Ness County Hospital

All Charges

Charge

Type

Setting

Price

CLOTTING FACTOR V,LABILE FACT

Facility

$155.00

Service Code	HCPCS 85220
Hospital Charge Code	8522000
Hospital Revenue Code	305
Min. Negotiated Rate	$65.72
Max. Negotiated Rate	$150.35
Rate for Payer: BCBS Commercial	$65.72
Rate for Payer: Cash Price	$116.25
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

CLOTTING INHIB,ANTITHROMBIN 3

Facility

$36.00

Service Code	HCPCS 85301
Hospital Charge Code	8530100
Hospital Revenue Code	305
Min. Negotiated Rate	$16.63
Max. Negotiated Rate	$34.92
Rate for Payer: BCBS Commercial	$28.23
Rate for Payer: Cash Price	$27.00
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 INHIB,ANTITHROMBIN 3

Facility

$36.00

Service Code	HCPCS 85301
Hospital Charge Code	8530100
Hospital Revenue Code	305
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

CLOTTING INHIBITORS ANTITHROM

Facility

$76.00

Service Code	HCPCS 85300
Hospital Charge Code	8530000
Hospital Revenue Code	305
Min. Negotiated Rate	$62.32
Max. Negotiated Rate	$73.72
Rate for Payer: Cash Price	$57.00
Rate for Payer: Health Partners Plans Commercial	$72.20
Rate for Payer: UnitedHealthcare Commercial	$73.72
Rate for Payer: WPPA Commercial	$62.32

CLOTTING INHIBITORS ANTITHROM

Facility

$76.00

Service Code	HCPCS 85300
Hospital Charge Code	8530000
Hospital Revenue Code	305
Min. Negotiated Rate	$35.11
Max. Negotiated Rate	$73.72
Rate for Payer: BCBS Commercial	$42.97
Rate for Payer: Cash Price	$57.00
Rate for Payer: Cash Price	$57.00
Rate for Payer: Celtic Commercial/Exchange	$35.11
Rate for Payer: Health Partners Plans Commercial	$72.20
Rate for Payer: UnitedHealthcare Commercial	$73.72
Rate for Payer: WPPA Commercial	$63.84

CLSD TX DISTAL FIB FX W/MANIP

Facility

$323.00

Service Code	HCPCS 27788
Hospital Charge Code	2778800
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

CLSD TX DISTAL FIB FX W/MANIP

Facility

$323.00

Service Code	HCPCS 27788
Hospital Charge Code	2778800
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

CLSD TX-METACARPAL FX W/MANIP

Facility

$323.00

Service Code	HCPCS 26605
Hospital Charge Code	2660500
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

CLSD TX-METACARPAL FX W/MANIP

Facility

$323.00

Service Code	HCPCS 26605
Hospital Charge Code	2660500
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

CLSD TX PELVIC RING FX

Facility

$269.00

Service Code	HCPCS 27197
Hospital Charge Code	2719700
Hospital Revenue Code	450
Min. Negotiated Rate	$220.58
Max. Negotiated Rate	$260.93
Rate for Payer: Cash Price	$201.75
Rate for Payer: Health Partners Plans Commercial	$255.55
Rate for Payer: UnitedHealthcare Commercial	$260.93
Rate for Payer: WPPA Commercial	$220.58

CLSD TX PELVIC RING FX

Facility

$269.00

Service Code	HCPCS 27197
Hospital Charge Code	2719700
Hospital Revenue Code	450
Min. Negotiated Rate	$124.28
Max. Negotiated Rate	$260.93
Rate for Payer: Cash Price	$201.75
Rate for Payer: Celtic Commercial/Exchange	$124.28
Rate for Payer: Health Partners Plans Commercial	$255.55
Rate for Payer: UnitedHealthcare Commercial	$260.93
Rate for Payer: WPPA Commercial	$225.96

CLSD TX RADIAL HEAD/NECK FX

Facility

$227.00

Service Code	HCPCS 24650
Hospital Charge Code	2465000
Hospital Revenue Code	450
Min. Negotiated Rate	$104.87
Max. Negotiated Rate	$809.01
Rate for Payer: BCBS Commercial	$809.01
Rate for Payer: Cash Price	$170.25
Rate for Payer: Cash Price	$170.25
Rate for Payer: Celtic Commercial/Exchange	$104.87
Rate for Payer: Health Partners Plans Commercial	$215.65
Rate for Payer: UnitedHealthcare Commercial	$220.19
Rate for Payer: WPPA Commercial	$190.68

CLSD TX RADIAL HEAD/NECK FX

Facility

$227.00

Service Code	HCPCS 24650
Hospital Charge Code	2465000
Hospital Revenue Code	450
Min. Negotiated Rate	$186.14
Max. Negotiated Rate	$220.19
Rate for Payer: Cash Price	$170.25
Rate for Payer: Health Partners Plans Commercial	$215.65
Rate for Payer: UnitedHealthcare Commercial	$220.19
Rate for Payer: WPPA Commercial	$186.14

CLSD TX TIBIAL FX W/MANIP

Facility

$1,530.00

Service Code	HCPCS 27752
Hospital Charge Code	2775200
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

CLSD TX TIBIAL FX W/MANIP

Facility

$1,530.00

Service Code	HCPCS 27752
Hospital Charge Code	2775200
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

CLSD TX ULNAR SHAFT FX,W/O MAN

Facility

$269.00

Service Code	HCPCS 25530
Hospital Charge Code	2553000
Hospital Revenue Code	450
Min. Negotiated Rate	$124.28
Max. Negotiated Rate	$1,454.40
Rate for Payer: BCBS Commercial	$1,454.40
Rate for Payer: Cash Price	$201.75
Rate for Payer: Cash Price	$201.75
Rate for Payer: Celtic Commercial/Exchange	$124.28
Rate for Payer: Health Partners Plans Commercial	$255.55
Rate for Payer: UnitedHealthcare Commercial	$260.93
Rate for Payer: WPPA Commercial	$225.96

CLSD TX ULNAR SHAFT FX,W/O MAN

Facility

$269.00

Service Code	HCPCS 25530
Hospital Charge Code	2553000
Hospital Revenue Code	450
Min. Negotiated Rate	$220.58
Max. Negotiated Rate	$260.93
Rate for Payer: Cash Price	$201.75
Rate for Payer: Health Partners Plans Commercial	$255.55
Rate for Payer: UnitedHealthcare Commercial	$260.93
Rate for Payer: WPPA Commercial	$220.58

CLSD TX VERTEBRAL BODY FX,W/O

Facility

$227.00

Service Code	HCPCS 22310
Hospital Charge Code	2231000
Hospital Revenue Code	450
Min. Negotiated Rate	$104.87
Max. Negotiated Rate	$220.19
Rate for Payer: Cash Price	$170.25
Rate for Payer: Celtic Commercial/Exchange	$104.87
Rate for Payer: Health Partners Plans Commercial	$215.65
Rate for Payer: UnitedHealthcare Commercial	$220.19
Rate for Payer: WPPA Commercial	$190.68

CLSD TX VERTEBRAL BODY FX,W/O

Facility

$227.00

Service Code	HCPCS 22310
Hospital Charge Code	2231000
Hospital Revenue Code	450
Min. Negotiated Rate	$186.14
Max. Negotiated Rate	$220.19
Rate for Payer: Cash Price	$170.25
Rate for Payer: Health Partners Plans Commercial	$215.65
Rate for Payer: UnitedHealthcare Commercial	$220.19
Rate for Payer: WPPA Commercial	$186.14

CMP Daily x 5 days

Facility

$176.00

Hospital Charge Code	8005301
Hospital Revenue Code	301
Min. Negotiated Rate	$144.32
Max. Negotiated Rate	$170.72
Rate for Payer: Cash Price	$132.00
Rate for Payer: Health Partners Plans Commercial	$167.20
Rate for Payer: UnitedHealthcare Commercial	$170.72
Rate for Payer: WPPA Commercial	$144.32

CMP Daily x 5 days

Facility

$176.00

Hospital Charge Code	8005301
Hospital Revenue Code	301
Min. Negotiated Rate	$81.31
Max. Negotiated Rate	$170.72
Rate for Payer: Cash Price	$132.00
Rate for Payer: Celtic Commercial/Exchange	$81.31
Rate for Payer: Health Partners Plans Commercial	$167.20
Rate for Payer: UnitedHealthcare Commercial	$170.72
Rate for Payer: WPPA Commercial	$147.84

CNTRL NASL HEMOR PACKS/CAUT IN

Facility

$296.00

Service Code	HCPCS 30905
Hospital Charge Code	3090500
Hospital Revenue Code	761
Min. Negotiated Rate	$242.72
Max. Negotiated Rate	$287.12
Rate for Payer: Cash Price	$222.00
Rate for Payer: Health Partners Plans Commercial	$281.20
Rate for Payer: UnitedHealthcare Commercial	$287.12
Rate for Payer: WPPA Commercial	$242.72

CNTRL NASL HEMOR PACKS/CAUT IN

Facility

$296.00

Service Code	HCPCS 30905
Hospital Charge Code	3090500
Hospital Revenue Code	761
Min. Negotiated Rate	$136.75
Max. Negotiated Rate	$354.51
Rate for Payer: BCBS Commercial	$354.51
Rate for Payer: Cash Price	$222.00
Rate for Payer: Cash Price	$222.00
Rate for Payer: Celtic Commercial/Exchange	$136.75
Rate for Payer: Health Partners Plans Commercial	$281.20
Rate for Payer: UnitedHealthcare Commercial	$287.12
Rate for Payer: WPPA Commercial	$248.64

CNTRL NASL HEMORR ANT CMPLX ME

Facility

$215.00

Service Code	HCPCS 30903
Hospital Charge Code	3090300
Hospital Revenue Code	450
Min. Negotiated Rate	$176.30
Max. Negotiated Rate	$208.55
Rate for Payer: Cash Price	$161.25
Rate for Payer: Health Partners Plans Commercial	$204.25
Rate for Payer: UnitedHealthcare Commercial	$208.55
Rate for Payer: WPPA Commercial	$176.30

CNTRL NASL HEMORR ANT CMPLX ME

Facility

$215.00

Service Code	HCPCS 30903
Hospital Charge Code	3090300
Hospital Revenue Code	450
Min. Negotiated Rate	$99.33
Max. Negotiated Rate	$593.88
Rate for Payer: BCBS Commercial	$593.88
Rate for Payer: Cash Price	$161.25
Rate for Payer: Cash Price	$161.25
Rate for Payer: Celtic Commercial/Exchange	$99.33
Rate for Payer: Health Partners Plans Commercial	$204.25
Rate for Payer: UnitedHealthcare Commercial	$208.55
Rate for Payer: WPPA Commercial	$180.60

Know your out-of-pocket cost for care.

All Charges