Ness County Hospital

All Charges

Charge

Type

Setting

Price

C-SPINE COMPLETE 6 OR MORE

Facility

$350.00

Service Code	HCPCS 72052
Hospital Charge Code	7205200
Hospital Revenue Code	320
Min. Negotiated Rate	$161.70
Max. Negotiated Rate	$339.50
Rate for Payer: BCBS Commercial	$271.33
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

CT 3D RECON W/INTERP OF CT

Facility

$350.00

Service Code	HCPCS 76376
Hospital Charge Code	7637600
Hospital Revenue Code	350
Min. Negotiated Rate	$161.70
Max. Negotiated Rate	$339.50
Rate for Payer: BCBS Commercial	$318.72
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

CT 3D RECON W/INTERP OF CT

Facility

$350.00

Service Code	HCPCS 76376
Hospital Charge Code	7637600
Hospital Revenue Code	350
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

CTA ABD/PEL with runoff

Facility

$4,189.00

Service Code	HCPCS 75635
Hospital Charge Code	7563500
Hospital Revenue Code	350
Min. Negotiated Rate	$3,434.98
Max. Negotiated Rate	$4,063.33
Rate for Payer: Cash Price	$3,141.75
Rate for Payer: Health Partners Plans Commercial	$3,979.55
Rate for Payer: UnitedHealthcare Commercial	$4,063.33
Rate for Payer: WPPA Commercial	$3,434.98

CTA ABD/PEL with runoff

Facility

$4,189.00

Service Code	HCPCS 75635
Hospital Charge Code	7563500
Hospital Revenue Code	350
Min. Negotiated Rate	$1,249.77
Max. Negotiated Rate	$4,063.33
Rate for Payer: BCBS Commercial	$1,249.77
Rate for Payer: Cash Price	$3,141.75
Rate for Payer: Cash Price	$3,141.75
Rate for Payer: Celtic Commercial/Exchange	$1,935.32
Rate for Payer: Health Partners Plans Commercial	$3,979.55
Rate for Payer: UnitedHealthcare Commercial	$4,063.33
Rate for Payer: WPPA Commercial	$3,518.76

CTA ABD/PEL W/O OR WITH CONTRA

Facility

$2,807.00

Service Code	HCPCS 74174
Hospital Charge Code	7417400
Hospital Revenue Code	350
Min. Negotiated Rate	$2,301.74
Max. Negotiated Rate	$2,722.79
Rate for Payer: Cash Price	$2,105.25
Rate for Payer: Health Partners Plans Commercial	$2,666.65
Rate for Payer: UnitedHealthcare Commercial	$2,722.79
Rate for Payer: WPPA Commercial	$2,301.74

CTA ABD/PEL W/O OR WITH CONTRA

Facility

$2,807.00

Service Code	HCPCS 74174
Hospital Charge Code	7417400
Hospital Revenue Code	350
Min. Negotiated Rate	$1,296.83
Max. Negotiated Rate	$2,722.79
Rate for Payer: BCBS Commercial	$1,704.15
Rate for Payer: Cash Price	$2,105.25
Rate for Payer: Cash Price	$2,105.25
Rate for Payer: Celtic Commercial/Exchange	$1,296.83
Rate for Payer: Health Partners Plans Commercial	$2,666.65
Rate for Payer: UnitedHealthcare Commercial	$2,722.79
Rate for Payer: WPPA Commercial	$2,357.88

CTA ABD WO OR WITH CONTRAST

Facility

$1,456.00

Service Code	HCPCS 74175
Hospital Charge Code	7417500
Hospital Revenue Code	350
Min. Negotiated Rate	$1,193.92
Max. Negotiated Rate	$1,412.32
Rate for Payer: Cash Price	$1,092.00
Rate for Payer: Health Partners Plans Commercial	$1,383.20
Rate for Payer: UnitedHealthcare Commercial	$1,412.32
Rate for Payer: WPPA Commercial	$1,193.92

CTA ABD WO OR WITH CONTRAST

Facility

$1,456.00

Service Code	HCPCS 74175
Hospital Charge Code	7417500
Hospital Revenue Code	350
Min. Negotiated Rate	$672.67
Max. Negotiated Rate	$1,412.32
Rate for Payer: BCBS Commercial	$1,186.59
Rate for Payer: Cash Price	$1,092.00
Rate for Payer: Cash Price	$1,092.00
Rate for Payer: Celtic Commercial/Exchange	$672.67
Rate for Payer: Health Partners Plans Commercial	$1,383.20
Rate for Payer: UnitedHealthcare Commercial	$1,412.32
Rate for Payer: WPPA Commercial	$1,223.04

CT ABD/PEL WITH CONTRAST

Facility

$3,102.00

Service Code	HCPCS 74177
Hospital Charge Code	7417700
Hospital Revenue Code	350
Min. Negotiated Rate	$2,543.64
Max. Negotiated Rate	$3,008.94
Rate for Payer: Cash Price	$2,326.50
Rate for Payer: Health Partners Plans Commercial	$2,946.90
Rate for Payer: UnitedHealthcare Commercial	$3,008.94
Rate for Payer: WPPA Commercial	$2,543.64

CT ABD/PEL WITH CONTRAST

Facility

$3,102.00

Service Code	HCPCS 74177
Hospital Charge Code	7417700
Hospital Revenue Code	350
Min. Negotiated Rate	$480.41
Max. Negotiated Rate	$3,008.94
Rate for Payer: BCBS Commercial	$480.41
Rate for Payer: Cash Price	$2,326.50
Rate for Payer: Cash Price	$2,326.50
Rate for Payer: Celtic Commercial/Exchange	$1,433.12
Rate for Payer: Health Partners Plans Commercial	$2,946.90
Rate for Payer: UnitedHealthcare Commercial	$3,008.94
Rate for Payer: WPPA Commercial	$2,605.68

CT ABD/PEL W/O CONTRAST

Facility

$2,196.00

Service Code	HCPCS 74176
Hospital Charge Code	7417600
Hospital Revenue Code	350
Min. Negotiated Rate	$480.41
Max. Negotiated Rate	$2,130.12
Rate for Payer: BCBS Commercial	$480.41
Rate for Payer: Cash Price	$1,647.00
Rate for Payer: Cash Price	$1,647.00
Rate for Payer: Celtic Commercial/Exchange	$1,014.55
Rate for Payer: Health Partners Plans Commercial	$2,086.20
Rate for Payer: UnitedHealthcare Commercial	$2,130.12
Rate for Payer: WPPA Commercial	$1,844.64

CT ABD/PEL W/O CONTRAST

Facility

$2,196.00

Service Code	HCPCS 74176
Hospital Charge Code	7417600
Hospital Revenue Code	350
Min. Negotiated Rate	$1,800.72
Max. Negotiated Rate	$2,130.12
Rate for Payer: Cash Price	$1,647.00
Rate for Payer: Health Partners Plans Commercial	$2,086.20
Rate for Payer: UnitedHealthcare Commercial	$2,130.12
Rate for Payer: WPPA Commercial	$1,800.72

CT ABD/PEL WO/W CONTRAST

Facility

$3,548.00

Service Code	HCPCS 74178
Hospital Charge Code	7417800
Hospital Revenue Code	350
Min. Negotiated Rate	$2,909.36
Max. Negotiated Rate	$3,441.56
Rate for Payer: Cash Price	$2,661.00
Rate for Payer: Health Partners Plans Commercial	$3,370.60
Rate for Payer: UnitedHealthcare Commercial	$3,441.56
Rate for Payer: WPPA Commercial	$2,909.36

CT ABD/PEL WO/W CONTRAST

Facility

$3,548.00

Service Code	HCPCS 74178
Hospital Charge Code	7417800
Hospital Revenue Code	350
Min. Negotiated Rate	$480.41
Max. Negotiated Rate	$3,441.56
Rate for Payer: BCBS Commercial	$480.41
Rate for Payer: Cash Price	$2,661.00
Rate for Payer: Cash Price	$2,661.00
Rate for Payer: Celtic Commercial/Exchange	$1,639.18
Rate for Payer: Health Partners Plans Commercial	$3,370.60
Rate for Payer: UnitedHealthcare Commercial	$3,441.56
Rate for Payer: WPPA Commercial	$2,980.32

CT ABD WITH CONTRAST

Facility

$1,877.00

Service Code	HCPCS 74160
Hospital Charge Code	3330006
Hospital Revenue Code	350
Min. Negotiated Rate	$1,539.14
Max. Negotiated Rate	$1,820.69
Rate for Payer: Cash Price	$1,407.75
Rate for Payer: Health Partners Plans Commercial	$1,783.15
Rate for Payer: UnitedHealthcare Commercial	$1,820.69
Rate for Payer: WPPA Commercial	$1,539.14

CT ABD WITH CONTRAST

Facility

$1,877.00

Service Code	HCPCS 74160
Hospital Charge Code	3330006
Hospital Revenue Code	350
Min. Negotiated Rate	$480.41
Max. Negotiated Rate	$1,820.69
Rate for Payer: BCBS Commercial	$480.41
Rate for Payer: Cash Price	$1,407.75
Rate for Payer: Cash Price	$1,407.75
Rate for Payer: Celtic Commercial/Exchange	$867.17
Rate for Payer: Health Partners Plans Commercial	$1,783.15
Rate for Payer: UnitedHealthcare Commercial	$1,820.69
Rate for Payer: WPPA Commercial	$1,576.68

CT ABD W/O CONTRAST

Facility

$1,589.00

Service Code	HCPCS 74150
Hospital Charge Code	3330004
Hospital Revenue Code	350
Min. Negotiated Rate	$1,302.98
Max. Negotiated Rate	$1,541.33
Rate for Payer: Cash Price	$1,191.75
Rate for Payer: Health Partners Plans Commercial	$1,509.55
Rate for Payer: UnitedHealthcare Commercial	$1,541.33
Rate for Payer: WPPA Commercial	$1,302.98

CT ABD W/O CONTRAST

Facility

$1,589.00

Service Code	HCPCS 74150
Hospital Charge Code	3330004
Hospital Revenue Code	350
Min. Negotiated Rate	$480.41
Max. Negotiated Rate	$1,541.33
Rate for Payer: BCBS Commercial	$480.41
Rate for Payer: Cash Price	$1,191.75
Rate for Payer: Cash Price	$1,191.75
Rate for Payer: Celtic Commercial/Exchange	$734.12
Rate for Payer: Health Partners Plans Commercial	$1,509.55
Rate for Payer: UnitedHealthcare Commercial	$1,541.33
Rate for Payer: WPPA Commercial	$1,334.76

CT ABD WO/O CONTRAST

Facility

$2,268.00

Service Code	HCPCS 74170
Hospital Charge Code	3330002
Hospital Revenue Code	350
Min. Negotiated Rate	$480.41
Max. Negotiated Rate	$2,199.96
Rate for Payer: BCBS Commercial	$480.41
Rate for Payer: Cash Price	$1,701.00
Rate for Payer: Cash Price	$1,701.00
Rate for Payer: Celtic Commercial/Exchange	$1,047.82
Rate for Payer: Health Partners Plans Commercial	$2,154.60
Rate for Payer: UnitedHealthcare Commercial	$2,199.96
Rate for Payer: WPPA Commercial	$1,905.12

CT ABD WO/O CONTRAST

Facility

$2,268.00

Service Code	HCPCS 74170
Hospital Charge Code	3330002
Hospital Revenue Code	350
Min. Negotiated Rate	$1,859.76
Max. Negotiated Rate	$2,199.96
Rate for Payer: Cash Price	$1,701.00
Rate for Payer: Health Partners Plans Commercial	$2,154.60
Rate for Payer: UnitedHealthcare Commercial	$2,199.96
Rate for Payer: WPPA Commercial	$1,859.76

CTA CHEST W/O OR WITH CONTRAST

Facility

$2,723.00

Service Code	HCPCS 71275
Hospital Charge Code	3330082
Hospital Revenue Code	350
Min. Negotiated Rate	$1,143.85
Max. Negotiated Rate	$2,641.31
Rate for Payer: BCBS Commercial	$1,143.85
Rate for Payer: Cash Price	$2,042.25
Rate for Payer: Cash Price	$2,042.25
Rate for Payer: Celtic Commercial/Exchange	$1,258.03
Rate for Payer: Health Partners Plans Commercial	$2,586.85
Rate for Payer: UnitedHealthcare Commercial	$2,641.31
Rate for Payer: WPPA Commercial	$2,287.32

CTA CHEST W/O OR WITH CONTRAST

Facility

$2,723.00

Service Code	HCPCS 71275
Hospital Charge Code	3330082
Hospital Revenue Code	350
Min. Negotiated Rate	$2,232.86
Max. Negotiated Rate	$2,641.31
Rate for Payer: Cash Price	$2,042.25
Rate for Payer: Health Partners Plans Commercial	$2,586.85
Rate for Payer: UnitedHealthcare Commercial	$2,641.31
Rate for Payer: WPPA Commercial	$2,232.86

CTA HEAD (COW) W OR W/O

Facility

$2,641.00

Service Code	HCPCS 70496
Hospital Charge Code	7049600
Hospital Revenue Code	350
Min. Negotiated Rate	$1,158.71
Max. Negotiated Rate	$2,561.77
Rate for Payer: BCBS Commercial	$1,158.71
Rate for Payer: Cash Price	$1,980.75
Rate for Payer: Cash Price	$1,980.75
Rate for Payer: Celtic Commercial/Exchange	$1,220.14
Rate for Payer: Health Partners Plans Commercial	$2,508.95
Rate for Payer: UnitedHealthcare Commercial	$2,561.77
Rate for Payer: WPPA Commercial	$2,218.44

CTA HEAD (COW) W OR W/O

Facility

$2,641.00

Service Code	HCPCS 70496
Hospital Charge Code	7049600
Hospital Revenue Code	350
Min. Negotiated Rate	$2,165.62
Max. Negotiated Rate	$2,561.77
Rate for Payer: Cash Price	$1,980.75
Rate for Payer: Health Partners Plans Commercial	$2,508.95
Rate for Payer: UnitedHealthcare Commercial	$2,561.77
Rate for Payer: WPPA Commercial	$2,165.62

Know your out-of-pocket cost for care.

All Charges