Ness County Hospital

All Charges

Charge

Type

Setting

Price

CLOS TX SCAP FX WO MANIPULATIO

Facility

$323.00

Service Code	HCPCS 23570
Hospital Charge Code	2357000
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 SCAP FX WO MANIPULATIO

Facility

$323.00

Service Code	HCPCS 23570
Hospital Charge Code	2357000
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 SHLDR DISLC W/MANIP WO

Facility

$914.00

Service Code	HCPCS 23650
Hospital Charge Code	2365000
Hospital Revenue Code	761
Min. Negotiated Rate	$749.48
Max. Negotiated Rate	$886.58
Rate for Payer: Cash Price	$685.50
Rate for Payer: Health Partners Plans Commercial	$868.30
Rate for Payer: UnitedHealthcare Commercial	$886.58
Rate for Payer: WPPA Commercial	$749.48

CLOS TX SHLDR DISLC W/MANIP WO

Facility

$914.00

Service Code	HCPCS 23650
Hospital Charge Code	2365000
Hospital Revenue Code	761
Min. Negotiated Rate	$422.27
Max. Negotiated Rate	$897.89
Rate for Payer: BCBS Commercial	$897.89
Rate for Payer: Cash Price	$685.50
Rate for Payer: Cash Price	$685.50
Rate for Payer: Celtic Commercial/Exchange	$422.27
Rate for Payer: Health Partners Plans Commercial	$868.30
Rate for Payer: UnitedHealthcare Commercial	$886.58
Rate for Payer: WPPA Commercial	$767.76

CLOS TX SHLDR DISLOC W/FX SURG

Facility

$1,530.00

Service Code	HCPCS 23675
Hospital Charge Code	2367500
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 SHLDR DISLOC W/FX SURG

Facility

$1,530.00

Service Code	HCPCS 23675
Hospital Charge Code	2367500
Hospital Revenue Code	450
Min. Negotiated Rate	$706.86
Max. Negotiated Rate	$1,484.10
Rate for Payer: BCBS Commercial	$809.01
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 SPRCOND HUM FX WO MANI

Facility

$323.00

Service Code	HCPCS 24530
Hospital Charge Code	2453000
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 SPRCOND HUM FX WO MANI

Facility

$323.00

Service Code	HCPCS 24530
Hospital Charge Code	2453000
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

CLOT INHIBITORS PROT. C ACTVTY

Facility

$160.00

Service Code	HCPCS 85303
Hospital Charge Code	8530300
Hospital Revenue Code	305
Min. Negotiated Rate	$73.92
Max. Negotiated Rate	$155.20
Rate for Payer: BCBS Commercial	$85.69
Rate for Payer: Cash Price	$120.00
Rate for Payer: Cash Price	$120.00
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

CLOT INHIBITORS PROT. C ACTVTY

Facility

$160.00

Service Code	HCPCS 85303
Hospital Charge Code	8530300
Hospital Revenue Code	305
Min. Negotiated Rate	$131.20
Max. Negotiated Rate	$155.20
Rate for Payer: Cash Price	$120.00
Rate for Payer: Health Partners Plans Commercial	$152.00
Rate for Payer: UnitedHealthcare Commercial	$155.20
Rate for Payer: WPPA Commercial	$131.20

CLOT INHIBITORS PROTEIN S,FREE

Facility

$252.00

Service Code	HCPCS 85306
Hospital Charge Code	8530600
Hospital Revenue Code	305
Min. Negotiated Rate	$108.26
Max. Negotiated Rate	$244.44
Rate for Payer: BCBS Commercial	$108.26
Rate for Payer: Cash Price	$189.00
Rate for Payer: Cash Price	$189.00
Rate for Payer: Celtic Commercial/Exchange	$116.42
Rate for Payer: Health Partners Plans Commercial	$239.40
Rate for Payer: UnitedHealthcare Commercial	$244.44
Rate for Payer: WPPA Commercial	$211.68

CLOT INHIBITORS PROTEIN S,FREE

Facility

$252.00

Service Code	HCPCS 85306
Hospital Charge Code	8530600
Hospital Revenue Code	305
Min. Negotiated Rate	$206.64
Max. Negotiated Rate	$244.44
Rate for Payer: Cash Price	$189.00
Rate for Payer: Health Partners Plans Commercial	$239.40
Rate for Payer: UnitedHealthcare Commercial	$244.44
Rate for Payer: WPPA Commercial	$206.64

CLOTRIMAZOLE VAG. CREAM

Facility

$36.00

Hospital Charge Code	2519213
Hospital Revenue Code	250
Min. Negotiated Rate	$29.52
Max. Negotiated Rate	$34.92
Rate for Payer: Cash Price	$27.00
Rate for Payer: Health Partners Plans Commercial	$34.20
Rate for Payer: UnitedHealthcare Commercial	$34.92
Rate for Payer: WPPA Commercial	$29.52

CLOTRIMAZOLE VAG. CREAM

Facility

$36.00

Hospital Charge Code	2519213
Hospital Revenue Code	250
Min. Negotiated Rate	$16.63
Max. Negotiated Rate	$34.92
Rate for Payer: Cash Price	$27.00
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

CLOTTING FACTOR IX

Facility

$83.00

Service Code	HCPCS 85250
Hospital Charge Code	8525000
Hospital Revenue Code	305
Min. Negotiated Rate	$38.35
Max. Negotiated Rate	$80.51
Rate for Payer: BCBS Commercial	$69.63
Rate for Payer: Cash Price	$62.25
Rate for Payer: Cash Price	$62.25
Rate for Payer: Celtic Commercial/Exchange	$38.35
Rate for Payer: Health Partners Plans Commercial	$78.85
Rate for Payer: UnitedHealthcare Commercial	$80.51
Rate for Payer: WPPA Commercial	$69.72

CLOTTING FACTOR IX

Facility

$83.00

Service Code	HCPCS 85250
Hospital Charge Code	8525000
Hospital Revenue Code	305
Min. Negotiated Rate	$68.06
Max. Negotiated Rate	$80.51
Rate for Payer: Cash Price	$62.25
Rate for Payer: Health Partners Plans Commercial	$78.85
Rate for Payer: UnitedHealthcare Commercial	$80.51
Rate for Payer: WPPA Commercial	$68.06

CLOTTING-FACTOR VIII (AHG)

Facility

$164.00

Service Code	HCPCS 85240
Hospital Charge Code	8524000
Hospital Revenue Code	305
Min. Negotiated Rate	$134.48
Max. Negotiated Rate	$159.08
Rate for Payer: Cash Price	$123.00
Rate for Payer: Health Partners Plans Commercial	$155.80
Rate for Payer: UnitedHealthcare Commercial	$159.08
Rate for Payer: WPPA Commercial	$134.48

CLOTTING-FACTOR VIII (AHG)

Facility

$164.00

Service Code	HCPCS 85240
Hospital Charge Code	8524000
Hospital Revenue Code	305
Min. Negotiated Rate	$75.77
Max. Negotiated Rate	$159.08
Rate for Payer: BCBS Commercial	$88.47
Rate for Payer: Cash Price	$123.00
Rate for Payer: Cash Price	$123.00
Rate for Payer: Celtic Commercial/Exchange	$75.77
Rate for Payer: Health Partners Plans Commercial	$155.80
Rate for Payer: UnitedHealthcare Commercial	$159.08
Rate for Payer: WPPA Commercial	$137.76

CLOTTING FACTOR VIII RLTD ANTI

Facility

$165.00

Service Code	HCPCS 85244
Hospital Charge Code	8524400
Hospital Revenue Code	305
Min. Negotiated Rate	$76.23
Max. Negotiated Rate	$160.05
Rate for Payer: BCBS Commercial	$99.20
Rate for Payer: Cash Price	$123.75
Rate for Payer: Cash Price	$123.75
Rate for Payer: Celtic Commercial/Exchange	$76.23
Rate for Payer: Health Partners Plans Commercial	$156.75
Rate for Payer: UnitedHealthcare Commercial	$160.05
Rate for Payer: WPPA Commercial	$138.60

CLOTTING FACTOR VIII RLTD ANTI

Facility

$165.00

Service Code	HCPCS 85244
Hospital Charge Code	8524400
Hospital Revenue Code	305
Min. Negotiated Rate	$135.30
Max. Negotiated Rate	$160.05
Rate for Payer: Cash Price	$123.75
Rate for Payer: Health Partners Plans Commercial	$156.75
Rate for Payer: UnitedHealthcare Commercial	$160.05
Rate for Payer: WPPA Commercial	$135.30

CLOTTING FACTOR VIII,VW FACTOR

Facility

$126.00

Service Code	HCPCS 85245
Hospital Charge Code	8524500
Hospital Revenue Code	305
Min. Negotiated Rate	$103.32
Max. Negotiated Rate	$122.22
Rate for Payer: Cash Price	$94.50
Rate for Payer: Health Partners Plans Commercial	$119.70
Rate for Payer: UnitedHealthcare Commercial	$122.22
Rate for Payer: WPPA Commercial	$103.32

CLOTTING FACTOR VIII,VW FACTOR

Facility

$126.00

Service Code	HCPCS 85245
Hospital Charge Code	8524500
Hospital Revenue Code	305
Min. Negotiated Rate	$18.60
Max. Negotiated Rate	$122.22
Rate for Payer: BCBS Commercial	$18.60
Rate for Payer: Cash Price	$94.50
Rate for Payer: Cash Price	$94.50
Rate for Payer: Celtic Commercial/Exchange	$58.21
Rate for Payer: Health Partners Plans Commercial	$119.70
Rate for Payer: UnitedHealthcare Commercial	$122.22
Rate for Payer: WPPA Commercial	$105.84

CLOTTING; FACTOR VIII,VW FACTR

Facility

$44.00

Service Code	HCPCS 85246
Hospital Charge Code	8524600
Hospital Revenue Code	305
Min. Negotiated Rate	$18.60
Max. Negotiated Rate	$42.68
Rate for Payer: BCBS Commercial	$18.60
Rate for Payer: Cash Price	$33.00
Rate for Payer: Cash Price	$33.00
Rate for Payer: Celtic Commercial/Exchange	$20.33
Rate for Payer: Health Partners Plans Commercial	$41.80
Rate for Payer: UnitedHealthcare Commercial	$42.68
Rate for Payer: WPPA Commercial	$36.96

CLOTTING; FACTOR VIII,VW FACTR

Facility

$44.00

Service Code	HCPCS 85246
Hospital Charge Code	8524600
Hospital Revenue Code	305
Min. Negotiated Rate	$36.08
Max. Negotiated Rate	$42.68
Rate for Payer: Cash Price	$33.00
Rate for Payer: Health Partners Plans Commercial	$41.80
Rate for Payer: UnitedHealthcare Commercial	$42.68
Rate for Payer: WPPA Commercial	$36.08

CLOTTING FACTOR V,LABILE FACT

Facility

$155.00

Service Code	HCPCS 85220
Hospital Charge Code	8522000
Hospital Revenue Code	305
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

Know your out-of-pocket cost for care.

All Charges