Ness County Hospital

All Charges

Charge

Type

Setting

Price

CLOS TREAT PROX HUM FX W/0 MAN

Facility

$300.00

Service Code	HCPCS 23600
Hospital Charge Code	2360000
Hospital Revenue Code	761
Min. Negotiated Rate	$246.00
Max. Negotiated Rate	$291.00
Rate for Payer: Cash Price	$225.00
Rate for Payer: Health Partners Plans Commercial	$285.00
Rate for Payer: UnitedHealthcare Commercial	$291.00
Rate for Payer: WPPA Commercial	$246.00

CLOS TX AC DISLOC WO MANIPULAT

Facility

$323.00

Service Code	HCPCS 23540
Hospital Charge Code	2354000
Hospital Revenue Code	450
Min. Negotiated Rate	$149.23
Max. Negotiated Rate	$809.01
Rate for Payer: BCBS Commercial	$809.01
Rate for Payer: Cash Price	$242.25
Rate for Payer: Cash Price	$242.25
Rate for Payer: Celtic Commercial/Exchange	$149.23
Rate for Payer: Health Partners Plans Commercial	$306.85
Rate for Payer: UnitedHealthcare Commercial	$313.31
Rate for Payer: WPPA Commercial	$271.32

CLOS TX AC DISLOC WO MANIPULAT

Facility

$323.00

Service Code	HCPCS 23540
Hospital Charge Code	2354000
Hospital Revenue Code	450
Min. Negotiated Rate	$264.86
Max. Negotiated Rate	$313.31
Rate for Payer: Cash Price	$242.25
Rate for Payer: Health Partners Plans Commercial	$306.85
Rate for Payer: UnitedHealthcare Commercial	$313.31
Rate for Payer: WPPA Commercial	$264.86

CLOS TX DIST PHALANG FX WO MAN

Facility

$413.00

Service Code	HCPCS 26750
Hospital Charge Code	2675000
Hospital Revenue Code	450
Min. Negotiated Rate	$338.66
Max. Negotiated Rate	$400.61
Rate for Payer: Cash Price	$309.75
Rate for Payer: Health Partners Plans Commercial	$392.35
Rate for Payer: UnitedHealthcare Commercial	$400.61
Rate for Payer: WPPA Commercial	$338.66

CLOS TX DIST PHALANG FX WO MAN

Facility

$413.00

Service Code	HCPCS 26750
Hospital Charge Code	2675000
Hospital Revenue Code	450
Min. Negotiated Rate	$190.81
Max. Negotiated Rate	$432.28
Rate for Payer: BCBS Commercial	$432.28
Rate for Payer: Cash Price	$309.75
Rate for Payer: Cash Price	$309.75
Rate for Payer: Celtic Commercial/Exchange	$190.81
Rate for Payer: Health Partners Plans Commercial	$392.35
Rate for Payer: UnitedHealthcare Commercial	$400.61
Rate for Payer: WPPA Commercial	$346.92

CLOS TX DIST RADIAL FX WO MAN

Facility

$323.00

Service Code	HCPCS 25600
Hospital Charge Code	2560000
Hospital Revenue Code	450
Min. Negotiated Rate	$149.23
Max. Negotiated Rate	$313.31
Rate for Payer: BCBS Commercial	$299.85
Rate for Payer: Cash Price	$242.25
Rate for Payer: Cash Price	$242.25
Rate for Payer: Celtic Commercial/Exchange	$149.23
Rate for Payer: Health Partners Plans Commercial	$306.85
Rate for Payer: UnitedHealthcare Commercial	$313.31
Rate for Payer: WPPA Commercial	$271.32

CLOS TX DIST RADIAL FX WO MAN

Facility

$323.00

Service Code	HCPCS 25600
Hospital Charge Code	2560000
Hospital Revenue Code	450
Min. Negotiated Rate	$264.86
Max. Negotiated Rate	$313.31
Rate for Payer: Cash Price	$242.25
Rate for Payer: Health Partners Plans Commercial	$306.85
Rate for Payer: UnitedHealthcare Commercial	$313.31
Rate for Payer: WPPA Commercial	$264.86

CLOS TX GT HUM TUBEROS FX WO M

Facility

$323.00

Service Code	HCPCS 23620
Hospital Charge Code	2362000
Hospital Revenue Code	450
Min. Negotiated Rate	$264.86
Max. Negotiated Rate	$313.31
Rate for Payer: Cash Price	$242.25
Rate for Payer: Health Partners Plans Commercial	$306.85
Rate for Payer: UnitedHealthcare Commercial	$313.31
Rate for Payer: WPPA Commercial	$264.86

CLOS TX GT HUM TUBEROS FX WO M

Facility

$323.00

Service Code	HCPCS 23620
Hospital Charge Code	2362000
Hospital Revenue Code	450
Min. Negotiated Rate	$149.23
Max. Negotiated Rate	$1,454.40
Rate for Payer: BCBS Commercial	$1,454.40
Rate for Payer: Cash Price	$242.25
Rate for Payer: Cash Price	$242.25
Rate for Payer: Celtic Commercial/Exchange	$149.23
Rate for Payer: Health Partners Plans Commercial	$306.85
Rate for Payer: UnitedHealthcare Commercial	$313.31
Rate for Payer: WPPA Commercial	$271.32

CLOS TX HUM EPICOND FX WO MANI

Facility

$323.00

Service Code	HCPCS 24560
Hospital Charge Code	2456000
Hospital Revenue Code	450
Min. Negotiated Rate	$264.86
Max. Negotiated Rate	$313.31
Rate for Payer: Cash Price	$242.25
Rate for Payer: Health Partners Plans Commercial	$306.85
Rate for Payer: UnitedHealthcare Commercial	$313.31
Rate for Payer: WPPA Commercial	$264.86

CLOS TX HUM EPICOND FX WO MANI

Facility

$323.00

Service Code	HCPCS 24560
Hospital Charge Code	2456000
Hospital Revenue Code	450
Min. Negotiated Rate	$149.23
Max. Negotiated Rate	$1,454.40
Rate for Payer: BCBS Commercial	$1,454.40
Rate for Payer: Cash Price	$242.25
Rate for Payer: Cash Price	$242.25
Rate for Payer: Celtic Commercial/Exchange	$149.23
Rate for Payer: Health Partners Plans Commercial	$306.85
Rate for Payer: UnitedHealthcare Commercial	$313.31
Rate for Payer: WPPA Commercial	$271.32

CLOS TX HUM FX W/MANIP W/WO TR

Facility

$1,530.00

Service Code	HCPCS 24505
Hospital Charge Code	2450500
Hospital Revenue Code	450
Min. Negotiated Rate	$1,254.60
Max. Negotiated Rate	$1,484.10
Rate for Payer: Cash Price	$1,147.50
Rate for Payer: Health Partners Plans Commercial	$1,453.50
Rate for Payer: UnitedHealthcare Commercial	$1,484.10
Rate for Payer: WPPA Commercial	$1,254.60

CLOS TX HUM FX W/MANIP W/WO TR

Facility

$1,530.00

Service Code	HCPCS 24505
Hospital Charge Code	2450500
Hospital Revenue Code	450
Min. Negotiated Rate	$706.86
Max. Negotiated Rate	$1,484.10
Rate for Payer: BCBS Commercial	$1,454.40
Rate for Payer: Cash Price	$1,147.50
Rate for Payer: Cash Price	$1,147.50
Rate for Payer: Celtic Commercial/Exchange	$706.86
Rate for Payer: Health Partners Plans Commercial	$1,453.50
Rate for Payer: UnitedHealthcare Commercial	$1,484.10
Rate for Payer: WPPA Commercial	$1,285.20

CLOS TX HUM SHAFT FX WO MANIP

Facility

$323.00

Service Code	HCPCS 24500
Hospital Charge Code	2450000
Hospital Revenue Code	450
Min. Negotiated Rate	$264.86
Max. Negotiated Rate	$313.31
Rate for Payer: Cash Price	$242.25
Rate for Payer: Health Partners Plans Commercial	$306.85
Rate for Payer: UnitedHealthcare Commercial	$313.31
Rate for Payer: WPPA Commercial	$264.86

CLOS TX HUM SHAFT FX WO MANIP

Facility

$323.00

Service Code	HCPCS 24500
Hospital Charge Code	2450000
Hospital Revenue Code	450
Min. Negotiated Rate	$149.23
Max. Negotiated Rate	$1,454.40
Rate for Payer: BCBS Commercial	$1,454.40
Rate for Payer: Cash Price	$242.25
Rate for Payer: Cash Price	$242.25
Rate for Payer: Celtic Commercial/Exchange	$149.23
Rate for Payer: Health Partners Plans Commercial	$306.85
Rate for Payer: UnitedHealthcare Commercial	$313.31
Rate for Payer: WPPA Commercial	$271.32

CLOS TX IP DISLOC W/MANIP WO A

Facility

$773.00

Service Code	HCPCS 26770
Hospital Charge Code	2677000
Hospital Revenue Code	450
Min. Negotiated Rate	$357.13
Max. Negotiated Rate	$809.01
Rate for Payer: BCBS Commercial	$809.01
Rate for Payer: Cash Price	$579.75
Rate for Payer: Cash Price	$579.75
Rate for Payer: Celtic Commercial/Exchange	$357.13
Rate for Payer: Health Partners Plans Commercial	$734.35
Rate for Payer: UnitedHealthcare Commercial	$749.81
Rate for Payer: WPPA Commercial	$649.32

CLOS TX IP DISLOC W/MANIP WO A

Facility

$773.00

Service Code	HCPCS 26770
Hospital Charge Code	2677000
Hospital Revenue Code	450
Min. Negotiated Rate	$633.86
Max. Negotiated Rate	$749.81
Rate for Payer: Cash Price	$579.75
Rate for Payer: Health Partners Plans Commercial	$734.35
Rate for Payer: UnitedHealthcare Commercial	$749.81
Rate for Payer: WPPA Commercial	$633.86

CLOS TX MONTEGGIA FX ELBOW W/M

Facility

$2,688.00

Service Code	HCPCS 24620
Hospital Charge Code	2462000
Hospital Revenue Code	450
Min. Negotiated Rate	$2,204.16
Max. Negotiated Rate	$2,607.36
Rate for Payer: Cash Price	$2,016.00
Rate for Payer: Health Partners Plans Commercial	$2,553.60
Rate for Payer: UnitedHealthcare Commercial	$2,607.36
Rate for Payer: WPPA Commercial	$2,204.16

CLOS TX MONTEGGIA FX ELBOW W/M

Facility

$2,688.00

Service Code	HCPCS 24620
Hospital Charge Code	2462000
Hospital Revenue Code	450
Min. Negotiated Rate	$1,241.86
Max. Negotiated Rate	$2,607.36
Rate for Payer: BCBS Commercial	$2,167.46
Rate for Payer: Cash Price	$2,016.00
Rate for Payer: Cash Price	$2,016.00
Rate for Payer: Celtic Commercial/Exchange	$1,241.86
Rate for Payer: Health Partners Plans Commercial	$2,553.60
Rate for Payer: UnitedHealthcare Commercial	$2,607.36
Rate for Payer: WPPA Commercial	$2,257.92

CLOS TX PHALANGEAL FX WO MANIP

Facility

$323.00

Service Code	HCPCS 26720
Hospital Charge Code	2672000
Hospital Revenue Code	450
Min. Negotiated Rate	$149.23
Max. Negotiated Rate	$809.01
Rate for Payer: BCBS Commercial	$809.01
Rate for Payer: Cash Price	$242.25
Rate for Payer: Cash Price	$242.25
Rate for Payer: Celtic Commercial/Exchange	$149.23
Rate for Payer: Health Partners Plans Commercial	$306.85
Rate for Payer: UnitedHealthcare Commercial	$313.31
Rate for Payer: WPPA Commercial	$271.32

CLOS TX PHALANGEAL FX WO MANIP

Facility

$323.00

Service Code	HCPCS 26720
Hospital Charge Code	2672000
Hospital Revenue Code	450
Min. Negotiated Rate	$264.86
Max. Negotiated Rate	$313.31
Rate for Payer: Cash Price	$242.25
Rate for Payer: Health Partners Plans Commercial	$306.85
Rate for Payer: UnitedHealthcare Commercial	$313.31
Rate for Payer: WPPA Commercial	$264.86

CLOS TX RADIAL&ULNA FX WO MANI

Facility

$323.00

Service Code	HCPCS 25560
Hospital Charge Code	2556000
Hospital Revenue Code	450
Min. Negotiated Rate	$264.86
Max. Negotiated Rate	$313.31
Rate for Payer: Cash Price	$242.25
Rate for Payer: Health Partners Plans Commercial	$306.85
Rate for Payer: UnitedHealthcare Commercial	$313.31
Rate for Payer: WPPA Commercial	$264.86

CLOS TX RADIAL&ULNA FX WO MANI

Facility

$323.00

Service Code	HCPCS 25560
Hospital Charge Code	2556000
Hospital Revenue Code	450
Min. Negotiated Rate	$149.23
Max. Negotiated Rate	$1,454.40
Rate for Payer: BCBS Commercial	$1,454.40
Rate for Payer: Cash Price	$242.25
Rate for Payer: Cash Price	$242.25
Rate for Payer: Celtic Commercial/Exchange	$149.23
Rate for Payer: Health Partners Plans Commercial	$306.85
Rate for Payer: UnitedHealthcare Commercial	$313.31
Rate for Payer: WPPA Commercial	$271.32

CLOS TX RADIOULNAR DISLOC W/MA

Facility

$323.00

Service Code	HCPCS 25675
Hospital Charge Code	2567500
Hospital Revenue Code	450
Min. Negotiated Rate	$264.86
Max. Negotiated Rate	$313.31
Rate for Payer: Cash Price	$242.25
Rate for Payer: Health Partners Plans Commercial	$306.85
Rate for Payer: UnitedHealthcare Commercial	$313.31
Rate for Payer: WPPA Commercial	$264.86

CLOS TX RADIOULNAR DISLOC W/MA

Facility

$323.00

Service Code	HCPCS 25675
Hospital Charge Code	2567500
Hospital Revenue Code	450
Min. Negotiated Rate	$149.23
Max. Negotiated Rate	$809.01
Rate for Payer: BCBS Commercial	$809.01
Rate for Payer: Cash Price	$242.25
Rate for Payer: Cash Price	$242.25
Rate for Payer: Celtic Commercial/Exchange	$149.23
Rate for Payer: Health Partners Plans Commercial	$306.85
Rate for Payer: UnitedHealthcare Commercial	$313.31
Rate for Payer: WPPA Commercial	$271.32

Know your out-of-pocket cost for care.

All Charges