Ness County Hospital

All Charges

Charge

Type

Setting

Price

MANUAL THERAPY PER 15 MIN

Facility

$121.00

Service Code	HCPCS 97140 GO
Hospital Charge Code	9714000
Hospital Revenue Code	430
Min. Negotiated Rate	$55.90
Max. Negotiated Rate	$117.37
Rate for Payer: BCBS Commercial	$58.08
Rate for Payer: Cash Price	$90.75
Rate for Payer: Cash Price	$90.75
Rate for Payer: Celtic Commercial/Exchange	$55.90
Rate for Payer: Health Partners Plans Commercial	$114.95
Rate for Payer: UnitedHealthcare Commercial	$117.37
Rate for Payer: WPPA Commercial	$101.64

MANUAL THERAPY PER 15 MIN

Facility

$121.00

Service Code	HCPCS 97140 GO
Hospital Charge Code	9714000
Hospital Revenue Code	430
Min. Negotiated Rate	$99.22
Max. Negotiated Rate	$117.37
Rate for Payer: Cash Price	$90.75
Rate for Payer: Health Partners Plans Commercial	$114.95
Rate for Payer: UnitedHealthcare Commercial	$117.37
Rate for Payer: WPPA Commercial	$99.22

MANUAL THER. & HOT/COLD PACKS

Facility

$132.00

Service Code	HCPCS 97140 GP
Hospital Charge Code	4201482
Hospital Revenue Code	420
Min. Negotiated Rate	$58.08
Max. Negotiated Rate	$128.04
Rate for Payer: BCBS Commercial	$58.08
Rate for Payer: Cash Price	$99.00
Rate for Payer: Cash Price	$99.00
Rate for Payer: Celtic Commercial/Exchange	$60.98
Rate for Payer: Health Partners Plans Commercial	$125.40
Rate for Payer: UnitedHealthcare Commercial	$128.04
Rate for Payer: WPPA Commercial	$110.88

MANUAL THER. & HOT/COLD PACKS

Facility

$132.00

Service Code	HCPCS 97140 GP
Hospital Charge Code	4201482
Hospital Revenue Code	420
Min. Negotiated Rate	$108.24
Max. Negotiated Rate	$128.04
Rate for Payer: Cash Price	$99.00
Rate for Payer: Health Partners Plans Commercial	$125.40
Rate for Payer: UnitedHealthcare Commercial	$128.04
Rate for Payer: WPPA Commercial	$108.24

MANUAL THER.(MOB/MANIP/MYOFAC

Facility

$125.00

Service Code	HCPCS 97140 GP
Hospital Charge Code	4201472
Hospital Revenue Code	420
Min. Negotiated Rate	$57.75
Max. Negotiated Rate	$121.25
Rate for Payer: BCBS Commercial	$58.08
Rate for Payer: Cash Price	$93.75
Rate for Payer: Cash Price	$93.75
Rate for Payer: Celtic Commercial/Exchange	$57.75
Rate for Payer: Health Partners Plans Commercial	$118.75
Rate for Payer: UnitedHealthcare Commercial	$121.25
Rate for Payer: WPPA Commercial	$105.00

MANUAL THER.(MOB/MANIP/MYOFAC

Facility

$125.00

Service Code	HCPCS 97140 GP
Hospital Charge Code	4201472
Hospital Revenue Code	420
Min. Negotiated Rate	$102.50
Max. Negotiated Rate	$121.25
Rate for Payer: Cash Price	$93.75
Rate for Payer: Health Partners Plans Commercial	$118.75
Rate for Payer: UnitedHealthcare Commercial	$121.25
Rate for Payer: WPPA Commercial	$102.50

MASK 02 PEDS

Facility

$15.00

Hospital Charge Code	4100269
Hospital Revenue Code	270
Min. Negotiated Rate	$12.30
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$11.25
Rate for Payer: Health Partners Plans Commercial	$14.25
Rate for Payer: UnitedHealthcare Commercial	$14.55
Rate for Payer: WPPA Commercial	$12.30

MASK 02 PEDS

Facility

$15.00

Hospital Charge Code	4100269
Hospital Revenue Code	270
Min. Negotiated Rate	$6.93
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$11.25
Rate for Payer: Celtic Commercial/Exchange	$6.93
Rate for Payer: Health Partners Plans Commercial	$14.25
Rate for Payer: UnitedHealthcare Commercial	$14.55
Rate for Payer: WPPA Commercial	$12.60

MASK AEROMIST ADULT

Facility

$15.00

Hospital Charge Code	4100236
Hospital Revenue Code	270
Min. Negotiated Rate	$6.93
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$11.25
Rate for Payer: Celtic Commercial/Exchange	$6.93
Rate for Payer: Health Partners Plans Commercial	$14.25
Rate for Payer: UnitedHealthcare Commercial	$14.55
Rate for Payer: WPPA Commercial	$12.60

MASK AEROMIST ADULT

Facility

$15.00

Hospital Charge Code	4100236
Hospital Revenue Code	270
Min. Negotiated Rate	$12.30
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$11.25
Rate for Payer: Health Partners Plans Commercial	$14.25
Rate for Payer: UnitedHealthcare Commercial	$14.55
Rate for Payer: WPPA Commercial	$12.30

MASK AEROMIST PED

Facility

$15.00

Hospital Charge Code	4100244
Hospital Revenue Code	270
Min. Negotiated Rate	$12.30
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$11.25
Rate for Payer: Health Partners Plans Commercial	$14.25
Rate for Payer: UnitedHealthcare Commercial	$14.55
Rate for Payer: WPPA Commercial	$12.30

MASK AEROMIST PED

Facility

$15.00

Hospital Charge Code	4100244
Hospital Revenue Code	270
Min. Negotiated Rate	$6.93
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$11.25
Rate for Payer: Celtic Commercial/Exchange	$6.93
Rate for Payer: Health Partners Plans Commercial	$14.25
Rate for Payer: UnitedHealthcare Commercial	$14.55
Rate for Payer: WPPA Commercial	$12.60

MASK AEROSOL ELONGATED ADULT LTC

Facility

$17.00

Hospital Charge Code	4100236LTC
Hospital Revenue Code	272
Min. Negotiated Rate	$7.85
Max. Negotiated Rate	$16.49
Rate for Payer: Cash Price	$12.75
Rate for Payer: Celtic Commercial/Exchange	$7.85
Rate for Payer: Health Partners Plans Commercial	$16.15
Rate for Payer: UnitedHealthcare Commercial	$16.49
Rate for Payer: WPPA Commercial	$14.28

MASK AEROSOL ELONGATED ADULT LTC

Facility

$17.00

Hospital Charge Code	4100236LTC
Hospital Revenue Code	272
Min. Negotiated Rate	$13.94
Max. Negotiated Rate	$16.49
Rate for Payer: Cash Price	$12.75
Rate for Payer: Health Partners Plans Commercial	$16.15
Rate for Payer: UnitedHealthcare Commercial	$16.49
Rate for Payer: WPPA Commercial	$13.94

MASK O2 ADULT

Facility

$15.00

Hospital Charge Code	4100251
Hospital Revenue Code	270
Min. Negotiated Rate	$6.93
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$11.25
Rate for Payer: Celtic Commercial/Exchange	$6.93
Rate for Payer: Health Partners Plans Commercial	$14.25
Rate for Payer: UnitedHealthcare Commercial	$14.55
Rate for Payer: WPPA Commercial	$12.60

MASK O2 ADULT

Facility

$15.00

Hospital Charge Code	4100251
Hospital Revenue Code	270
Min. Negotiated Rate	$12.30
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$11.25
Rate for Payer: Health Partners Plans Commercial	$14.25
Rate for Payer: UnitedHealthcare Commercial	$14.55
Rate for Payer: WPPA Commercial	$12.30

MASK O2 ELONGATED INFANT

Facility

$15.00

Hospital Charge Code	4100252
Hospital Revenue Code	270
Min. Negotiated Rate	$12.30
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$11.25
Rate for Payer: Health Partners Plans Commercial	$14.25
Rate for Payer: UnitedHealthcare Commercial	$14.55
Rate for Payer: WPPA Commercial	$12.30

MASK O2 ELONGATED INFANT

Facility

$15.00

Hospital Charge Code	4100252
Hospital Revenue Code	270
Min. Negotiated Rate	$6.93
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$11.25
Rate for Payer: Celtic Commercial/Exchange	$6.93
Rate for Payer: Health Partners Plans Commercial	$14.25
Rate for Payer: UnitedHealthcare Commercial	$14.55
Rate for Payer: WPPA Commercial	$12.60

MASON ALLEN SPLINT

Facility

$39.00

Hospital Charge Code	2701324
Hospital Revenue Code	270
Min. Negotiated Rate	$31.98
Max. Negotiated Rate	$37.83
Rate for Payer: Cash Price	$29.62
Rate for Payer: Health Partners Plans Commercial	$37.05
Rate for Payer: UnitedHealthcare Commercial	$37.83
Rate for Payer: WPPA Commercial	$31.98

MASON ALLEN SPLINT

Facility

$39.00

Hospital Charge Code	2701324
Hospital Revenue Code	270
Min. Negotiated Rate	$18.02
Max. Negotiated Rate	$37.83
Rate for Payer: Cash Price	$29.62
Rate for Payer: Celtic Commercial/Exchange	$18.02
Rate for Payer: Health Partners Plans Commercial	$37.05
Rate for Payer: UnitedHealthcare Commercial	$37.83
Rate for Payer: WPPA Commercial	$32.76

MASSAGE,15 MIN & HOT/COLD PAKS

Facility

$100.00

Service Code	HCPCS 97124 GP
Hospital Charge Code	4200913
Hospital Revenue Code	420
Min. Negotiated Rate	$82.00
Max. Negotiated Rate	$97.00
Rate for Payer: Cash Price	$75.38
Rate for Payer: Health Partners Plans Commercial	$95.00
Rate for Payer: UnitedHealthcare Commercial	$97.00
Rate for Payer: WPPA Commercial	$82.00

MASSAGE,15 MIN & HOT/COLD PAKS

Facility

$100.00

Service Code	HCPCS 97124 GP
Hospital Charge Code	4200913
Hospital Revenue Code	420
Min. Negotiated Rate	$42.42
Max. Negotiated Rate	$97.00
Rate for Payer: BCBS Commercial	$42.42
Rate for Payer: Cash Price	$75.38
Rate for Payer: Cash Price	$75.38
Rate for Payer: Celtic Commercial/Exchange	$46.20
Rate for Payer: Health Partners Plans Commercial	$95.00
Rate for Payer: UnitedHealthcare Commercial	$97.00
Rate for Payer: WPPA Commercial	$84.00

MASSAGE, PER 15 MIN.

Facility

$55.00

Service Code	HCPCS 97124 GP
Hospital Charge Code	4200903
Hospital Revenue Code	420
Min. Negotiated Rate	$45.10
Max. Negotiated Rate	$53.35
Rate for Payer: Cash Price	$41.25
Rate for Payer: Health Partners Plans Commercial	$52.25
Rate for Payer: UnitedHealthcare Commercial	$53.35
Rate for Payer: WPPA Commercial	$45.10

MASSAGE, PER 15 MIN.

Facility

$55.00

Service Code	HCPCS 97124 GP
Hospital Charge Code	4200903
Hospital Revenue Code	420
Min. Negotiated Rate	$25.41
Max. Negotiated Rate	$53.35
Rate for Payer: BCBS Commercial	$42.42
Rate for Payer: Cash Price	$41.25
Rate for Payer: Cash Price	$41.25
Rate for Payer: Celtic Commercial/Exchange	$25.41
Rate for Payer: Health Partners Plans Commercial	$52.25
Rate for Payer: UnitedHealthcare Commercial	$53.35
Rate for Payer: WPPA Commercial	$46.20

MASSAGE/VIBRA/PERCUS INITIAL

Facility

$183.00

Service Code	HCPCS 94667 59
Hospital Charge Code	9466700
Hospital Revenue Code	410
Min. Negotiated Rate	$150.06
Max. Negotiated Rate	$177.51
Rate for Payer: Cash Price	$137.25
Rate for Payer: Health Partners Plans Commercial	$173.85
Rate for Payer: UnitedHealthcare Commercial	$177.51
Rate for Payer: WPPA Commercial	$150.06

Know your out-of-pocket cost for care.

All Charges