Ness County Hospital

All Charges

Charge

Type

Setting

Price

SENSOR SPO2 CABLE ADTX ADULT

Facility

$37.00

Hospital Charge Code	2700800
Hospital Revenue Code	272
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

SENSOR SPO2 CABLE ADTX ADULT

Facility

$37.00

Hospital Charge Code	2700800
Hospital Revenue Code	272
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

SENSOR SPO2 CABLE PDTX PED

Facility

$50.00

Hospital Charge Code	2700801
Hospital Revenue Code	272
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 SPO2 CABLE PDTX PED

Facility

$50.00

Hospital Charge Code	2700801
Hospital Revenue Code	272
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 SPO2 EAR

Facility

$106.00

Hospital Charge Code	2700802
Hospital Revenue Code	272
Min. Negotiated Rate	$86.92
Max. Negotiated Rate	$102.82
Rate for Payer: Cash Price	$79.50
Rate for Payer: Health Partners Plans Commercial	$100.70
Rate for Payer: UnitedHealthcare Commercial	$102.82
Rate for Payer: WPPA Commercial	$86.92

SENSOR SPO2 EAR

Facility

$106.00

Hospital Charge Code	2700802
Hospital Revenue Code	272
Min. Negotiated Rate	$48.97
Max. Negotiated Rate	$102.82
Rate for Payer: Cash Price	$79.50
Rate for Payer: Celtic Commercial/Exchange	$48.97
Rate for Payer: Health Partners Plans Commercial	$100.70
Rate for Payer: UnitedHealthcare Commercial	$102.82
Rate for Payer: WPPA Commercial	$89.04

SEPTIC ARTHRITIS WITH CC

Facility

$11,093.48

Service Code	MSDRG 549
Min. Negotiated Rate	$11,093.48
Max. Negotiated Rate	$11,093.48
Rate for Payer: BCBS Commercial	$11,093.48

SEPTIC ARTHRITIS WITH MCC

Facility

$15,319.86

Service Code	MSDRG 548
Min. Negotiated Rate	$15,319.86
Max. Negotiated Rate	$15,319.86
Rate for Payer: BCBS Commercial	$15,319.86

SEPTIC ARTHRITIS WITHOUT CC/MCC

Facility

$6,721.41

Service Code	MSDRG 550
Min. Negotiated Rate	$6,721.41
Max. Negotiated Rate	$6,721.41
Rate for Payer: BCBS Commercial	$6,721.41

SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS

Facility

$57,733.71

Service Code	MSDRG 870
Min. Negotiated Rate	$57,733.71
Max. Negotiated Rate	$57,733.71
Rate for Payer: BCBS Commercial	$57,733.71

SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC

Facility

$17,657.09

Service Code	MSDRG 871
Min. Negotiated Rate	$17,657.09
Max. Negotiated Rate	$17,657.09
Rate for Payer: BCBS Commercial	$17,657.09

SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC

Facility

$10,016.62

Service Code	MSDRG 872
Min. Negotiated Rate	$10,016.62
Max. Negotiated Rate	$10,016.62
Rate for Payer: BCBS Commercial	$10,016.62

SERO-HEPATITIS B SURFACE AG

Facility

$40.00

Service Code	HCPCS 86287
Hospital Charge Code	8628700
Hospital Revenue Code	302
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

SERO-HEPATITIS B SURFACE AG

Facility

$40.00

Service Code	HCPCS 86287
Hospital Charge Code	8628700
Hospital Revenue Code	302
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

SEROQUEL 25 MG TAB (QUETIAPINE)

Facility

$13.00

Service Code	NDC 60687032711
Hospital Charge Code	2516268
Hospital Revenue Code	250
Min. Negotiated Rate	$6.01
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$10.01
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

SEROQUEL 25 MG TAB (QUETIAPINE)

Facility

$13.00

Service Code	NDC 60687032711
Hospital Charge Code	2516268
Hospital Revenue Code	250
Min. Negotiated Rate	$10.66
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$10.01
Rate for Payer: Health Partners Plans Commercial	$12.35
Rate for Payer: UnitedHealthcare Commercial	$12.61
Rate for Payer: WPPA Commercial	$10.66

SEROQUEL XR 50 MG TAB (QUETIAPINE ER)

Facility

$16.00

Service Code	NDC 00904680161
Hospital Charge Code	2517019
Hospital Revenue Code	250
Min. Negotiated Rate	$13.12
Max. Negotiated Rate	$15.52
Rate for Payer: Cash Price	$12.26
Rate for Payer: Health Partners Plans Commercial	$15.20
Rate for Payer: UnitedHealthcare Commercial	$15.52
Rate for Payer: WPPA Commercial	$13.12

SEROQUEL XR 50 MG TAB (QUETIAPINE ER)

Facility

$16.00

Service Code	NDC 00904680161
Hospital Charge Code	2517019
Hospital Revenue Code	250
Min. Negotiated Rate	$7.39
Max. Negotiated Rate	$15.52
Rate for Payer: Cash Price	$12.26
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

SEROTONIN

Facility

$219.00

Service Code	HCPCS 84260
Hospital Charge Code	8426000
Hospital Revenue Code	301
Min. Negotiated Rate	$179.58
Max. Negotiated Rate	$212.43
Rate for Payer: Cash Price	$164.25
Rate for Payer: Health Partners Plans Commercial	$208.05
Rate for Payer: UnitedHealthcare Commercial	$212.43
Rate for Payer: WPPA Commercial	$179.58

SEROTONIN

Facility

$219.00

Service Code	HCPCS 84260
Hospital Charge Code	8426000
Hospital Revenue Code	301
Min. Negotiated Rate	$101.18
Max. Negotiated Rate	$212.43
Rate for Payer: BCBS Commercial	$123.67
Rate for Payer: Cash Price	$164.25
Rate for Payer: Cash Price	$164.25
Rate for Payer: Celtic Commercial/Exchange	$101.18
Rate for Payer: Health Partners Plans Commercial	$208.05
Rate for Payer: UnitedHealthcare Commercial	$212.43
Rate for Payer: WPPA Commercial	$183.96

SEX CHROMATIN ID PERIPHERAL

Facility

$92.00

Service Code	HCPCS 88140
Hospital Charge Code	8814000
Hospital Revenue Code	311
Min. Negotiated Rate	$75.44
Max. Negotiated Rate	$89.24
Rate for Payer: Cash Price	$69.00
Rate for Payer: Health Partners Plans Commercial	$87.40
Rate for Payer: UnitedHealthcare Commercial	$89.24
Rate for Payer: WPPA Commercial	$75.44

SEX CHROMATIN ID PERIPHERAL

Facility

$92.00

Service Code	HCPCS 88140
Hospital Charge Code	8814000
Hospital Revenue Code	311
Min. Negotiated Rate	$42.50
Max. Negotiated Rate	$89.24
Rate for Payer: BCBS Commercial	$56.54
Rate for Payer: Cash Price	$69.00
Rate for Payer: Cash Price	$69.00
Rate for Payer: Celtic Commercial/Exchange	$42.50
Rate for Payer: Health Partners Plans Commercial	$87.40
Rate for Payer: UnitedHealthcare Commercial	$89.24
Rate for Payer: WPPA Commercial	$77.28

SEX HORMONE BINDING GLOBULIN

Facility

$211.00

Service Code	HCPCS 84270
Hospital Charge Code	8427000
Hospital Revenue Code	301
Min. Negotiated Rate	$173.02
Max. Negotiated Rate	$204.67
Rate for Payer: Cash Price	$158.25
Rate for Payer: Health Partners Plans Commercial	$200.45
Rate for Payer: UnitedHealthcare Commercial	$204.67
Rate for Payer: WPPA Commercial	$173.02

SEX HORMONE BINDING GLOBULIN

Facility

$211.00

Service Code	HCPCS 84270
Hospital Charge Code	8427000
Hospital Revenue Code	301
Min. Negotiated Rate	$97.48
Max. Negotiated Rate	$204.67
Rate for Payer: BCBS Commercial	$128.86
Rate for Payer: Cash Price	$158.25
Rate for Payer: Cash Price	$158.25
Rate for Payer: Celtic Commercial/Exchange	$97.48
Rate for Payer: Health Partners Plans Commercial	$200.45
Rate for Payer: UnitedHealthcare Commercial	$204.67
Rate for Payer: WPPA Commercial	$177.24

SHAMPOO CAP

Facility

$11.00

Hospital Charge Code	9999050
Hospital Revenue Code	990
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

Know your out-of-pocket cost for care.

All Charges