Ness County Hospital

All Charges

Charge

Type

Setting

Price

RVP PANEL

Facility

$1,385.00

Service Code	HCPCS 87633
Hospital Charge Code	8763300
Hospital Revenue Code	306
Min. Negotiated Rate	$639.87
Max. Negotiated Rate	$1,398.85
Rate for Payer: BCBS Commercial	$1,398.85
Rate for Payer: Cash Price	$1,038.75
Rate for Payer: Cash Price	$1,038.75
Rate for Payer: Celtic Commercial/Exchange	$639.87
Rate for Payer: Health Partners Plans Commercial	$1,315.75
Rate for Payer: UnitedHealthcare Commercial	$1,343.45
Rate for Payer: WPPA Commercial	$1,163.40

SA11G 5-0 SILK SUTURE

Facility

$10.00

Hospital Charge Code	2721603
Hospital Revenue Code	270
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$7.50
Rate for Payer: Celtic Commercial/Exchange	$4.62
Rate for Payer: Health Partners Plans Commercial	$9.50
Rate for Payer: UnitedHealthcare Commercial	$9.70
Rate for Payer: WPPA Commercial	$8.40

SA11G 5-0 SILK SUTURE

Facility

$10.00

Hospital Charge Code	2721603
Hospital Revenue Code	270
Min. Negotiated Rate	$8.20
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$7.50
Rate for Payer: Health Partners Plans Commercial	$9.50
Rate for Payer: UnitedHealthcare Commercial	$9.70
Rate for Payer: WPPA Commercial	$8.20

SACRUM/COCCYX 2V MINIMUM

Facility

$257.00

Service Code	HCPCS 72220
Hospital Charge Code	3270020
Hospital Revenue Code	320
Min. Negotiated Rate	$118.73
Max. Negotiated Rate	$249.29
Rate for Payer: BCBS Commercial	$143.10
Rate for Payer: Cash Price	$192.75
Rate for Payer: Cash Price	$192.75
Rate for Payer: Celtic Commercial/Exchange	$118.73
Rate for Payer: Health Partners Plans Commercial	$244.15
Rate for Payer: UnitedHealthcare Commercial	$249.29
Rate for Payer: WPPA Commercial	$215.88

SACRUM/COCCYX 2V MINIMUM

Facility

$257.00

Service Code	HCPCS 72220
Hospital Charge Code	3270020
Hospital Revenue Code	320
Min. Negotiated Rate	$210.74
Max. Negotiated Rate	$249.29
Rate for Payer: Cash Price	$192.75
Rate for Payer: Health Partners Plans Commercial	$244.15
Rate for Payer: UnitedHealthcare Commercial	$249.29
Rate for Payer: WPPA Commercial	$210.74

SAEFTY INFUSION SET 20G

Facility

$42.00

Hospital Charge Code	2702509
Hospital Revenue Code	272
Min. Negotiated Rate	$19.40
Max. Negotiated Rate	$40.74
Rate for Payer: Cash Price	$31.50
Rate for Payer: Celtic Commercial/Exchange	$19.40
Rate for Payer: Health Partners Plans Commercial	$39.90
Rate for Payer: UnitedHealthcare Commercial	$40.74
Rate for Payer: WPPA Commercial	$35.28

SAEFTY INFUSION SET 20G

Facility

$42.00

Hospital Charge Code	2702509
Hospital Revenue Code	272
Min. Negotiated Rate	$34.44
Max. Negotiated Rate	$40.74
Rate for Payer: Cash Price	$31.50
Rate for Payer: Health Partners Plans Commercial	$39.90
Rate for Payer: UnitedHealthcare Commercial	$40.74
Rate for Payer: WPPA Commercial	$34.44

SAFETY INFUSION SET 22G

Facility

$42.00

Hospital Charge Code	2702510
Hospital Revenue Code	272
Min. Negotiated Rate	$34.44
Max. Negotiated Rate	$40.74
Rate for Payer: Cash Price	$31.50
Rate for Payer: Health Partners Plans Commercial	$39.90
Rate for Payer: UnitedHealthcare Commercial	$40.74
Rate for Payer: WPPA Commercial	$34.44

SAFETY INFUSION SET 22G

Facility

$42.00

Hospital Charge Code	2702510
Hospital Revenue Code	272
Min. Negotiated Rate	$19.40
Max. Negotiated Rate	$40.74
Rate for Payer: Cash Price	$31.50
Rate for Payer: Celtic Commercial/Exchange	$19.40
Rate for Payer: Health Partners Plans Commercial	$39.90
Rate for Payer: UnitedHealthcare Commercial	$40.74
Rate for Payer: WPPA Commercial	$35.28

SALEM SUMP 16FR

Facility

$4.00

Hospital Charge Code	2720291
Hospital Revenue Code	272
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$3.00
Rate for Payer: Celtic Commercial/Exchange	$1.85
Rate for Payer: Health Partners Plans Commercial	$3.80
Rate for Payer: UnitedHealthcare Commercial	$3.88
Rate for Payer: WPPA Commercial	$3.36

SALEM SUMP 16FR

Facility

$4.00

Hospital Charge Code	2720291
Hospital Revenue Code	272
Min. Negotiated Rate	$3.28
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$3.00
Rate for Payer: Health Partners Plans Commercial	$3.80
Rate for Payer: UnitedHealthcare Commercial	$3.88
Rate for Payer: WPPA Commercial	$3.28

SALEM SUMP TUBE

Facility

$16.00

Hospital Charge Code	2720290
Hospital Revenue Code	270
Min. Negotiated Rate	$13.12
Max. Negotiated Rate	$15.52
Rate for Payer: Cash Price	$12.19
Rate for Payer: Health Partners Plans Commercial	$15.20
Rate for Payer: UnitedHealthcare Commercial	$15.52
Rate for Payer: WPPA Commercial	$13.12

SALEM SUMP TUBE

Facility

$16.00

Hospital Charge Code	2720290
Hospital Revenue Code	270
Min. Negotiated Rate	$7.39
Max. Negotiated Rate	$15.52
Rate for Payer: Cash Price	$12.19
Rate for Payer: Celtic Commercial/Exchange	$7.39
Rate for Payer: Health Partners Plans Commercial	$15.20
Rate for Payer: UnitedHealthcare Commercial	$15.52
Rate for Payer: WPPA Commercial	$13.44

SALEM SUMP TUBE/REFLUX 12FR

Facility

$11.00

Hospital Charge Code	2720293
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

SALEM SUMP TUBE/REFLUX 12FR

Facility

$11.00

Hospital Charge Code	2720293
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

SALEM SUMP TUBE/REFLUX 14FR

Facility

$4.00

Hospital Charge Code	2720292
Hospital Revenue Code	272
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$3.00
Rate for Payer: Celtic Commercial/Exchange	$1.85
Rate for Payer: Health Partners Plans Commercial	$3.80
Rate for Payer: UnitedHealthcare Commercial	$3.88
Rate for Payer: WPPA Commercial	$3.36

SALEM SUMP TUBE/REFLUX 14FR

Facility

$4.00

Hospital Charge Code	2720292
Hospital Revenue Code	272
Min. Negotiated Rate	$3.28
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$3.00
Rate for Payer: Health Partners Plans Commercial	$3.80
Rate for Payer: UnitedHealthcare Commercial	$3.88
Rate for Payer: WPPA Commercial	$3.28

SALICYLATE

Facility

$32.00

Service Code	HCPCS 80196
Hospital Charge Code	8019600
Hospital Revenue Code	301
Min. Negotiated Rate	$14.78
Max. Negotiated Rate	$31.04
Rate for Payer: Cash Price	$24.00
Rate for Payer: Celtic Commercial/Exchange	$14.78
Rate for Payer: Health Partners Plans Commercial	$30.40
Rate for Payer: UnitedHealthcare Commercial	$31.04
Rate for Payer: WPPA Commercial	$26.88

SALICYLATE

Facility

$32.00

Service Code	HCPCS 80196
Hospital Charge Code	8019600
Hospital Revenue Code	301
Min. Negotiated Rate	$26.24
Max. Negotiated Rate	$31.04
Rate for Payer: Cash Price	$24.00
Rate for Payer: Health Partners Plans Commercial	$30.40
Rate for Payer: UnitedHealthcare Commercial	$31.04
Rate for Payer: WPPA Commercial	$26.24

SALICYLATE

Facility

$206.00

Service Code	HCPCS 80329
Hospital Charge Code	8032900
Hospital Revenue Code	301
Min. Negotiated Rate	$57.86
Max. Negotiated Rate	$199.82
Rate for Payer: BCBS Commercial	$57.86
Rate for Payer: Cash Price	$154.50
Rate for Payer: Cash Price	$154.50
Rate for Payer: Celtic Commercial/Exchange	$95.17
Rate for Payer: Health Partners Plans Commercial	$195.70
Rate for Payer: UnitedHealthcare Commercial	$199.82
Rate for Payer: WPPA Commercial	$173.04

SALICYLATE

Facility

$206.00

Service Code	HCPCS 80329
Hospital Charge Code	8032900
Hospital Revenue Code	301
Min. Negotiated Rate	$168.92
Max. Negotiated Rate	$199.82
Rate for Payer: Cash Price	$154.50
Rate for Payer: Health Partners Plans Commercial	$195.70
Rate for Payer: UnitedHealthcare Commercial	$199.82
Rate for Payer: WPPA Commercial	$168.92

SALINE FLUSHES INJ

Facility

$10.00

Hospital Charge Code	2506277
Hospital Revenue Code	250
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$7.72
Rate for Payer: Celtic Commercial/Exchange	$4.62
Rate for Payer: Health Partners Plans Commercial	$9.50
Rate for Payer: UnitedHealthcare Commercial	$9.70
Rate for Payer: WPPA Commercial	$8.40

SALINE FLUSHES INJ

Facility

$10.00

Hospital Charge Code	2506277
Hospital Revenue Code	250
Min. Negotiated Rate	$8.20
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$7.72
Rate for Payer: Health Partners Plans Commercial	$9.50
Rate for Payer: UnitedHealthcare Commercial	$9.70
Rate for Payer: WPPA Commercial	$8.20

SALINE WOUND WASH (SODIUM CHLORIDE) TOP AEROSOL, SPRAY

Facility

$3.00

Service Code	NDC 87701040511
Hospital Charge Code	2510642
Hospital Revenue Code	250
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.63
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

SALINE WOUND WASH (SODIUM CHLORIDE) TOP AEROSOL, SPRAY

Facility

$3.00

Service Code	NDC 87701040511
Hospital Charge Code	2510642
Hospital Revenue Code	250
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.63
Rate for Payer: Health Partners Plans Commercial	$2.85
Rate for Payer: UnitedHealthcare Commercial	$2.91
Rate for Payer: WPPA Commercial	$2.46

Know your out-of-pocket cost for care.

All Charges