Ness County Hospital

All Charges

Charge

Type

Setting

Price

CT LE WO/W CONTRAST

Facility

$1,900.00

Service Code	HCPCS 73702
Hospital Charge Code	3330022
Hospital Revenue Code	350
Min. Negotiated Rate	$1,558.00
Max. Negotiated Rate	$1,843.00
Rate for Payer: Cash Price	$1,425.00
Rate for Payer: Health Partners Plans Commercial	$1,805.00
Rate for Payer: UnitedHealthcare Commercial	$1,843.00
Rate for Payer: WPPA Commercial	$1,558.00

CT LE WO/W CONTRAST

Facility

$1,900.00

Service Code	HCPCS 73702
Hospital Charge Code	3330022
Hospital Revenue Code	350
Min. Negotiated Rate	$480.41
Max. Negotiated Rate	$1,843.00
Rate for Payer: BCBS Commercial	$480.41
Rate for Payer: Cash Price	$1,425.00
Rate for Payer: Cash Price	$1,425.00
Rate for Payer: Celtic Commercial/Exchange	$877.80
Rate for Payer: Health Partners Plans Commercial	$1,805.00
Rate for Payer: UnitedHealthcare Commercial	$1,843.00
Rate for Payer: WPPA Commercial	$1,596.00

CT LIMITED/LOCALIZED F/U STDY

Facility

$520.00

Service Code	HCPCS 76380
Hospital Charge Code	3330073
Hospital Revenue Code	350
Min. Negotiated Rate	$240.24
Max. Negotiated Rate	$504.40
Rate for Payer: BCBS Commercial	$480.41
Rate for Payer: Cash Price	$390.00
Rate for Payer: Cash Price	$390.00
Rate for Payer: Celtic Commercial/Exchange	$240.24
Rate for Payer: Health Partners Plans Commercial	$494.00
Rate for Payer: UnitedHealthcare Commercial	$504.40
Rate for Payer: WPPA Commercial	$436.80

CT LIMITED/LOCALIZED F/U STDY

Facility

$520.00

Service Code	HCPCS 76380
Hospital Charge Code	3330073
Hospital Revenue Code	350
Min. Negotiated Rate	$426.40
Max. Negotiated Rate	$504.40
Rate for Payer: Cash Price	$390.00
Rate for Payer: Health Partners Plans Commercial	$494.00
Rate for Payer: UnitedHealthcare Commercial	$504.40
Rate for Payer: WPPA Commercial	$426.40

CT L-SPINE W/0 CONTRAST

Facility

$1,737.00

Service Code	HCPCS 72131
Hospital Charge Code	3330028
Hospital Revenue Code	350
Min. Negotiated Rate	$480.41
Max. Negotiated Rate	$1,684.89
Rate for Payer: BCBS Commercial	$480.41
Rate for Payer: Cash Price	$1,302.75
Rate for Payer: Cash Price	$1,302.75
Rate for Payer: Celtic Commercial/Exchange	$802.49
Rate for Payer: Health Partners Plans Commercial	$1,650.15
Rate for Payer: UnitedHealthcare Commercial	$1,684.89
Rate for Payer: WPPA Commercial	$1,459.08

CT L-SPINE W/0 CONTRAST

Facility

$1,737.00

Service Code	HCPCS 72131
Hospital Charge Code	3330028
Hospital Revenue Code	350
Min. Negotiated Rate	$1,424.34
Max. Negotiated Rate	$1,684.89
Rate for Payer: Cash Price	$1,302.75
Rate for Payer: Health Partners Plans Commercial	$1,650.15
Rate for Payer: UnitedHealthcare Commercial	$1,684.89
Rate for Payer: WPPA Commercial	$1,424.34

CT LUNG CANCER SCR WO CONTRAST

Facility

$1,141.00

Service Code	HCPCS 71271
Hospital Charge Code	3330019
Hospital Revenue Code	350
Min. Negotiated Rate	$935.62
Max. Negotiated Rate	$1,106.77
Rate for Payer: Cash Price	$855.75
Rate for Payer: Health Partners Plans Commercial	$1,083.95
Rate for Payer: UnitedHealthcare Commercial	$1,106.77
Rate for Payer: WPPA Commercial	$935.62

CT LUNG CANCER SCR WO CONTRAST

Facility

$1,141.00

Service Code	HCPCS 71271
Hospital Charge Code	3330019
Hospital Revenue Code	350
Min. Negotiated Rate	$480.41
Max. Negotiated Rate	$1,106.77
Rate for Payer: BCBS Commercial	$480.41
Rate for Payer: Cash Price	$855.75
Rate for Payer: Cash Price	$855.75
Rate for Payer: Celtic Commercial/Exchange	$527.14
Rate for Payer: Health Partners Plans Commercial	$1,083.95
Rate for Payer: UnitedHealthcare Commercial	$1,106.77
Rate for Payer: WPPA Commercial	$958.44

CT MAXILLOFACIAL WITH CONTRAST

Facility

$1,150.00

Service Code	HCPCS 70487
Hospital Charge Code	3330030
Hospital Revenue Code	350
Min. Negotiated Rate	$480.41
Max. Negotiated Rate	$1,115.50
Rate for Payer: BCBS Commercial	$480.41
Rate for Payer: Cash Price	$862.50
Rate for Payer: Cash Price	$862.50
Rate for Payer: Celtic Commercial/Exchange	$531.30
Rate for Payer: Health Partners Plans Commercial	$1,092.50
Rate for Payer: UnitedHealthcare Commercial	$1,115.50
Rate for Payer: WPPA Commercial	$966.00

CT MAXILLOFACIAL WITH CONTRAST

Facility

$1,150.00

Service Code	HCPCS 70487
Hospital Charge Code	3330030
Hospital Revenue Code	350
Min. Negotiated Rate	$943.00
Max. Negotiated Rate	$1,115.50
Rate for Payer: Cash Price	$862.50
Rate for Payer: Health Partners Plans Commercial	$1,092.50
Rate for Payer: UnitedHealthcare Commercial	$1,115.50
Rate for Payer: WPPA Commercial	$943.00

CT MAXILLOFACIAL W/O CONTRAST

Facility

$1,444.00

Service Code	HCPCS 70486
Hospital Charge Code	3330034
Hospital Revenue Code	350
Min. Negotiated Rate	$1,184.08
Max. Negotiated Rate	$1,400.68
Rate for Payer: Cash Price	$1,083.00
Rate for Payer: Health Partners Plans Commercial	$1,371.80
Rate for Payer: UnitedHealthcare Commercial	$1,400.68
Rate for Payer: WPPA Commercial	$1,184.08

CT MAXILLOFACIAL W/O CONTRAST

Facility

$1,444.00

Service Code	HCPCS 70486
Hospital Charge Code	3330034
Hospital Revenue Code	350
Min. Negotiated Rate	$480.41
Max. Negotiated Rate	$1,400.68
Rate for Payer: BCBS Commercial	$480.41
Rate for Payer: Cash Price	$1,083.00
Rate for Payer: Cash Price	$1,083.00
Rate for Payer: Celtic Commercial/Exchange	$667.13
Rate for Payer: Health Partners Plans Commercial	$1,371.80
Rate for Payer: UnitedHealthcare Commercial	$1,400.68
Rate for Payer: WPPA Commercial	$1,212.96

CT MAXILLOFACIAL WO/W CONTRAST

Facility

$1,160.00

Service Code	HCPCS 70488
Hospital Charge Code	3330032
Hospital Revenue Code	350
Min. Negotiated Rate	$480.41
Max. Negotiated Rate	$1,125.20
Rate for Payer: BCBS Commercial	$480.41
Rate for Payer: Cash Price	$870.00
Rate for Payer: Cash Price	$870.00
Rate for Payer: Celtic Commercial/Exchange	$535.92
Rate for Payer: Health Partners Plans Commercial	$1,102.00
Rate for Payer: UnitedHealthcare Commercial	$1,125.20
Rate for Payer: WPPA Commercial	$974.40

CT MAXILLOFACIAL WO/W CONTRAST

Facility

$1,160.00

Service Code	HCPCS 70488
Hospital Charge Code	3330032
Hospital Revenue Code	350
Min. Negotiated Rate	$951.20
Max. Negotiated Rate	$1,125.20
Rate for Payer: Cash Price	$870.00
Rate for Payer: Health Partners Plans Commercial	$1,102.00
Rate for Payer: UnitedHealthcare Commercial	$1,125.20
Rate for Payer: WPPA Commercial	$951.20

CT ORBIT SELLA/EAR WITH CONTRA

Facility

$1,149.00

Service Code	HCPCS 70481
Hospital Charge Code	3330036
Hospital Revenue Code	350
Min. Negotiated Rate	$942.18
Max. Negotiated Rate	$1,114.53
Rate for Payer: Cash Price	$861.75
Rate for Payer: Health Partners Plans Commercial	$1,091.55
Rate for Payer: UnitedHealthcare Commercial	$1,114.53
Rate for Payer: WPPA Commercial	$942.18

CT ORBIT SELLA/EAR WITH CONTRA

Facility

$1,149.00

Service Code	HCPCS 70481
Hospital Charge Code	3330036
Hospital Revenue Code	350
Min. Negotiated Rate	$480.41
Max. Negotiated Rate	$1,114.53
Rate for Payer: BCBS Commercial	$480.41
Rate for Payer: Cash Price	$861.75
Rate for Payer: Cash Price	$861.75
Rate for Payer: Celtic Commercial/Exchange	$530.84
Rate for Payer: Health Partners Plans Commercial	$1,091.55
Rate for Payer: UnitedHealthcare Commercial	$1,114.53
Rate for Payer: WPPA Commercial	$965.16

CT ORBIT SELLA/EAR W/O CONTRAS

Facility

$1,579.00

Service Code	HCPCS 70480
Hospital Charge Code	3330041
Hospital Revenue Code	350
Min. Negotiated Rate	$1,294.78
Max. Negotiated Rate	$1,531.63
Rate for Payer: Cash Price	$1,184.25
Rate for Payer: Health Partners Plans Commercial	$1,500.05
Rate for Payer: UnitedHealthcare Commercial	$1,531.63
Rate for Payer: WPPA Commercial	$1,294.78

CT ORBIT SELLA/EAR W/O CONTRAS

Facility

$1,579.00

Service Code	HCPCS 70480
Hospital Charge Code	3330041
Hospital Revenue Code	350
Min. Negotiated Rate	$480.41
Max. Negotiated Rate	$1,531.63
Rate for Payer: BCBS Commercial	$480.41
Rate for Payer: Cash Price	$1,184.25
Rate for Payer: Cash Price	$1,184.25
Rate for Payer: Celtic Commercial/Exchange	$729.50
Rate for Payer: Health Partners Plans Commercial	$1,500.05
Rate for Payer: UnitedHealthcare Commercial	$1,531.63
Rate for Payer: WPPA Commercial	$1,326.36

CT ORBIT SELLA/EAR WO/W CONTRA

Facility

$1,169.00

Service Code	HCPCS 70482
Hospital Charge Code	3330040
Hospital Revenue Code	350
Min. Negotiated Rate	$958.58
Max. Negotiated Rate	$1,133.93
Rate for Payer: Cash Price	$876.75
Rate for Payer: Health Partners Plans Commercial	$1,110.55
Rate for Payer: UnitedHealthcare Commercial	$1,133.93
Rate for Payer: WPPA Commercial	$958.58

CT ORBIT SELLA/EAR WO/W CONTRA

Facility

$1,169.00

Service Code	HCPCS 70482
Hospital Charge Code	3330040
Hospital Revenue Code	350
Min. Negotiated Rate	$480.41
Max. Negotiated Rate	$1,133.93
Rate for Payer: BCBS Commercial	$480.41
Rate for Payer: Cash Price	$876.75
Rate for Payer: Cash Price	$876.75
Rate for Payer: Celtic Commercial/Exchange	$540.08
Rate for Payer: Health Partners Plans Commercial	$1,110.55
Rate for Payer: UnitedHealthcare Commercial	$1,133.93
Rate for Payer: WPPA Commercial	$981.96

CT PELVIS WITH CONTRAST

Facility

$2,068.00

Service Code	HCPCS 72193
Hospital Charge Code	3330044
Hospital Revenue Code	350
Min. Negotiated Rate	$1,695.76
Max. Negotiated Rate	$2,005.96
Rate for Payer: Cash Price	$1,551.00
Rate for Payer: Health Partners Plans Commercial	$1,964.60
Rate for Payer: UnitedHealthcare Commercial	$2,005.96
Rate for Payer: WPPA Commercial	$1,695.76

CT PELVIS WITH CONTRAST

Facility

$2,068.00

Service Code	HCPCS 72193
Hospital Charge Code	3330044
Hospital Revenue Code	350
Min. Negotiated Rate	$480.41
Max. Negotiated Rate	$2,005.96
Rate for Payer: BCBS Commercial	$480.41
Rate for Payer: Cash Price	$1,551.00
Rate for Payer: Cash Price	$1,551.00
Rate for Payer: Celtic Commercial/Exchange	$955.42
Rate for Payer: Health Partners Plans Commercial	$1,964.60
Rate for Payer: UnitedHealthcare Commercial	$2,005.96
Rate for Payer: WPPA Commercial	$1,737.12

CT PELVIS W/O CONTRAST

Facility

$1,668.00

Service Code	HCPCS 72192
Hospital Charge Code	3330046
Hospital Revenue Code	350
Min. Negotiated Rate	$480.41
Max. Negotiated Rate	$1,617.96
Rate for Payer: BCBS Commercial	$480.41
Rate for Payer: Cash Price	$1,251.00
Rate for Payer: Cash Price	$1,251.00
Rate for Payer: Celtic Commercial/Exchange	$770.62
Rate for Payer: Health Partners Plans Commercial	$1,584.60
Rate for Payer: UnitedHealthcare Commercial	$1,617.96
Rate for Payer: WPPA Commercial	$1,401.12

CT PELVIS W/O CONTRAST

Facility

$1,668.00

Service Code	HCPCS 72192
Hospital Charge Code	3330046
Hospital Revenue Code	350
Min. Negotiated Rate	$1,367.76
Max. Negotiated Rate	$1,617.96
Rate for Payer: Cash Price	$1,251.00
Rate for Payer: Health Partners Plans Commercial	$1,584.60
Rate for Payer: UnitedHealthcare Commercial	$1,617.96
Rate for Payer: WPPA Commercial	$1,367.76

CT PELVIS WO/W CONTRAST

Facility

$2,150.00

Service Code	HCPCS 72194
Hospital Charge Code	3330042
Hospital Revenue Code	350
Min. Negotiated Rate	$480.41
Max. Negotiated Rate	$2,085.50
Rate for Payer: BCBS Commercial	$480.41
Rate for Payer: Cash Price	$1,612.50
Rate for Payer: Cash Price	$1,612.50
Rate for Payer: Celtic Commercial/Exchange	$993.30
Rate for Payer: Health Partners Plans Commercial	$2,042.50
Rate for Payer: UnitedHealthcare Commercial	$2,085.50
Rate for Payer: WPPA Commercial	$1,806.00

Know your out-of-pocket cost for care.

All Charges