Ness County Hospital

All Charges

Charge

Type

Setting

Price

SORBAVIEW SHIELD

Facility

$9.00

Hospital Charge Code	2725044
Hospital Revenue Code	270
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$6.75
Rate for Payer: Celtic Commercial/Exchange	$4.16
Rate for Payer: Health Partners Plans Commercial	$8.55
Rate for Payer: UnitedHealthcare Commercial	$8.73
Rate for Payer: WPPA Commercial	$7.56

SPACER¨C FOR INHALER- INSPIREASE

Facility

$88.00

Service Code	NDC 00085460202
Hospital Charge Code	2512333
Hospital Revenue Code	270
Min. Negotiated Rate	$72.16
Max. Negotiated Rate	$85.36
Rate for Payer: Cash Price	$66.49
Rate for Payer: Health Partners Plans Commercial	$83.60
Rate for Payer: UnitedHealthcare Commercial	$85.36
Rate for Payer: WPPA Commercial	$72.16

SPACER¨C FOR INHALER- INSPIREASE

Facility

$88.00

Service Code	NDC 00085460202
Hospital Charge Code	2512333
Hospital Revenue Code	270
Min. Negotiated Rate	$40.66
Max. Negotiated Rate	$85.36
Rate for Payer: Cash Price	$66.49
Rate for Payer: Celtic Commercial/Exchange	$40.66
Rate for Payer: Health Partners Plans Commercial	$83.60
Rate for Payer: UnitedHealthcare Commercial	$85.36
Rate for Payer: WPPA Commercial	$73.92

SPACER FOR INHALERS-ELLIPSE

Facility

$27.00

Hospital Charge Code	2515914
Hospital Revenue Code	270
Min. Negotiated Rate	$12.47
Max. Negotiated Rate	$26.19
Rate for Payer: Cash Price	$20.81
Rate for Payer: Celtic Commercial/Exchange	$12.47
Rate for Payer: Health Partners Plans Commercial	$25.65
Rate for Payer: UnitedHealthcare Commercial	$26.19
Rate for Payer: WPPA Commercial	$22.68

SPACER FOR INHALERS-ELLIPSE

Facility

$27.00

Hospital Charge Code	2515914
Hospital Revenue Code	270
Min. Negotiated Rate	$22.14
Max. Negotiated Rate	$26.19
Rate for Payer: Cash Price	$20.81
Rate for Payer: Health Partners Plans Commercial	$25.65
Rate for Payer: UnitedHealthcare Commercial	$26.19
Rate for Payer: WPPA Commercial	$22.14

SPANDAGE 10" SIZE

Facility

$3.00

Hospital Charge Code	2702264
Hospital Revenue Code	270
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.70
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

SPANDAGE 10" SIZE

Facility

$3.00

Hospital Charge Code	2702264
Hospital Revenue Code	270
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.70
Rate for Payer: Health Partners Plans Commercial	$2.85
Rate for Payer: UnitedHealthcare Commercial	$2.91
Rate for Payer: WPPA Commercial	$2.46

SPECIAL STAINS-GROUP I, MICRO-

Facility

$120.00

Service Code	HCPCS 88312
Hospital Charge Code	8831200
Hospital Revenue Code	310
Min. Negotiated Rate	$55.44
Max. Negotiated Rate	$116.40
Rate for Payer: BCBS Commercial	$77.68
Rate for Payer: Cash Price	$90.00
Rate for Payer: Cash Price	$90.00
Rate for Payer: Celtic Commercial/Exchange	$55.44
Rate for Payer: Health Partners Plans Commercial	$114.00
Rate for Payer: UnitedHealthcare Commercial	$116.40
Rate for Payer: WPPA Commercial	$100.80

SPECIAL STAINS-GROUP I, MICRO-

Facility

$120.00

Service Code	HCPCS 88312
Hospital Charge Code	8831200
Hospital Revenue Code	310
Min. Negotiated Rate	$98.40
Max. Negotiated Rate	$116.40
Rate for Payer: Cash Price	$90.00
Rate for Payer: Health Partners Plans Commercial	$114.00
Rate for Payer: UnitedHealthcare Commercial	$116.40
Rate for Payer: WPPA Commercial	$98.40

SPECIPAN

Facility

$12.00

Hospital Charge Code	2700938LTC
Hospital Revenue Code	270
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$11.64
Rate for Payer: Cash Price	$9.00
Rate for Payer: Celtic Commercial/Exchange	$5.54
Rate for Payer: Health Partners Plans Commercial	$11.40
Rate for Payer: UnitedHealthcare Commercial	$11.64
Rate for Payer: WPPA Commercial	$10.08

SPECIPAN

Facility

$12.00

Hospital Charge Code	2700938LTC
Hospital Revenue Code	270
Min. Negotiated Rate	$9.84
Max. Negotiated Rate	$11.64
Rate for Payer: Cash Price	$9.00
Rate for Payer: Health Partners Plans Commercial	$11.40
Rate for Payer: UnitedHealthcare Commercial	$11.64
Rate for Payer: WPPA Commercial	$9.84

SPECIPANS

Facility

$12.00

Hospital Charge Code	2700938
Hospital Revenue Code	270
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$11.64
Rate for Payer: Cash Price	$9.00
Rate for Payer: Celtic Commercial/Exchange	$5.54
Rate for Payer: Health Partners Plans Commercial	$11.40
Rate for Payer: UnitedHealthcare Commercial	$11.64
Rate for Payer: WPPA Commercial	$10.08

SPECIPANS

Facility

$12.00

Hospital Charge Code	2700938
Hospital Revenue Code	270
Min. Negotiated Rate	$9.84
Max. Negotiated Rate	$11.64
Rate for Payer: Cash Price	$9.00
Rate for Payer: Health Partners Plans Commercial	$11.40
Rate for Payer: UnitedHealthcare Commercial	$11.64
Rate for Payer: WPPA Commercial	$9.84

SPEC.STAINS, GROUP II, OTHERS

Facility

$86.00

Service Code	HCPCS 88313
Hospital Charge Code	8831300
Hospital Revenue Code	310
Min. Negotiated Rate	$39.73
Max. Negotiated Rate	$83.42
Rate for Payer: BCBS Commercial	$60.30
Rate for Payer: Cash Price	$64.50
Rate for Payer: Cash Price	$64.50
Rate for Payer: Celtic Commercial/Exchange	$39.73
Rate for Payer: Health Partners Plans Commercial	$81.70
Rate for Payer: UnitedHealthcare Commercial	$83.42
Rate for Payer: WPPA Commercial	$72.24

SPEC.STAINS, GROUP II, OTHERS

Facility

$86.00

Service Code	HCPCS 88313
Hospital Charge Code	8831300
Hospital Revenue Code	310
Min. Negotiated Rate	$70.52
Max. Negotiated Rate	$83.42
Rate for Payer: Cash Price	$64.50
Rate for Payer: Health Partners Plans Commercial	$81.70
Rate for Payer: UnitedHealthcare Commercial	$83.42
Rate for Payer: WPPA Commercial	$70.52

SPECULA LIGHTED, MEDIUM

Facility

$11.00

Hospital Charge Code	2700939
Hospital Revenue Code	272
Min. Negotiated Rate	$9.02
Max. Negotiated Rate	$10.67
Rate for Payer: Cash Price	$8.25
Rate for Payer: Health Partners Plans Commercial	$10.45
Rate for Payer: UnitedHealthcare Commercial	$10.67
Rate for Payer: WPPA Commercial	$9.02

SPECULA LIGHTED, MEDIUM

Facility

$11.00

Hospital Charge Code	2700939
Hospital Revenue Code	272
Min. Negotiated Rate	$5.08
Max. Negotiated Rate	$10.67
Rate for Payer: Cash Price	$8.25
Rate for Payer: Celtic Commercial/Exchange	$5.08
Rate for Payer: Health Partners Plans Commercial	$10.45
Rate for Payer: UnitedHealthcare Commercial	$10.67
Rate for Payer: WPPA Commercial	$9.24

SPEECH EVAL (AEGIS) 1/4 HR

Facility

$49.00

Service Code	HCPCS G0153
Hospital Charge Code	4408811
Hospital Revenue Code	441
Min. Negotiated Rate	$40.18
Max. Negotiated Rate	$47.53
Rate for Payer: Cash Price	$36.94
Rate for Payer: Health Partners Plans Commercial	$46.55
Rate for Payer: UnitedHealthcare Commercial	$47.53
Rate for Payer: WPPA Commercial	$40.18

SPEECH EVAL (AEGIS) 1/4 HR

Facility

$49.00

Service Code	HCPCS G0153
Hospital Charge Code	4408811
Hospital Revenue Code	441
Min. Negotiated Rate	$22.64
Max. Negotiated Rate	$47.53
Rate for Payer: Cash Price	$36.94
Rate for Payer: Celtic Commercial/Exchange	$22.64
Rate for Payer: Health Partners Plans Commercial	$46.55
Rate for Payer: UnitedHealthcare Commercial	$47.53
Rate for Payer: WPPA Commercial	$41.16

SPEECH EVAL BEHAV/QUAL ANALYS

Facility

$350.00

Service Code	HCPCS 92524 GN
Hospital Charge Code	9252400
Hospital Revenue Code	444
Min. Negotiated Rate	$287.00
Max. Negotiated Rate	$339.50
Rate for Payer: Cash Price	$262.50
Rate for Payer: Health Partners Plans Commercial	$332.50
Rate for Payer: UnitedHealthcare Commercial	$339.50
Rate for Payer: WPPA Commercial	$287.00

SPEECH EVAL BEHAV/QUAL ANALYS

Facility

$350.00

Service Code	HCPCS 92524 GN
Hospital Charge Code	9252400
Hospital Revenue Code	444
Min. Negotiated Rate	$116.15
Max. Negotiated Rate	$339.50
Rate for Payer: BCBS Commercial	$116.15
Rate for Payer: Cash Price	$262.50
Rate for Payer: Cash Price	$262.50
Rate for Payer: Celtic Commercial/Exchange	$161.70
Rate for Payer: Health Partners Plans Commercial	$332.50
Rate for Payer: UnitedHealthcare Commercial	$339.50
Rate for Payer: WPPA Commercial	$294.00

SPEECH EVAL-COGNITIVE/RECEPTIV

Facility

$350.00

Service Code	HCPCS 92523 GN
Hospital Charge Code	9252300
Hospital Revenue Code	444
Min. Negotiated Rate	$287.00
Max. Negotiated Rate	$339.50
Rate for Payer: Cash Price	$262.50
Rate for Payer: Health Partners Plans Commercial	$332.50
Rate for Payer: UnitedHealthcare Commercial	$339.50
Rate for Payer: WPPA Commercial	$287.00

SPEECH EVAL-COGNITIVE/RECEPTIV

Facility

$350.00

Service Code	HCPCS 92523 GN
Hospital Charge Code	9252300
Hospital Revenue Code	444
Min. Negotiated Rate	$116.15
Max. Negotiated Rate	$339.50
Rate for Payer: BCBS Commercial	$116.15
Rate for Payer: Cash Price	$262.50
Rate for Payer: Cash Price	$262.50
Rate for Payer: Celtic Commercial/Exchange	$161.70
Rate for Payer: Health Partners Plans Commercial	$332.50
Rate for Payer: UnitedHealthcare Commercial	$339.50
Rate for Payer: WPPA Commercial	$294.00

SPEECH EVAL,FLUENCY,STUTTER,

Facility

$350.00

Service Code	HCPCS 92521 GN
Hospital Charge Code	9252100
Hospital Revenue Code	444
Min. Negotiated Rate	$287.00
Max. Negotiated Rate	$339.50
Rate for Payer: Cash Price	$262.50
Rate for Payer: Health Partners Plans Commercial	$332.50
Rate for Payer: UnitedHealthcare Commercial	$339.50
Rate for Payer: WPPA Commercial	$287.00

SPEECH EVAL,FLUENCY,STUTTER,

Facility

$350.00

Service Code	HCPCS 92521 GN
Hospital Charge Code	9252100
Hospital Revenue Code	444
Min. Negotiated Rate	$116.15
Max. Negotiated Rate	$339.50
Rate for Payer: BCBS Commercial	$116.15
Rate for Payer: Cash Price	$262.50
Rate for Payer: Cash Price	$262.50
Rate for Payer: Celtic Commercial/Exchange	$161.70
Rate for Payer: Health Partners Plans Commercial	$332.50
Rate for Payer: UnitedHealthcare Commercial	$339.50
Rate for Payer: WPPA Commercial	$294.00

Know your out-of-pocket cost for care.

All Charges