Ness County Hospital

All Charges

Charge

Type

Setting

Price

L-SPINE 2-3 VIEWS

Facility

$351.00

Service Code	HCPCS 72100
Hospital Charge Code	3270012
Hospital Revenue Code	320
Min. Negotiated Rate	$162.16
Max. Negotiated Rate	$340.47
Rate for Payer: BCBS Commercial	$174.69
Rate for Payer: Cash Price	$263.25
Rate for Payer: Cash Price	$263.25
Rate for Payer: Celtic Commercial/Exchange	$162.16
Rate for Payer: Health Partners Plans Commercial	$333.45
Rate for Payer: UnitedHealthcare Commercial	$340.47
Rate for Payer: WPPA Commercial	$294.84

L-SPINE 4V MINIMUM

Facility

$447.00

Service Code	HCPCS 72110
Hospital Charge Code	3270014
Hospital Revenue Code	320
Min. Negotiated Rate	$206.51
Max. Negotiated Rate	$433.59
Rate for Payer: BCBS Commercial	$248.10
Rate for Payer: Cash Price	$335.25
Rate for Payer: Cash Price	$335.25
Rate for Payer: Celtic Commercial/Exchange	$206.51
Rate for Payer: Health Partners Plans Commercial	$424.65
Rate for Payer: UnitedHealthcare Commercial	$433.59
Rate for Payer: WPPA Commercial	$375.48

L-SPINE 4V MINIMUM

Facility

$447.00

Service Code	HCPCS 72110
Hospital Charge Code	3270014
Hospital Revenue Code	320
Min. Negotiated Rate	$366.54
Max. Negotiated Rate	$433.59
Rate for Payer: Cash Price	$335.25
Rate for Payer: Health Partners Plans Commercial	$424.65
Rate for Payer: UnitedHealthcare Commercial	$433.59
Rate for Payer: WPPA Commercial	$366.54

L-SPINE BENDING ONLY 2-3V

Facility

$301.00

Service Code	HCPCS 72120
Hospital Charge Code	3270016
Hospital Revenue Code	320
Min. Negotiated Rate	$246.82
Max. Negotiated Rate	$291.97
Rate for Payer: Cash Price	$225.75
Rate for Payer: Health Partners Plans Commercial	$285.95
Rate for Payer: UnitedHealthcare Commercial	$291.97
Rate for Payer: WPPA Commercial	$246.82

L-SPINE BENDING ONLY 2-3V

Facility

$301.00

Service Code	HCPCS 72120
Hospital Charge Code	3270016
Hospital Revenue Code	320
Min. Negotiated Rate	$139.06
Max. Negotiated Rate	$291.97
Rate for Payer: BCBS Commercial	$233.23
Rate for Payer: Cash Price	$225.75
Rate for Payer: Cash Price	$225.75
Rate for Payer: Celtic Commercial/Exchange	$139.06
Rate for Payer: Health Partners Plans Commercial	$285.95
Rate for Payer: UnitedHealthcare Commercial	$291.97
Rate for Payer: WPPA Commercial	$252.84

L-SPINE COMP W BEND 6V MIN

Facility

$482.00

Service Code	HCPCS 72114
Hospital Charge Code	7211400
Hospital Revenue Code	320
Min. Negotiated Rate	$222.68
Max. Negotiated Rate	$467.54
Rate for Payer: BCBS Commercial	$299.20
Rate for Payer: Cash Price	$361.50
Rate for Payer: Cash Price	$361.50
Rate for Payer: Celtic Commercial/Exchange	$222.68
Rate for Payer: Health Partners Plans Commercial	$457.90
Rate for Payer: UnitedHealthcare Commercial	$467.54
Rate for Payer: WPPA Commercial	$404.88

L-SPINE COMP W BEND 6V MIN

Facility

$482.00

Service Code	HCPCS 72114
Hospital Charge Code	7211400
Hospital Revenue Code	320
Min. Negotiated Rate	$395.24
Max. Negotiated Rate	$467.54
Rate for Payer: Cash Price	$361.50
Rate for Payer: Health Partners Plans Commercial	$457.90
Rate for Payer: UnitedHealthcare Commercial	$467.54
Rate for Payer: WPPA Commercial	$395.24

LT 3D UNIL DIAG MAMMOGRAM

Facility

$32.00

Service Code	HCPCS 77061 LT
Hospital Charge Code	7706100
Hospital Revenue Code	401
Min. Negotiated Rate	$14.78
Max. Negotiated Rate	$31.04
Rate for Payer: BCBS Commercial	$16.00
Rate for Payer: Cash Price	$24.00
Rate for Payer: Cash Price	$24.00
Rate for Payer: Celtic Commercial/Exchange	$14.78
Rate for Payer: Health Partners Plans Commercial	$30.40
Rate for Payer: UnitedHealthcare Commercial	$31.04
Rate for Payer: WPPA Commercial	$26.88

LT 3D UNIL DIAG MAMMOGRAM

Facility

$32.00

Service Code	HCPCS 77061 LT
Hospital Charge Code	7706100
Hospital Revenue Code	401
Min. Negotiated Rate	$26.24
Max. Negotiated Rate	$31.04
Rate for Payer: Cash Price	$24.00
Rate for Payer: Health Partners Plans Commercial	$30.40
Rate for Payer: UnitedHealthcare Commercial	$31.04
Rate for Payer: WPPA Commercial	$26.24

LTC ATRIUM EXPRESS CHEST DRAIN

Facility

$165.00

Hospital Charge Code	4100326LTC
Hospital Revenue Code	272
Min. Negotiated Rate	$76.23
Max. Negotiated Rate	$160.05
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

LTC ATRIUM EXPRESS CHEST DRAIN

Facility

$165.00

Hospital Charge Code	4100326LTC
Hospital Revenue Code	272
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

LTC-HAIR CARE-OUTSIDE SOURCE

Facility

$18.00

Hospital Charge Code	9998833
Hospital Revenue Code	990
Min. Negotiated Rate	$8.32
Max. Negotiated Rate	$17.46
Rate for Payer: Cash Price	$13.50
Rate for Payer: Celtic Commercial/Exchange	$8.32
Rate for Payer: Health Partners Plans Commercial	$17.10
Rate for Payer: UnitedHealthcare Commercial	$17.46
Rate for Payer: WPPA Commercial	$15.12

LTC-HAIR CARE-OUTSIDE SOURCE

Facility

$18.00

Hospital Charge Code	9998833
Hospital Revenue Code	990
Min. Negotiated Rate	$14.76
Max. Negotiated Rate	$17.46
Rate for Payer: Cash Price	$13.50
Rate for Payer: Health Partners Plans Commercial	$17.10
Rate for Payer: UnitedHealthcare Commercial	$17.46
Rate for Payer: WPPA Commercial	$14.76

LTC HAIRCUT/COLOR-OUTSIDE PERS

Facility

$35.00

Hospital Charge Code	9998834
Hospital Revenue Code	990
Min. Negotiated Rate	$16.17
Max. Negotiated Rate	$33.95
Rate for Payer: Cash Price	$26.25
Rate for Payer: Celtic Commercial/Exchange	$16.17
Rate for Payer: Health Partners Plans Commercial	$33.25
Rate for Payer: UnitedHealthcare Commercial	$33.95
Rate for Payer: WPPA Commercial	$29.40

LTC HAIRCUT/COLOR-OUTSIDE PERS

Facility

$35.00

Hospital Charge Code	9998834
Hospital Revenue Code	990
Min. Negotiated Rate	$28.70
Max. Negotiated Rate	$33.95
Rate for Payer: Cash Price	$26.25
Rate for Payer: Health Partners Plans Commercial	$33.25
Rate for Payer: UnitedHealthcare Commercial	$33.95
Rate for Payer: WPPA Commercial	$28.70

LTC HAIRCUT-OUTSIDE SOURCE

Facility

$25.00

Hospital Charge Code	9998811
Hospital Revenue Code	990
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

LTC HAIRCUT-OUTSIDE SOURCE

Facility

$25.00

Hospital Charge Code	9998811
Hospital Revenue Code	990
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

LTC LEVEL 1- Room & Board

Facility

$245.00

Hospital Charge Code	1300003
Hospital Revenue Code	130
Min. Negotiated Rate	$200.90
Max. Negotiated Rate	$4,738.80
Rate for Payer: Cash Price	$183.75
Rate for Payer: Cash Price	$183.75
Rate for Payer: Celtic Commercial/Exchange	$4,738.80
Rate for Payer: Health Partners Plans Commercial	$232.75
Rate for Payer: UnitedHealthcare Commercial	$237.65
Rate for Payer: WPPA Commercial	$200.90

LTC LEVEL 2- Room & Board

Facility

$255.00

Hospital Charge Code	1300011
Hospital Revenue Code	130
Min. Negotiated Rate	$209.10
Max. Negotiated Rate	$4,738.80
Rate for Payer: Cash Price	$191.25
Rate for Payer: Cash Price	$191.25
Rate for Payer: Celtic Commercial/Exchange	$4,738.80
Rate for Payer: Health Partners Plans Commercial	$242.25
Rate for Payer: UnitedHealthcare Commercial	$247.35
Rate for Payer: WPPA Commercial	$209.10

LTC MEAL CREDIT

Facility

$3.00

Hospital Charge Code	1300029
Hospital Revenue Code	271
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.25
Rate for Payer: Health Partners Plans Commercial	$2.85
Rate for Payer: UnitedHealthcare Commercial	$2.91
Rate for Payer: WPPA Commercial	$2.46

LTC MEAL CREDIT

Facility

$3.00

Hospital Charge Code	1300029
Hospital Revenue Code	271
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.25
Rate for Payer: Celtic Commercial/Exchange	$1.39
Rate for Payer: Health Partners Plans Commercial	$2.85
Rate for Payer: UnitedHealthcare Commercial	$2.91
Rate for Payer: WPPA Commercial	$2.52

LT. COLLES SPLINT

Facility

$19.00

Hospital Charge Code	2702348
Hospital Revenue Code	270
Min. Negotiated Rate	$8.78
Max. Negotiated Rate	$18.43
Rate for Payer: Cash Price	$14.25
Rate for Payer: Celtic Commercial/Exchange	$8.78
Rate for Payer: Health Partners Plans Commercial	$18.05
Rate for Payer: UnitedHealthcare Commercial	$18.43
Rate for Payer: WPPA Commercial	$15.96

LT. COLLES SPLINT

Facility

$19.00

Hospital Charge Code	2702348
Hospital Revenue Code	270
Min. Negotiated Rate	$15.58
Max. Negotiated Rate	$18.43
Rate for Payer: Cash Price	$14.25
Rate for Payer: Health Partners Plans Commercial	$18.05
Rate for Payer: UnitedHealthcare Commercial	$18.43
Rate for Payer: WPPA Commercial	$15.58

LTC PERM-OUTSIDE SOURCE

Facility

$35.00

Hospital Charge Code	9998822
Hospital Revenue Code	990
Min. Negotiated Rate	$28.70
Max. Negotiated Rate	$33.95
Rate for Payer: Cash Price	$26.25
Rate for Payer: Health Partners Plans Commercial	$33.25
Rate for Payer: UnitedHealthcare Commercial	$33.95
Rate for Payer: WPPA Commercial	$28.70

LTC PERM-OUTSIDE SOURCE

Facility

$35.00

Hospital Charge Code	9998822
Hospital Revenue Code	990
Min. Negotiated Rate	$16.17
Max. Negotiated Rate	$33.95
Rate for Payer: Cash Price	$26.25
Rate for Payer: Celtic Commercial/Exchange	$16.17
Rate for Payer: Health Partners Plans Commercial	$33.25
Rate for Payer: UnitedHealthcare Commercial	$33.95
Rate for Payer: WPPA Commercial	$29.40

Know your out-of-pocket cost for care.

All Charges