health Partners Plans Commercial	$3.80
Rate for Payer: UnitedHealthcare Commercial	$3.88
Rate for Payer: WPPA Commercial	$3.28

WRIST/FOREARM SPLINT 11" MC

Facility

$61.00

Hospital Charge Code	9907023
Hospital Revenue Code	270
Min. Negotiated Rate	$28.18
Max. Negotiated Rate	$59.17
Rate for Payer: Cash Price	$45.75
Rate for Payer: Celtic Commercial/Exchange	$28.18
Rate for Payer: Health Partners Plans Commercial	$57.95
Rate for Payer: UnitedHealthcare Commercial	$59.17
Rate for Payer: WPPA Commercial	$51.24

WRIST/FOREARM SPLINT 11" MC

Facility

$61.00

Hospital Charge Code	9907023
Hospital Revenue Code	270
Min. Negotiated Rate	$50.02
Max. Negotiated Rate	$59.17
Rate for Payer: Cash Price	$45.75
Rate for Payer: Health Partners Plans Commercial	$57.95
Rate for Payer: UnitedHealthcare Commercial	$59.17
Rate for Payer: WPPA Commercial	$50.02

WRIST LT 2V

Facility

$186.00

Service Code	HCPCS 73100 LT
Hospital Charge Code	3280009
Hospital Revenue Code	320
Min. Negotiated Rate	$85.93
Max. Negotiated Rate	$180.42
Rate for Payer: BCBS Commercial	$110.06
Rate for Payer: Cash Price	$139.50
Rate for Payer: Cash Price	$139.50
Rate for Payer: Celtic Commercial/Exchange	$85.93
Rate for Payer: Health Partners Plans Commercial	$176.70
Rate for Payer: UnitedHealthcare Commercial	$180.42
Rate for Payer: WPPA Commercial	$156.24

WRIST LT 2V

Facility

$186.00

Service Code	HCPCS 73100 LT
Hospital Charge Code	3280009
Hospital Revenue Code	320
Min. Negotiated Rate	$152.52
Max. Negotiated Rate	$180.42
Rate for Payer: Cash Price	$139.50
Rate for Payer: Health Partners Plans Commercial	$176.70
Rate for Payer: UnitedHealthcare Commercial	$180.42
Rate for Payer: WPPA Commercial	$152.52

WRIST LT 3V

Facility

$274.00

Service Code	HCPCS 73110 LT
Hospital Charge Code	3280011
Hospital Revenue Code	320
Min. Negotiated Rate	$224.68
Max. Negotiated Rate	$265.78
Rate for Payer: Cash Price	$205.50
Rate for Payer: Health Partners Plans Commercial	$260.30
Rate for Payer: UnitedHealthcare Commercial	$265.78
Rate for Payer: WPPA Commercial	$224.68

WRIST LT 3V

Facility

$274.00

Service Code	HCPCS 73110 LT
Hospital Charge Code	3280011
Hospital Revenue Code	320
Min. Negotiated Rate	$126.59
Max. Negotiated Rate	$265.78
Rate for Payer: BCBS Commercial	$143.10
Rate for Payer: Cash Price	$205.50
Rate for Payer: Cash Price	$205.50
Rate for Payer: Celtic Commercial/Exchange	$126.59
Rate for Payer: Health Partners Plans Commercial	$260.30
Rate for Payer: UnitedHealthcare Commercial	$265.78
Rate for Payer: WPPA Commercial	$230.16

WRIST RT 2V

Facility

$186.00

Service Code	HCPCS 73100 RT
Hospital Charge Code	3280008
Hospital Revenue Code	320
Min. Negotiated Rate	$85.93
Max. Negotiated Rate	$180.42
Rate for Payer: BCBS Commercial	$110.06
Rate for Payer: Cash Price	$139.50
Rate for Payer: Cash Price	$139.50
Rate for Payer: Celtic Commercial/Exchange	$85.93
Rate for Payer: Health Partners Plans Commercial	$176.70
Rate for Payer: UnitedHealthcare Commercial	$180.42
Rate for Payer: WPPA Commercial	$156.24

WRIST RT 2V

Facility

$186.00

Service Code	HCPCS 73100 RT
Hospital Charge Code	3280008
Hospital Revenue Code	320
Min. Negotiated Rate	$152.52
Max. Negotiated Rate	$180.42
Rate for Payer: Cash Price	$139.50
Rate for Payer: Health Partners Plans Commercial	$176.70
Rate for Payer: UnitedHealthcare Commercial	$180.42
Rate for Payer: WPPA Commercial	$152.52

WRIST RT 3V

Facility

$274.00

Service Code	HCPCS 73110 RT
Hospital Charge Code	3280010
Hospital Revenue Code	320
Min. Negotiated Rate	$224.68
Max. Negotiated Rate	$265.78
Rate for Payer: Cash Price	$205.50
Rate for Payer: Health Partners Plans Commercial	$260.30
Rate for Payer: UnitedHealthcare Commercial	$265.78
Rate for Payer: WPPA Commercial	$224.68

WRIST RT 3V

Facility

$274.00

Service Code	HCPCS 73110 RT
Hospital Charge Code	3280010
Hospital Revenue Code	320
Min. Negotiated Rate	$126.59
Max. Negotiated Rate	$265.78
Rate for Payer: BCBS Commercial	$143.10
Rate for Payer: Cash Price	$205.50
Rate for Payer: Cash Price	$205.50
Rate for Payer: Celtic Commercial/Exchange	$126.59
Rate for Payer: Health Partners Plans Commercial	$260.30
Rate for Payer: UnitedHealthcare Commercial	$265.78
Rate for Payer: WPPA Commercial	$230.16

WRIST SPLINT COCKUP LG RIGHT

Facility

$36.00

Hospital Charge Code	2702000
Hospital Revenue Code	270
Min. Negotiated Rate	$16.63
Max. Negotiated Rate	$34.92
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

WRIST SPLINT COCKUP LG RIGHT

Facility

$36.00

Hospital Charge Code	2702000
Hospital Revenue Code	270
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

Know your out-of-pocket cost for care.

All Charges