Ness County Hospital

All Charges

Charge

Type

Setting

Price

PT-PROSTHETIC TRAINING

Facility

$102.00

Service Code	HCPCS 97761 GP
Hospital Charge Code	9776101
Hospital Revenue Code	420
Min. Negotiated Rate	$47.12
Max. Negotiated Rate	$98.94
Rate for Payer: BCBS Commercial	$50.50
Rate for Payer: Cash Price	$76.50
Rate for Payer: Cash Price	$76.50
Rate for Payer: Celtic Commercial/Exchange	$47.12
Rate for Payer: Health Partners Plans Commercial	$96.90
Rate for Payer: UnitedHealthcare Commercial	$98.94
Rate for Payer: WPPA Commercial	$85.68

PT-PROSTHETIC TRAINING

Facility

$102.00

Service Code	HCPCS 97761 GP
Hospital Charge Code	9776101
Hospital Revenue Code	420
Min. Negotiated Rate	$83.64
Max. Negotiated Rate	$98.94
Rate for Payer: Cash Price	$76.50
Rate for Payer: Health Partners Plans Commercial	$96.90
Rate for Payer: UnitedHealthcare Commercial	$98.94
Rate for Payer: WPPA Commercial	$83.64

PT RE-EVAL EST PLAN OF CARE

Facility

$135.00

Service Code	HCPCS 97164 GP
Hospital Charge Code	9716400
Hospital Revenue Code	424
Min. Negotiated Rate	$62.37
Max. Negotiated Rate	$130.95
Rate for Payer: BCBS Commercial	$81.34
Rate for Payer: Cash Price	$101.25
Rate for Payer: Cash Price	$101.25
Rate for Payer: Celtic Commercial/Exchange	$62.37
Rate for Payer: Health Partners Plans Commercial	$128.25
Rate for Payer: UnitedHealthcare Commercial	$130.95
Rate for Payer: WPPA Commercial	$113.40

PT RE-EVAL EST PLAN OF CARE

Facility

$135.00

Service Code	HCPCS 97164 GP
Hospital Charge Code	9716400
Hospital Revenue Code	424
Min. Negotiated Rate	$110.70
Max. Negotiated Rate	$130.95
Rate for Payer: Cash Price	$101.25
Rate for Payer: Health Partners Plans Commercial	$128.25
Rate for Payer: UnitedHealthcare Commercial	$130.95
Rate for Payer: WPPA Commercial	$110.70

P T TRACTION PELVIC

Facility

$91.00

Service Code	HCPCS 97012 GP
Hospital Charge Code	4200929
Hospital Revenue Code	420
Min. Negotiated Rate	$36.36
Max. Negotiated Rate	$88.27
Rate for Payer: BCBS Commercial	$36.36
Rate for Payer: Cash Price	$68.25
Rate for Payer: Cash Price	$68.25
Rate for Payer: Celtic Commercial/Exchange	$42.04
Rate for Payer: Health Partners Plans Commercial	$86.45
Rate for Payer: UnitedHealthcare Commercial	$88.27
Rate for Payer: WPPA Commercial	$76.44

P T TRACTION PELVIC

Facility

$91.00

Service Code	HCPCS 97012 GP
Hospital Charge Code	4200929
Hospital Revenue Code	420
Min. Negotiated Rate	$74.62
Max. Negotiated Rate	$88.27
Rate for Payer: Cash Price	$68.25
Rate for Payer: Health Partners Plans Commercial	$86.45
Rate for Payer: UnitedHealthcare Commercial	$88.27
Rate for Payer: WPPA Commercial	$74.62

PT TX BY PTA (AEGIS) EA 1/4 HR

Facility

$45.00

Service Code	HCPCS G0157
Hospital Charge Code	4209955
Hospital Revenue Code	421
Min. Negotiated Rate	$36.90
Max. Negotiated Rate	$43.65
Rate for Payer: Cash Price	$33.75
Rate for Payer: Health Partners Plans Commercial	$42.75
Rate for Payer: UnitedHealthcare Commercial	$43.65
Rate for Payer: WPPA Commercial	$36.90

PT TX BY PTA (AEGIS) EA 1/4 HR

Facility

$45.00

Service Code	HCPCS G0157
Hospital Charge Code	4209955
Hospital Revenue Code	421
Min. Negotiated Rate	$20.79
Max. Negotiated Rate	$43.65
Rate for Payer: Cash Price	$33.75
Rate for Payer: Celtic Commercial/Exchange	$20.79
Rate for Payer: Health Partners Plans Commercial	$42.75
Rate for Payer: UnitedHealthcare Commercial	$43.65
Rate for Payer: WPPA Commercial	$37.80

PT TX BY PT (AEGIS) EA 1/4 HR

Facility

$46.00

Service Code	HCPCS G0151
Hospital Charge Code	4209900
Hospital Revenue Code	421
Min. Negotiated Rate	$21.25
Max. Negotiated Rate	$44.62
Rate for Payer: Cash Price	$34.69
Rate for Payer: Celtic Commercial/Exchange	$21.25
Rate for Payer: Health Partners Plans Commercial	$43.70
Rate for Payer: UnitedHealthcare Commercial	$44.62
Rate for Payer: WPPA Commercial	$38.64

PT TX BY PT (AEGIS) EA 1/4 HR

Facility

$46.00

Service Code	HCPCS G0151
Hospital Charge Code	4209900
Hospital Revenue Code	421
Min. Negotiated Rate	$37.72
Max. Negotiated Rate	$44.62
Rate for Payer: Cash Price	$34.69
Rate for Payer: Health Partners Plans Commercial	$43.70
Rate for Payer: UnitedHealthcare Commercial	$44.62
Rate for Payer: WPPA Commercial	$37.72

PULL UP

Facility

$14.00

Hospital Charge Code	2706721ISB
Hospital Revenue Code	270
Min. Negotiated Rate	$11.48
Max. Negotiated Rate	$13.58
Rate for Payer: Cash Price	$10.88
Rate for Payer: Health Partners Plans Commercial	$13.30
Rate for Payer: UnitedHealthcare Commercial	$13.58
Rate for Payer: WPPA Commercial	$11.48

PULL UP

Facility

$14.00

Hospital Charge Code	2706721ISB
Hospital Revenue Code	270
Min. Negotiated Rate	$6.47
Max. Negotiated Rate	$13.58
Rate for Payer: Cash Price	$10.88
Rate for Payer: Celtic Commercial/Exchange	$6.47
Rate for Payer: Health Partners Plans Commercial	$13.30
Rate for Payer: UnitedHealthcare Commercial	$13.58
Rate for Payer: WPPA Commercial	$11.76

PULL UP

Facility

$14.00

Hospital Charge Code	2706721
Hospital Revenue Code	990
Min. Negotiated Rate	$6.47
Max. Negotiated Rate	$13.58
Rate for Payer: Cash Price	$10.88
Rate for Payer: Celtic Commercial/Exchange	$6.47
Rate for Payer: Health Partners Plans Commercial	$13.30
Rate for Payer: UnitedHealthcare Commercial	$13.58
Rate for Payer: WPPA Commercial	$11.76

PULL UP

Facility

$14.00

Hospital Charge Code	2706721
Hospital Revenue Code	990
Min. Negotiated Rate	$11.48
Max. Negotiated Rate	$13.58
Rate for Payer: Cash Price	$10.88
Rate for Payer: Health Partners Plans Commercial	$13.30
Rate for Payer: UnitedHealthcare Commercial	$13.58
Rate for Payer: WPPA Commercial	$11.48

PULL UP L

Facility

$14.00

Hospital Charge Code	2706722LTC
Hospital Revenue Code	270
Min. Negotiated Rate	$6.47
Max. Negotiated Rate	$13.58
Rate for Payer: Cash Price	$10.88
Rate for Payer: Celtic Commercial/Exchange	$6.47
Rate for Payer: Health Partners Plans Commercial	$13.30
Rate for Payer: UnitedHealthcare Commercial	$13.58
Rate for Payer: WPPA Commercial	$11.76

PULL UP L

Facility

$14.00

Hospital Charge Code	2706722LTC
Hospital Revenue Code	270
Min. Negotiated Rate	$11.48
Max. Negotiated Rate	$13.58
Rate for Payer: Cash Price	$10.88
Rate for Payer: Health Partners Plans Commercial	$13.30
Rate for Payer: UnitedHealthcare Commercial	$13.58
Rate for Payer: WPPA Commercial	$11.48

PULL UP M

Facility

$14.00

Hospital Charge Code	2706721LTC
Hospital Revenue Code	272
Min. Negotiated Rate	$6.47
Max. Negotiated Rate	$13.58
Rate for Payer: Cash Price	$10.88
Rate for Payer: Celtic Commercial/Exchange	$6.47
Rate for Payer: Health Partners Plans Commercial	$13.30
Rate for Payer: UnitedHealthcare Commercial	$13.58
Rate for Payer: WPPA Commercial	$11.76

PULL UP M

Facility

$14.00

Hospital Charge Code	2706721LTC
Hospital Revenue Code	272
Min. Negotiated Rate	$11.48
Max. Negotiated Rate	$13.58
Rate for Payer: Cash Price	$10.88
Rate for Payer: Health Partners Plans Commercial	$13.30
Rate for Payer: UnitedHealthcare Commercial	$13.58
Rate for Payer: WPPA Commercial	$11.48

PULL-UPS

Facility

$14.00

Hospital Charge Code	2706722
Hospital Revenue Code	270
Min. Negotiated Rate	$6.47
Max. Negotiated Rate	$13.58
Rate for Payer: Cash Price	$10.88
Rate for Payer: Celtic Commercial/Exchange	$6.47
Rate for Payer: Health Partners Plans Commercial	$13.30
Rate for Payer: UnitedHealthcare Commercial	$13.58
Rate for Payer: WPPA Commercial	$11.76

PULL-UPS

Facility

$14.00

Hospital Charge Code	2706722
Hospital Revenue Code	270
Min. Negotiated Rate	$11.48
Max. Negotiated Rate	$13.58
Rate for Payer: Cash Price	$10.88
Rate for Payer: Health Partners Plans Commercial	$13.30
Rate for Payer: UnitedHealthcare Commercial	$13.58
Rate for Payer: WPPA Commercial	$11.48

PULL UPS XLG

Facility

$14.00

Hospital Charge Code	2706720
Hospital Revenue Code	990
Min. Negotiated Rate	$11.48
Max. Negotiated Rate	$13.58
Rate for Payer: Cash Price	$10.88
Rate for Payer: Health Partners Plans Commercial	$13.30
Rate for Payer: UnitedHealthcare Commercial	$13.58
Rate for Payer: WPPA Commercial	$11.48

PULL UPS XLG

Facility

$14.00

Hospital Charge Code	2706720
Hospital Revenue Code	990
Min. Negotiated Rate	$6.47
Max. Negotiated Rate	$13.58
Rate for Payer: Cash Price	$10.88
Rate for Payer: Celtic Commercial/Exchange	$6.47
Rate for Payer: Health Partners Plans Commercial	$13.30
Rate for Payer: UnitedHealthcare Commercial	$13.58
Rate for Payer: WPPA Commercial	$11.76

PULL UP XL

Facility

$14.00

Hospital Charge Code	2706720LTC
Hospital Revenue Code	272
Min. Negotiated Rate	$11.48
Max. Negotiated Rate	$13.58
Rate for Payer: Cash Price	$10.88
Rate for Payer: Health Partners Plans Commercial	$13.30
Rate for Payer: UnitedHealthcare Commercial	$13.58
Rate for Payer: WPPA Commercial	$11.48

PULL UP XL

Facility

$14.00

Hospital Charge Code	2706720LTC
Hospital Revenue Code	272
Min. Negotiated Rate	$6.47
Max. Negotiated Rate	$13.58
Rate for Payer: Cash Price	$10.88
Rate for Payer: Celtic Commercial/Exchange	$6.47
Rate for Payer: Health Partners Plans Commercial	$13.30
Rate for Payer: UnitedHealthcare Commercial	$13.58
Rate for Payer: WPPA Commercial	$11.76

PULMICORT 180 MCG FLEXHALER

Facility

$893.00

Service Code	NDC 00186091612
Hospital Charge Code	2519767
Hospital Revenue Code	250
Min. Negotiated Rate	$412.57
Max. Negotiated Rate	$866.21
Rate for Payer: Cash Price	$670.20
Rate for Payer: Celtic Commercial/Exchange	$412.57
Rate for Payer: Health Partners Plans Commercial	$848.35
Rate for Payer: UnitedHealthcare Commercial	$866.21
Rate for Payer: WPPA Commercial	$750.12

Know your out-of-pocket cost for care.

All Charges