Ness County Hospital

All Charges

Charge

Type

Setting

Price

SELLA TURCICA

Facility

$160.00

Service Code	HCPCS 70240
Hospital Charge Code	3260016
Hospital Revenue Code	320
Min. Negotiated Rate	$131.20
Max. Negotiated Rate	$155.20
Rate for Payer: Cash Price	$120.45
Rate for Payer: Health Partners Plans Commercial	$152.00
Rate for Payer: UnitedHealthcare Commercial	$155.20
Rate for Payer: WPPA Commercial	$131.20

SELSUN BLUE SHAMPOO 7 OZ. bottle (selenium sulfide)(anti-dandruff shampoo)

Facility

$17.00

Service Code	NDC 00536199553
Hospital Charge Code	2510865
Hospital Revenue Code	250
Min. Negotiated Rate	$13.94
Max. Negotiated Rate	$16.49
Rate for Payer: Cash Price	$13.35
Rate for Payer: Health Partners Plans Commercial	$16.15
Rate for Payer: UnitedHealthcare Commercial	$16.49
Rate for Payer: WPPA Commercial	$13.94

SELSUN BLUE SHAMPOO 7 OZ. bottle (selenium sulfide)(anti-dandruff shampoo)

Facility

$17.00

Service Code	NDC 00536199553
Hospital Charge Code	2510865
Hospital Revenue Code	250
Min. Negotiated Rate	$7.85
Max. Negotiated Rate	$16.49
Rate for Payer: Cash Price	$13.35
Rate for Payer: Celtic Commercial/Exchange	$7.85
Rate for Payer: Health Partners Plans Commercial	$16.15
Rate for Payer: UnitedHealthcare Commercial	$16.49
Rate for Payer: WPPA Commercial	$14.28

SEMEN ANALYSIS MOTILITY/COUNT

Facility

$81.00

Service Code	HCPCS 89310
Hospital Charge Code	8931000
Hospital Revenue Code	309
Min. Negotiated Rate	$37.42
Max. Negotiated Rate	$78.57
Rate for Payer: BCBS Commercial	$44.93
Rate for Payer: Cash Price	$60.75
Rate for Payer: Cash Price	$60.75
Rate for Payer: Celtic Commercial/Exchange	$37.42
Rate for Payer: Health Partners Plans Commercial	$76.95
Rate for Payer: UnitedHealthcare Commercial	$78.57
Rate for Payer: WPPA Commercial	$68.04

SEMEN ANALYSIS MOTILITY/COUNT

Facility

$81.00

Service Code	HCPCS 89310
Hospital Charge Code	8931000
Hospital Revenue Code	309
Min. Negotiated Rate	$66.42
Max. Negotiated Rate	$78.57
Rate for Payer: Cash Price	$60.75
Rate for Payer: Health Partners Plans Commercial	$76.95
Rate for Payer: UnitedHealthcare Commercial	$78.57
Rate for Payer: WPPA Commercial	$66.42

SEMEN ANALYSIS SPERM

Facility

$57.00

Service Code	HCPCS 89321
Hospital Charge Code	8932100
Hospital Revenue Code	301
Min. Negotiated Rate	$26.33
Max. Negotiated Rate	$55.29
Rate for Payer: BCBS Commercial	$46.24
Rate for Payer: Cash Price	$42.75
Rate for Payer: Cash Price	$42.75
Rate for Payer: Celtic Commercial/Exchange	$26.33
Rate for Payer: Health Partners Plans Commercial	$54.15
Rate for Payer: UnitedHealthcare Commercial	$55.29
Rate for Payer: WPPA Commercial	$47.88

SEMEN ANALYSIS SPERM

Facility

$57.00

Service Code	HCPCS 89321
Hospital Charge Code	8932100
Hospital Revenue Code	301
Min. Negotiated Rate	$46.74
Max. Negotiated Rate	$55.29
Rate for Payer: Cash Price	$42.75
Rate for Payer: Health Partners Plans Commercial	$54.15
Rate for Payer: UnitedHealthcare Commercial	$55.29
Rate for Payer: WPPA Commercial	$46.74

SEMI-POSTERIOR FINGER SPLINT

Facility

$13.00

Hospital Charge Code	2701514
Hospital Revenue Code	270
Min. Negotiated Rate	$10.66
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$10.31
Rate for Payer: Health Partners Plans Commercial	$12.35
Rate for Payer: UnitedHealthcare Commercial	$12.61
Rate for Payer: WPPA Commercial	$10.66

SEMI-POSTERIOR FINGER SPLINT

Facility

$13.00

Hospital Charge Code	2701514
Hospital Revenue Code	270
Min. Negotiated Rate	$6.01
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$10.31
Rate for Payer: Celtic Commercial/Exchange	$6.01
Rate for Payer: Health Partners Plans Commercial	$12.35
Rate for Payer: UnitedHealthcare Commercial	$12.61
Rate for Payer: WPPA Commercial	$10.92

SENIORCARE-RESPITE CARE SERV

Facility

$6.00

Hospital Charge Code	5910021
Hospital Revenue Code	271
Min. Negotiated Rate	$4.92
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$4.50
Rate for Payer: Health Partners Plans Commercial	$5.70
Rate for Payer: UnitedHealthcare Commercial	$5.82
Rate for Payer: WPPA Commercial	$4.92

SENIORCARE-RESPITE CARE SERV

Facility

$6.00

Hospital Charge Code	5910021
Hospital Revenue Code	271
Min. Negotiated Rate	$2.77
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$4.50
Rate for Payer: Celtic Commercial/Exchange	$2.77
Rate for Payer: Health Partners Plans Commercial	$5.70
Rate for Payer: UnitedHealthcare Commercial	$5.82
Rate for Payer: WPPA Commercial	$5.04

SENIORCARE SKLD-MED BOX SET UP

Facility

$40.00

Hospital Charge Code	5710507
Hospital Revenue Code	550
Min. Negotiated Rate	$18.48
Max. Negotiated Rate	$38.80
Rate for Payer: Cash Price	$30.00
Rate for Payer: Celtic Commercial/Exchange	$18.48
Rate for Payer: Health Partners Plans Commercial	$38.00
Rate for Payer: UnitedHealthcare Commercial	$38.80
Rate for Payer: WPPA Commercial	$33.60

SENIORCARE SKLD-MED BOX SET UP

Facility

$40.00

Hospital Charge Code	5710507
Hospital Revenue Code	550
Min. Negotiated Rate	$32.80
Max. Negotiated Rate	$38.80
Rate for Payer: Cash Price	$30.00
Rate for Payer: Health Partners Plans Commercial	$38.00
Rate for Payer: UnitedHealthcare Commercial	$38.80
Rate for Payer: WPPA Commercial	$32.80

SENNA-LAX 8.6 MG TAB (SENNOSIDES)

Facility

$1.00

Service Code	NDC 00904725261
Hospital Charge Code	2506616
Hospital Revenue Code	250
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.75
Rate for Payer: Celtic Commercial/Exchange	$0.46
Rate for Payer: Health Partners Plans Commercial	$0.95
Rate for Payer: UnitedHealthcare Commercial	$0.97
Rate for Payer: WPPA Commercial	$0.84

SENNA-LAX 8.6 MG TAB (SENNOSIDES)

Facility

$1.00

Service Code	NDC 00904725261
Hospital Charge Code	2506616
Hospital Revenue Code	250
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.75
Rate for Payer: Health Partners Plans Commercial	$0.95
Rate for Payer: UnitedHealthcare Commercial	$0.97
Rate for Payer: WPPA Commercial	$0.82

SENNA PLUS TAB (SENNOSIDES + DOCUSATE SODIUM)

Facility

$1.00

Service Code	NDC 46122062572
Hospital Charge Code	2512697
Hospital Revenue Code	250
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$1.20
Rate for Payer: Health Partners Plans Commercial	$0.95
Rate for Payer: UnitedHealthcare Commercial	$0.97
Rate for Payer: WPPA Commercial	$0.82

SENNA PLUS TAB (SENNOSIDES + DOCUSATE SODIUM)

Facility

$1.00

Service Code	NDC 46122062572
Hospital Charge Code	2512697
Hospital Revenue Code	250
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$1.20
Rate for Payer: Celtic Commercial/Exchange	$0.46
Rate for Payer: Health Partners Plans Commercial	$0.95
Rate for Payer: UnitedHealthcare Commercial	$0.97
Rate for Payer: WPPA Commercial	$0.84

SENSOR LNOP SPO2 ADULT

Facility

$50.00

Hospital Charge Code	2700908
Hospital Revenue Code	270
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$48.50
Rate for Payer: Cash Price	$37.50
Rate for Payer: Celtic Commercial/Exchange	$23.10
Rate for Payer: Health Partners Plans Commercial	$47.50
Rate for Payer: UnitedHealthcare Commercial	$48.50
Rate for Payer: WPPA Commercial	$42.00

SENSOR LNOP SPO2 ADULT

Facility

$50.00

Hospital Charge Code	2700908
Hospital Revenue Code	270
Min. Negotiated Rate	$41.00
Max. Negotiated Rate	$48.50
Rate for Payer: Cash Price	$37.50
Rate for Payer: Health Partners Plans Commercial	$47.50
Rate for Payer: UnitedHealthcare Commercial	$48.50
Rate for Payer: WPPA Commercial	$41.00

SENSOR LNOP SPO2 PED

Facility

$50.00

Hospital Charge Code	2700906
Hospital Revenue Code	270
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$48.50
Rate for Payer: Cash Price	$37.50
Rate for Payer: Celtic Commercial/Exchange	$23.10
Rate for Payer: Health Partners Plans Commercial	$47.50
Rate for Payer: UnitedHealthcare Commercial	$48.50
Rate for Payer: WPPA Commercial	$42.00

SENSOR LNOP SPO2 PED

Facility

$50.00

Hospital Charge Code	2700906
Hospital Revenue Code	270
Min. Negotiated Rate	$41.00
Max. Negotiated Rate	$48.50
Rate for Payer: Cash Price	$37.50
Rate for Payer: Health Partners Plans Commercial	$47.50
Rate for Payer: UnitedHealthcare Commercial	$48.50
Rate for Payer: WPPA Commercial	$41.00

SENSOR NELLCOR SPO2 ADH INFANT

Facility

$31.00

Hospital Charge Code	2700907
Hospital Revenue Code	272
Min. Negotiated Rate	$14.32
Max. Negotiated Rate	$30.07
Rate for Payer: Cash Price	$23.25
Rate for Payer: Celtic Commercial/Exchange	$14.32
Rate for Payer: Health Partners Plans Commercial	$29.45
Rate for Payer: UnitedHealthcare Commercial	$30.07
Rate for Payer: WPPA Commercial	$26.04

SENSOR NELLCOR SPO2 ADH INFANT

Facility

$31.00

Hospital Charge Code	2700907
Hospital Revenue Code	272
Min. Negotiated Rate	$25.42
Max. Negotiated Rate	$30.07
Rate for Payer: Cash Price	$23.25
Rate for Payer: Health Partners Plans Commercial	$29.45
Rate for Payer: UnitedHealthcare Commercial	$30.07
Rate for Payer: WPPA Commercial	$25.42

SENSOR NELLCOR SPO2 ADH PED

Facility

$50.00

Hospital Charge Code	2709666
Hospital Revenue Code	270
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$48.50
Rate for Payer: Cash Price	$37.50
Rate for Payer: Celtic Commercial/Exchange	$23.10
Rate for Payer: Health Partners Plans Commercial	$47.50
Rate for Payer: UnitedHealthcare Commercial	$48.50
Rate for Payer: WPPA Commercial	$42.00

SENSOR NELLCOR SPO2 ADH PED

Facility

$50.00

Hospital Charge Code	2709666
Hospital Revenue Code	270
Min. Negotiated Rate	$41.00
Max. Negotiated Rate	$48.50
Rate for Payer: Cash Price	$37.50
Rate for Payer: Health Partners Plans Commercial	$47.50
Rate for Payer: UnitedHealthcare Commercial	$48.50
Rate for Payer: WPPA Commercial	$41.00

Know your out-of-pocket cost for care.

All Charges