Ness County Hospital

All Charges

Charge

Type

Setting

Price

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

CT SHOULDER LT WO

Facility

$1,518.00

Service Code	HCPCS 73200 LT
Hospital Charge Code	7111133
Hospital Revenue Code	350
Min. Negotiated Rate	$1,244.76
Max. Negotiated Rate	$1,472.46
Rate for Payer: Cash Price	$1,138.50
Rate for Payer: Health Partners Plans Commercial	$1,442.10
Rate for Payer: UnitedHealthcare Commercial	$1,472.46
Rate for Payer: WPPA Commercial	$1,244.76

CT SHOULDER LT WO

Facility

$1,518.00

Service Code	HCPCS 73200 LT
Hospital Charge Code	7111133
Hospital Revenue Code	350
Min. Negotiated Rate	$480.41
Max. Negotiated Rate	$1,472.46
Rate for Payer: BCBS Commercial	$480.41
Rate for Payer: Cash Price	$1,138.50
Rate for Payer: Cash Price	$1,138.50
Rate for Payer: Celtic Commercial/Exchange	$701.32
Rate for Payer: Health Partners Plans Commercial	$1,442.10
Rate for Payer: UnitedHealthcare Commercial	$1,472.46
Rate for Payer: WPPA Commercial	$1,275.12

CT SHOULDER RT WO

Facility

$1,518.00

Service Code	HCPCS 73200 RT
Hospital Charge Code	7111132
Hospital Revenue Code	350
Min. Negotiated Rate	$480.41
Max. Negotiated Rate	$1,472.46
Rate for Payer: BCBS Commercial	$480.41
Rate for Payer: Cash Price	$1,138.50
Rate for Payer: Cash Price	$1,138.50
Rate for Payer: Celtic Commercial/Exchange	$701.32
Rate for Payer: Health Partners Plans Commercial	$1,442.10
Rate for Payer: UnitedHealthcare Commercial	$1,472.46
Rate for Payer: WPPA Commercial	$1,275.12

CT SHOULDER RT WO

Facility

$1,518.00

Service Code	HCPCS 73200 RT
Hospital Charge Code	7111132
Hospital Revenue Code	350
Min. Negotiated Rate	$1,244.76
Max. Negotiated Rate	$1,472.46
Rate for Payer: Cash Price	$1,138.50
Rate for Payer: Health Partners Plans Commercial	$1,442.10
Rate for Payer: UnitedHealthcare Commercial	$1,472.46
Rate for Payer: WPPA Commercial	$1,244.76

CT SOFT NECK WITH CONTRAST

Facility

$1,837.00

Service Code	HCPCS 70491
Hospital Charge Code	3330052
Hospital Revenue Code	350
Min. Negotiated Rate	$480.41
Max. Negotiated Rate	$1,781.89
Rate for Payer: BCBS Commercial	$480.41
Rate for Payer: Cash Price	$1,377.75
Rate for Payer: Cash Price	$1,377.75
Rate for Payer: Celtic Commercial/Exchange	$848.69
Rate for Payer: Health Partners Plans Commercial	$1,745.15
Rate for Payer: UnitedHealthcare Commercial	$1,781.89
Rate for Payer: WPPA Commercial	$1,543.08

CT SOFT NECK WITH CONTRAST

Facility

$1,837.00

Service Code	HCPCS 70491
Hospital Charge Code	3330052
Hospital Revenue Code	350
Min. Negotiated Rate	$1,506.34
Max. Negotiated Rate	$1,781.89
Rate for Payer: Cash Price	$1,377.75
Rate for Payer: Health Partners Plans Commercial	$1,745.15
Rate for Payer: UnitedHealthcare Commercial	$1,781.89
Rate for Payer: WPPA Commercial	$1,506.34

CT SOFT NECK W/O CONTRAST

Facility

$1,520.00

Service Code	HCPCS 70490
Hospital Charge Code	3330050
Hospital Revenue Code	350
Min. Negotiated Rate	$1,246.40
Max. Negotiated Rate	$1,474.40
Rate for Payer: Cash Price	$1,140.00
Rate for Payer: Health Partners Plans Commercial	$1,444.00
Rate for Payer: UnitedHealthcare Commercial	$1,474.40
Rate for Payer: WPPA Commercial	$1,246.40

CT SOFT NECK W/O CONTRAST

Facility

$1,520.00

Service Code	HCPCS 70490
Hospital Charge Code	3330050
Hospital Revenue Code	350
Min. Negotiated Rate	$480.41
Max. Negotiated Rate	$1,474.40
Rate for Payer: BCBS Commercial	$480.41
Rate for Payer: Cash Price	$1,140.00
Rate for Payer: Cash Price	$1,140.00
Rate for Payer: Celtic Commercial/Exchange	$702.24
Rate for Payer: Health Partners Plans Commercial	$1,444.00
Rate for Payer: UnitedHealthcare Commercial	$1,474.40
Rate for Payer: WPPA Commercial	$1,276.80

CT SOFT NECK WO/W CONTRAST

Facility

$1,941.00

Service Code	HCPCS 70492
Hospital Charge Code	3330048
Hospital Revenue Code	350
Min. Negotiated Rate	$480.41
Max. Negotiated Rate	$1,882.77
Rate for Payer: BCBS Commercial	$480.41
Rate for Payer: Cash Price	$1,455.75
Rate for Payer: Cash Price	$1,455.75
Rate for Payer: Celtic Commercial/Exchange	$896.74
Rate for Payer: Health Partners Plans Commercial	$1,843.95
Rate for Payer: UnitedHealthcare Commercial	$1,882.77
Rate for Payer: WPPA Commercial	$1,630.44

CT SOFT NECK WO/W CONTRAST

Facility

$1,941.00

Service Code	HCPCS 70492
Hospital Charge Code	3330048
Hospital Revenue Code	350
Min. Negotiated Rate	$1,591.62
Max. Negotiated Rate	$1,882.77
Rate for Payer: Cash Price	$1,455.75
Rate for Payer: Health Partners Plans Commercial	$1,843.95
Rate for Payer: UnitedHealthcare Commercial	$1,882.77
Rate for Payer: WPPA Commercial	$1,591.62

CT T-SPINE W/O CONTRAST

Facility

$1,733.00

Service Code	HCPCS 72128
Hospital Charge Code	3330056
Hospital Revenue Code	350
Min. Negotiated Rate	$1,421.06
Max. Negotiated Rate	$1,681.01
Rate for Payer: Cash Price	$1,299.75
Rate for Payer: Health Partners Plans Commercial	$1,646.35
Rate for Payer: UnitedHealthcare Commercial	$1,681.01
Rate for Payer: WPPA Commercial	$1,421.06

CT T-SPINE W/O CONTRAST

Facility

$1,733.00

Service Code	HCPCS 72128
Hospital Charge Code	3330056
Hospital Revenue Code	350
Min. Negotiated Rate	$480.41
Max. Negotiated Rate	$1,681.01
Rate for Payer: BCBS Commercial	$480.41
Rate for Payer: Cash Price	$1,299.75
Rate for Payer: Cash Price	$1,299.75
Rate for Payer: Celtic Commercial/Exchange	$800.65
Rate for Payer: Health Partners Plans Commercial	$1,646.35
Rate for Payer: UnitedHealthcare Commercial	$1,681.01
Rate for Payer: WPPA Commercial	$1,455.72

CT T-Spine wo/w contrast

Facility

$2,000.00

Service Code	HCPCS 72130
Hospital Charge Code	7213000
Hospital Revenue Code	350
Min. Negotiated Rate	$1,640.00
Max. Negotiated Rate	$1,940.00
Rate for Payer: Cash Price	$1,500.00
Rate for Payer: Health Partners Plans Commercial	$1,900.00
Rate for Payer: UnitedHealthcare Commercial	$1,940.00
Rate for Payer: WPPA Commercial	$1,640.00

CT T-Spine wo/w contrast

Facility

$2,000.00

Service Code	HCPCS 72130
Hospital Charge Code	7213000
Hospital Revenue Code	350
Min. Negotiated Rate	$480.41
Max. Negotiated Rate	$1,940.00
Rate for Payer: BCBS Commercial	$480.41
Rate for Payer: Cash Price	$1,500.00
Rate for Payer: Cash Price	$1,500.00
Rate for Payer: Celtic Commercial/Exchange	$924.00
Rate for Payer: Health Partners Plans Commercial	$1,900.00
Rate for Payer: UnitedHealthcare Commercial	$1,940.00
Rate for Payer: WPPA Commercial	$1,680.00

CT UPPER EXT. W/ CONTRAST

Facility

$1,851.00

Service Code	HCPCS 73201
Hospital Charge Code	3330060
Hospital Revenue Code	350
Min. Negotiated Rate	$480.41
Max. Negotiated Rate	$1,795.47
Rate for Payer: BCBS Commercial	$480.41
Rate for Payer: Cash Price	$1,388.25
Rate for Payer: Cash Price	$1,388.25
Rate for Payer: Celtic Commercial/Exchange	$855.16
Rate for Payer: Health Partners Plans Commercial	$1,758.45
Rate for Payer: UnitedHealthcare Commercial	$1,795.47
Rate for Payer: WPPA Commercial	$1,554.84

CT UPPER EXT. W/ CONTRAST

Facility

$1,851.00

Service Code	HCPCS 73201
Hospital Charge Code	3330060
Hospital Revenue Code	350
Min. Negotiated Rate	$1,517.82
Max. Negotiated Rate	$1,795.47
Rate for Payer: Cash Price	$1,388.25
Rate for Payer: Health Partners Plans Commercial	$1,758.45
Rate for Payer: UnitedHealthcare Commercial	$1,795.47
Rate for Payer: WPPA Commercial	$1,517.82

CT UPPER EXT. W/O CONTRAST

Facility

$1,518.00

Service Code	HCPCS 73200
Hospital Charge Code	3330062
Hospital Revenue Code	350
Min. Negotiated Rate	$480.41
Max. Negotiated Rate	$1,472.46
Rate for Payer: BCBS Commercial	$480.41
Rate for Payer: Cash Price	$1,138.50
Rate for Payer: Cash Price	$1,138.50
Rate for Payer: Celtic Commercial/Exchange	$701.32
Rate for Payer: Health Partners Plans Commercial	$1,442.10
Rate for Payer: UnitedHealthcare Commercial	$1,472.46
Rate for Payer: WPPA Commercial	$1,275.12

CT UPPER EXT. W/O CONTRAST

Facility

$1,518.00

Service Code	HCPCS 73200
Hospital Charge Code	3330062
Hospital Revenue Code	350
Min. Negotiated Rate	$1,244.76
Max. Negotiated Rate	$1,472.46
Rate for Payer: Cash Price	$1,138.50
Rate for Payer: Health Partners Plans Commercial	$1,442.10
Rate for Payer: UnitedHealthcare Commercial	$1,472.46
Rate for Payer: WPPA Commercial	$1,244.76

CT UPPER EXT WO/W CONTRAST

Facility

$1,172.00

Service Code	HCPCS 73202
Hospital Charge Code	3330058
Hospital Revenue Code	350
Min. Negotiated Rate	$961.04
Max. Negotiated Rate	$1,136.84
Rate for Payer: Cash Price	$879.00
Rate for Payer: Health Partners Plans Commercial	$1,113.40
Rate for Payer: UnitedHealthcare Commercial	$1,136.84
Rate for Payer: WPPA Commercial	$961.04

CT UPPER EXT WO/W CONTRAST

Facility

$1,172.00

Service Code	HCPCS 73202
Hospital Charge Code	3330058
Hospital Revenue Code	350
Min. Negotiated Rate	$480.41
Max. Negotiated Rate	$1,136.84
Rate for Payer: BCBS Commercial	$480.41
Rate for Payer: Cash Price	$879.00
Rate for Payer: Cash Price	$879.00
Rate for Payer: Celtic Commercial/Exchange	$541.46
Rate for Payer: Health Partners Plans Commercial	$1,113.40
Rate for Payer: UnitedHealthcare Commercial	$1,136.84
Rate for Payer: WPPA Commercial	$984.48

CTV LOWER EXT runoff

Facility

$1,664.00

Service Code	HCPCS 73706
Hospital Charge Code	7370601
Hospital Revenue Code	350
Min. Negotiated Rate	$222.53
Max. Negotiated Rate	$1,614.08
Rate for Payer: BCBS Commercial	$222.53
Rate for Payer: Cash Price	$1,248.00
Rate for Payer: Cash Price	$1,248.00
Rate for Payer: Celtic Commercial/Exchange	$768.77
Rate for Payer: Health Partners Plans Commercial	$1,580.80
Rate for Payer: UnitedHealthcare Commercial	$1,614.08
Rate for Payer: WPPA Commercial	$1,397.76

CTV LOWER EXT runoff

Facility

$1,664.00

Service Code	HCPCS 73706
Hospital Charge Code	7370601
Hospital Revenue Code	350
Min. Negotiated Rate	$1,364.48
Max. Negotiated Rate	$1,614.08
Rate for Payer: Cash Price	$1,248.00
Rate for Payer: Health Partners Plans Commercial	$1,580.80
Rate for Payer: UnitedHealthcare Commercial	$1,614.08
Rate for Payer: WPPA Commercial	$1,364.48

CT WRIST LT WO

Facility

$1,518.00

Service Code	HCPCS 73200 LT
Hospital Charge Code	7111137
Hospital Revenue Code	350
Min. Negotiated Rate	$1,244.76
Max. Negotiated Rate	$1,472.46
Rate for Payer: Cash Price	$1,138.50
Rate for Payer: Health Partners Plans Commercial	$1,442.10
Rate for Payer: UnitedHealthcare Commercial	$1,472.46
Rate for Payer: WPPA Commercial	$1,244.76

CT WRIST LT WO

Facility

$1,518.00

Service Code	HCPCS 73200 LT
Hospital Charge Code	7111137
Hospital Revenue Code	350
Min. Negotiated Rate	$480.41
Max. Negotiated Rate	$1,472.46
Rate for Payer: BCBS Commercial	$480.41
Rate for Payer: Cash Price	$1,138.50
Rate for Payer: Cash Price	$1,138.50
Rate for Payer: Celtic Commercial/Exchange	$701.32
Rate for Payer: Health Partners Plans Commercial	$1,442.10
Rate for Payer: UnitedHealthcare Commercial	$1,472.46
Rate for Payer: WPPA Commercial	$1,275.12

Know your out-of-pocket cost for care.

All Charges