Ness County Hospital

All Charges

Charge

Type

Setting

Price

SALIVARY GLAND PROCEDURES

Facility

$8,374.67

Service Code	MSDRG 139
Min. Negotiated Rate	$8,374.67
Max. Negotiated Rate	$8,374.67
Rate for Payer: BCBS Commercial	$8,374.67

SALT AIRWAY

Facility

$70.00

Hospital Charge Code	2505730
Hospital Revenue Code	270
Min. Negotiated Rate	$32.34
Max. Negotiated Rate	$67.90
Rate for Payer: Cash Price	$52.50
Rate for Payer: Celtic Commercial/Exchange	$32.34
Rate for Payer: Health Partners Plans Commercial	$66.50
Rate for Payer: UnitedHealthcare Commercial	$67.90
Rate for Payer: WPPA Commercial	$58.80

SALT AIRWAY

Facility

$70.00

Hospital Charge Code	2505730
Hospital Revenue Code	270
Min. Negotiated Rate	$57.40
Max. Negotiated Rate	$67.90
Rate for Payer: Cash Price	$52.50
Rate for Payer: Health Partners Plans Commercial	$66.50
Rate for Payer: UnitedHealthcare Commercial	$67.90
Rate for Payer: WPPA Commercial	$57.40

SAM SPLINT 4.25X36" ROLLED

Facility

$37.00

Hospital Charge Code	2702013
Hospital Revenue Code	270
Min. Negotiated Rate	$30.34
Max. Negotiated Rate	$35.89
Rate for Payer: Cash Price	$27.75
Rate for Payer: Health Partners Plans Commercial	$35.15
Rate for Payer: UnitedHealthcare Commercial	$35.89
Rate for Payer: WPPA Commercial	$30.34

SAM SPLINT 4.25X36" ROLLED

Facility

$37.00

Hospital Charge Code	2702013
Hospital Revenue Code	270
Min. Negotiated Rate	$17.09
Max. Negotiated Rate	$35.89
Rate for Payer: Cash Price	$27.75
Rate for Payer: Celtic Commercial/Exchange	$17.09
Rate for Payer: Health Partners Plans Commercial	$35.15
Rate for Payer: UnitedHealthcare Commercial	$35.89
Rate for Payer: WPPA Commercial	$31.08

SAM SPLINT 9" WRIST FLAT

Facility

$35.00

Hospital Charge Code	2702014
Hospital Revenue Code	270
Min. Negotiated Rate	$28.70
Max. Negotiated Rate	$33.95
Rate for Payer: Cash Price	$26.25
Rate for Payer: Health Partners Plans Commercial	$33.25
Rate for Payer: UnitedHealthcare Commercial	$33.95
Rate for Payer: WPPA Commercial	$28.70

SAM SPLINT 9" WRIST FLAT

Facility

$35.00

Hospital Charge Code	2702014
Hospital Revenue Code	270
Min. Negotiated Rate	$16.17
Max. Negotiated Rate	$33.95
Rate for Payer: Cash Price	$26.25
Rate for Payer: Celtic Commercial/Exchange	$16.17
Rate for Payer: Health Partners Plans Commercial	$33.25
Rate for Payer: UnitedHealthcare Commercial	$33.95
Rate for Payer: WPPA Commercial	$29.40

SAM SPLINT CAST 4.25X36" FLAT

Facility

$37.00

Hospital Charge Code	2702012
Hospital Revenue Code	270
Min. Negotiated Rate	$30.34
Max. Negotiated Rate	$35.89
Rate for Payer: Cash Price	$27.75
Rate for Payer: Health Partners Plans Commercial	$35.15
Rate for Payer: UnitedHealthcare Commercial	$35.89
Rate for Payer: WPPA Commercial	$30.34

SAM SPLINT CAST 4.25X36" FLAT

Facility

$37.00

Hospital Charge Code	2702012
Hospital Revenue Code	270
Min. Negotiated Rate	$17.09
Max. Negotiated Rate	$35.89
Rate for Payer: Cash Price	$27.75
Rate for Payer: Celtic Commercial/Exchange	$17.09
Rate for Payer: Health Partners Plans Commercial	$35.15
Rate for Payer: UnitedHealthcare Commercial	$35.89
Rate for Payer: WPPA Commercial	$31.08

SAM SPLINT XL, 5 1/2 X 36

Facility

$26.00

Hospital Charge Code	2702015
Hospital Revenue Code	272
Min. Negotiated Rate	$12.01
Max. Negotiated Rate	$25.22
Rate for Payer: Cash Price	$19.50
Rate for Payer: Celtic Commercial/Exchange	$12.01
Rate for Payer: Health Partners Plans Commercial	$24.70
Rate for Payer: UnitedHealthcare Commercial	$25.22
Rate for Payer: WPPA Commercial	$21.84

SAM SPLINT XL, 5 1/2 X 36

Facility

$26.00

Hospital Charge Code	2702015
Hospital Revenue Code	272
Min. Negotiated Rate	$21.32
Max. Negotiated Rate	$25.22
Rate for Payer: Cash Price	$19.50
Rate for Payer: Health Partners Plans Commercial	$24.70
Rate for Payer: UnitedHealthcare Commercial	$25.22
Rate for Payer: WPPA Commercial	$21.32

SCALPEL #10 DISPOSABLE

Facility

$5.00

Hospital Charge Code	2726066
Hospital Revenue Code	272
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$4.12
Rate for Payer: Celtic Commercial/Exchange	$2.31
Rate for Payer: Health Partners Plans Commercial	$4.75
Rate for Payer: UnitedHealthcare Commercial	$4.85
Rate for Payer: WPPA Commercial	$4.20

SCALPEL #10 DISPOSABLE

Facility

$5.00

Hospital Charge Code	2726066
Hospital Revenue Code	272
Min. Negotiated Rate	$4.10
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$4.12
Rate for Payer: Health Partners Plans Commercial	$4.75
Rate for Payer: UnitedHealthcare Commercial	$4.85
Rate for Payer: WPPA Commercial	$4.10

SCALPEL #15 DISPOSABLE/STERILE

Facility

$5.00

Hospital Charge Code	2721697
Hospital Revenue Code	270
Min. Negotiated Rate	$4.10
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$4.12
Rate for Payer: Health Partners Plans Commercial	$4.75
Rate for Payer: UnitedHealthcare Commercial	$4.85
Rate for Payer: WPPA Commercial	$4.10

SCALPEL #15 DISPOSABLE/STERILE

Facility

$5.00

Hospital Charge Code	2721697
Hospital Revenue Code	270
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$4.12
Rate for Payer: Celtic Commercial/Exchange	$2.31
Rate for Payer: Health Partners Plans Commercial	$4.75
Rate for Payer: UnitedHealthcare Commercial	$4.85
Rate for Payer: WPPA Commercial	$4.20

SCAPULA LT

Facility

$244.00

Service Code	HCPCS 73010 LT
Hospital Charge Code	3280027
Hospital Revenue Code	320
Min. Negotiated Rate	$200.08
Max. Negotiated Rate	$236.68
Rate for Payer: Cash Price	$183.00
Rate for Payer: Health Partners Plans Commercial	$231.80
Rate for Payer: UnitedHealthcare Commercial	$236.68
Rate for Payer: WPPA Commercial	$200.08

SCAPULA LT

Facility

$244.00

Service Code	HCPCS 73010 LT
Hospital Charge Code	3280027
Hospital Revenue Code	320
Min. Negotiated Rate	$112.73
Max. Negotiated Rate	$236.68
Rate for Payer: BCBS Commercial	$132.93
Rate for Payer: Cash Price	$183.00
Rate for Payer: Cash Price	$183.00
Rate for Payer: Celtic Commercial/Exchange	$112.73
Rate for Payer: Health Partners Plans Commercial	$231.80
Rate for Payer: UnitedHealthcare Commercial	$236.68
Rate for Payer: WPPA Commercial	$204.96

SCAPULA RT

Facility

$166.00

Service Code	HCPCS 73010 RT
Hospital Charge Code	3280026
Hospital Revenue Code	320
Min. Negotiated Rate	$76.69
Max. Negotiated Rate	$161.02
Rate for Payer: BCBS Commercial	$132.93
Rate for Payer: Cash Price	$124.57
Rate for Payer: Cash Price	$124.57
Rate for Payer: Celtic Commercial/Exchange	$76.69
Rate for Payer: Health Partners Plans Commercial	$157.70
Rate for Payer: UnitedHealthcare Commercial	$161.02
Rate for Payer: WPPA Commercial	$139.44

SCAPULA RT

Facility

$166.00

Service Code	HCPCS 73010 RT
Hospital Charge Code	3280026
Hospital Revenue Code	320
Min. Negotiated Rate	$136.12
Max. Negotiated Rate	$161.02
Rate for Payer: Cash Price	$124.57
Rate for Payer: Health Partners Plans Commercial	$157.70
Rate for Payer: UnitedHealthcare Commercial	$161.02
Rate for Payer: WPPA Commercial	$136.12

SC JOINT/JOINTS 3V MINIMUM

Facility

$166.00

Service Code	HCPCS 71130
Hospital Charge Code	7113000
Hospital Revenue Code	320
Min. Negotiated Rate	$76.69
Max. Negotiated Rate	$161.02
Rate for Payer: BCBS Commercial	$110.06
Rate for Payer: Cash Price	$124.57
Rate for Payer: Cash Price	$124.57
Rate for Payer: Celtic Commercial/Exchange	$76.69
Rate for Payer: Health Partners Plans Commercial	$157.70
Rate for Payer: UnitedHealthcare Commercial	$161.02
Rate for Payer: WPPA Commercial	$139.44

SC JOINT/JOINTS 3V MINIMUM

Facility

$166.00

Service Code	HCPCS 71130
Hospital Charge Code	7113000
Hospital Revenue Code	320
Min. Negotiated Rate	$136.12
Max. Negotiated Rate	$161.02
Rate for Payer: Cash Price	$124.57
Rate for Payer: Health Partners Plans Commercial	$157.70
Rate for Payer: UnitedHealthcare Commercial	$161.02
Rate for Payer: WPPA Commercial	$136.12

SCL-70 ANTIBODY

Facility

$368.00

Service Code	HCPCS 86235
Hospital Charge Code	8623509
Hospital Revenue Code	302
Min. Negotiated Rate	$301.76
Max. Negotiated Rate	$356.96
Rate for Payer: Cash Price	$276.00
Rate for Payer: Health Partners Plans Commercial	$349.60
Rate for Payer: UnitedHealthcare Commercial	$356.96
Rate for Payer: WPPA Commercial	$301.76

SCL-70 ANTIBODY

Facility

$368.00

Service Code	HCPCS 86235
Hospital Charge Code	8623509
Hospital Revenue Code	302
Min. Negotiated Rate	$52.26
Max. Negotiated Rate	$356.96
Rate for Payer: BCBS Commercial	$52.26
Rate for Payer: Cash Price	$276.00
Rate for Payer: Cash Price	$276.00
Rate for Payer: Celtic Commercial/Exchange	$170.02
Rate for Payer: Health Partners Plans Commercial	$349.60
Rate for Payer: UnitedHealthcare Commercial	$356.96
Rate for Payer: WPPA Commercial	$309.12

SCLERODERMA ANTIBODY (SCL-70)

Facility

$368.00

Service Code	HCPCS 86235
Hospital Charge Code	8623510
Hospital Revenue Code	302
Min. Negotiated Rate	$52.26
Max. Negotiated Rate	$356.96
Rate for Payer: BCBS Commercial	$52.26
Rate for Payer: Cash Price	$276.00
Rate for Payer: Cash Price	$276.00
Rate for Payer: Celtic Commercial/Exchange	$170.02
Rate for Payer: Health Partners Plans Commercial	$349.60
Rate for Payer: UnitedHealthcare Commercial	$356.96
Rate for Payer: WPPA Commercial	$309.12

SCLERODERMA ANTIBODY (SCL-70)

Facility

$368.00

Service Code	HCPCS 86235
Hospital Charge Code	8623504
Hospital Revenue Code	302
Min. Negotiated Rate	$52.26
Max. Negotiated Rate	$356.96
Rate for Payer: BCBS Commercial	$52.26
Rate for Payer: Cash Price	$276.00
Rate for Payer: Cash Price	$276.00
Rate for Payer: Celtic Commercial/Exchange	$170.02
Rate for Payer: Health Partners Plans Commercial	$349.60
Rate for Payer: UnitedHealthcare Commercial	$356.96
Rate for Payer: WPPA Commercial	$309.12

Know your out-of-pocket cost for care.

All Charges