Ness County Hospital

All Charges

Charge

Type

Setting

Price

SPEECH EVAL,SND PROD,PHONOLOG,

Facility

$350.00

Service Code	HCPCS 92522 GN
Hospital Charge Code	9252200
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,SND PROD,PHONOLOG,

Facility

$350.00

Service Code	HCPCS 92522 GN
Hospital Charge Code	9252200
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 THER (AEGIS) EA 1/4 HR

Facility

$46.00

Service Code	HCPCS G0153
Hospital Charge Code	4408822
Hospital Revenue Code	441
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

SPEECH THER (AEGIS) EA 1/4 HR

Facility

$46.00

Service Code	HCPCS G0153
Hospital Charge Code	4408822
Hospital Revenue Code	441
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

SPEECH THERAPY

Facility

$350.00

Service Code	HCPCS 92507 GN
Hospital Charge Code	9250705
Hospital Revenue Code	441
Min. Negotiated Rate	$77.77
Max. Negotiated Rate	$339.50
Rate for Payer: BCBS Commercial	$77.77
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 THERAPY

Facility

$350.00

Service Code	HCPCS 92507 GN
Hospital Charge Code	9250705
Hospital Revenue Code	441
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 THERAPY BY ST (AEGIS)

Facility

$185.00

Service Code	HCPCS G0153
Hospital Charge Code	4408855
Hospital Revenue Code	441
Min. Negotiated Rate	$85.47
Max. Negotiated Rate	$179.45
Rate for Payer: Cash Price	$138.75
Rate for Payer: Celtic Commercial/Exchange	$85.47
Rate for Payer: Health Partners Plans Commercial	$175.75
Rate for Payer: UnitedHealthcare Commercial	$179.45
Rate for Payer: WPPA Commercial	$155.40

SPEECH THERAPY BY ST (AEGIS)

Facility

$185.00

Service Code	HCPCS G0153
Hospital Charge Code	4408855
Hospital Revenue Code	441
Min. Negotiated Rate	$151.70
Max. Negotiated Rate	$179.45
Rate for Payer: Cash Price	$138.75
Rate for Payer: Health Partners Plans Commercial	$175.75
Rate for Payer: UnitedHealthcare Commercial	$179.45
Rate for Payer: WPPA Commercial	$151.70

SPEECH THER EVAL (AEGIS)

Facility

$197.00

Service Code	HCPCS G0153
Hospital Charge Code	4408866
Hospital Revenue Code	441
Min. Negotiated Rate	$161.54
Max. Negotiated Rate	$191.09
Rate for Payer: Cash Price	$147.75
Rate for Payer: Health Partners Plans Commercial	$187.15
Rate for Payer: UnitedHealthcare Commercial	$191.09
Rate for Payer: WPPA Commercial	$161.54

SPEECH THER EVAL (AEGIS)

Facility

$197.00

Service Code	HCPCS G0153
Hospital Charge Code	4408866
Hospital Revenue Code	441
Min. Negotiated Rate	$91.01
Max. Negotiated Rate	$191.09
Rate for Payer: Cash Price	$147.75
Rate for Payer: Celtic Commercial/Exchange	$91.01
Rate for Payer: Health Partners Plans Commercial	$187.15
Rate for Payer: UnitedHealthcare Commercial	$191.09
Rate for Payer: WPPA Commercial	$165.48

SPINAL DISORDERS AND INJURIES WITH CC/MCC

Facility

$16,618.95

Service Code	MSDRG 052
Min. Negotiated Rate	$16,618.95
Max. Negotiated Rate	$16,618.95
Rate for Payer: BCBS Commercial	$16,618.95

SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC

Facility

$9,920.12

Service Code	MSDRG 053
Min. Negotiated Rate	$9,920.12
Max. Negotiated Rate	$9,920.12
Rate for Payer: BCBS Commercial	$9,920.12

SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH CC

Facility

$53,732.20

Service Code	MSDRG 457
Min. Negotiated Rate	$53,732.20
Max. Negotiated Rate	$53,732.20
Rate for Payer: BCBS Commercial	$53,732.20

SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH MCC

Facility

$76,329.38

Service Code	MSDRG 456
Min. Negotiated Rate	$76,329.38
Max. Negotiated Rate	$76,329.38
Rate for Payer: BCBS Commercial	$76,329.38

SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITHOUT CC/MCC

Facility

$40,945.95

Service Code	MSDRG 458
Min. Negotiated Rate	$40,945.95
Max. Negotiated Rate	$40,945.95
Rate for Payer: BCBS Commercial	$40,945.95

SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS

Facility

$29,260.79

Service Code	MSDRG 029
Min. Negotiated Rate	$29,260.79
Max. Negotiated Rate	$29,260.79
Rate for Payer: BCBS Commercial	$29,260.79

SPINAL PROCEDURES WITH MCC

Facility

$52,211.37

Service Code	MSDRG 028
Min. Negotiated Rate	$52,211.37
Max. Negotiated Rate	$52,211.37
Rate for Payer: BCBS Commercial	$52,211.37

SPINAL PROCEDURES WITHOUT CC/MCC

Facility

$20,917.79

Service Code	MSDRG 030
Min. Negotiated Rate	$20,917.79
Max. Negotiated Rate	$20,917.79
Rate for Payer: BCBS Commercial	$20,917.79

SPINE 1 VIEW ANY LEVEL

Facility

$225.00

Service Code	HCPCS 72020
Hospital Charge Code	3272020
Hospital Revenue Code	320
Min. Negotiated Rate	$184.50
Max. Negotiated Rate	$218.25
Rate for Payer: Cash Price	$168.75
Rate for Payer: Health Partners Plans Commercial	$213.75
Rate for Payer: UnitedHealthcare Commercial	$218.25
Rate for Payer: WPPA Commercial	$184.50

SPINE 1 VIEW ANY LEVEL

Facility

$225.00

Service Code	HCPCS 72020
Hospital Charge Code	3272020
Hospital Revenue Code	320
Min. Negotiated Rate	$103.95
Max. Negotiated Rate	$218.25
Rate for Payer: BCBS Commercial	$170.97
Rate for Payer: Cash Price	$168.75
Rate for Payer: Cash Price	$168.75
Rate for Payer: Celtic Commercial/Exchange	$103.95
Rate for Payer: Health Partners Plans Commercial	$213.75
Rate for Payer: UnitedHealthcare Commercial	$218.25
Rate for Payer: WPPA Commercial	$189.00

Spiriva with HandiHaler (tiotropium bromide)#5 caps

Facility

$340.00

Service Code	NDC 00597007575
Hospital Charge Code	2508943
Hospital Revenue Code	250
Min. Negotiated Rate	$278.80
Max. Negotiated Rate	$329.80
Rate for Payer: Cash Price	$255.60
Rate for Payer: Health Partners Plans Commercial	$323.00
Rate for Payer: UnitedHealthcare Commercial	$329.80
Rate for Payer: WPPA Commercial	$278.80

Spiriva with HandiHaler (tiotropium bromide)#5 caps

Facility

$340.00

Service Code	NDC 00597007575
Hospital Charge Code	2508943
Hospital Revenue Code	250
Min. Negotiated Rate	$157.08
Max. Negotiated Rate	$329.80
Rate for Payer: Cash Price	$255.60
Rate for Payer: Celtic Commercial/Exchange	$157.08
Rate for Payer: Health Partners Plans Commercial	$323.00
Rate for Payer: UnitedHealthcare Commercial	$329.80
Rate for Payer: WPPA Commercial	$285.60

SPIROMETRY TEST

Facility

$387.00

Service Code	HCPCS 94010 59
Hospital Charge Code	9401000
Hospital Revenue Code	410
Min. Negotiated Rate	$317.34
Max. Negotiated Rate	$375.39
Rate for Payer: Cash Price	$290.25
Rate for Payer: Health Partners Plans Commercial	$367.65
Rate for Payer: UnitedHealthcare Commercial	$375.39
Rate for Payer: WPPA Commercial	$317.34

SPIROMETRY TEST

Facility

$387.00

Service Code	HCPCS 94010 59
Hospital Charge Code	9401000
Hospital Revenue Code	410
Min. Negotiated Rate	$178.79
Max. Negotiated Rate	$375.39
Rate for Payer: BCBS Commercial	$300.98
Rate for Payer: Cash Price	$290.25
Rate for Payer: Cash Price	$290.25
Rate for Payer: Celtic Commercial/Exchange	$178.79
Rate for Payer: Health Partners Plans Commercial	$367.65
Rate for Payer: UnitedHealthcare Commercial	$375.39
Rate for Payer: WPPA Commercial	$325.08

SPLENIC PROCEDURES WITH CC

Facility

$24,782.76

Service Code	MSDRG 800
Min. Negotiated Rate	$24,782.76
Max. Negotiated Rate	$24,782.76
Rate for Payer: BCBS Commercial	$24,782.76

Know your out-of-pocket cost for care.

All Charges