Ness County Hospital

All Charges

Charge

Type

Setting

Price

SHOWER CHAIR WITH BACK

Facility

$173.00

Hospital Charge Code	5710256
Hospital Revenue Code	271
Min. Negotiated Rate	$141.86
Max. Negotiated Rate	$167.81
Rate for Payer: Cash Price	$130.31
Rate for Payer: Health Partners Plans Commercial	$164.35
Rate for Payer: UnitedHealthcare Commercial	$167.81
Rate for Payer: WPPA Commercial	$141.86

SHOWER SEAT

Facility

$121.00

Hospital Charge Code	5710266
Hospital Revenue Code	271
Min. Negotiated Rate	$99.22
Max. Negotiated Rate	$117.37
Rate for Payer: Cash Price	$91.31
Rate for Payer: Health Partners Plans Commercial	$114.95
Rate for Payer: UnitedHealthcare Commercial	$117.37
Rate for Payer: WPPA Commercial	$99.22

SHOWER SEAT

Facility

$121.00

Hospital Charge Code	5710266
Hospital Revenue Code	271
Min. Negotiated Rate	$55.90
Max. Negotiated Rate	$117.37
Rate for Payer: Cash Price	$91.31
Rate for Payer: Celtic Commercial/Exchange	$55.90
Rate for Payer: Health Partners Plans Commercial	$114.95
Rate for Payer: UnitedHealthcare Commercial	$117.37
Rate for Payer: WPPA Commercial	$101.64

SHOWER TRANSFER

Facility

$442.00

Hospital Charge Code	5710199
Hospital Revenue Code	271
Min. Negotiated Rate	$362.44
Max. Negotiated Rate	$428.74
Rate for Payer: Cash Price	$332.06
Rate for Payer: Health Partners Plans Commercial	$419.90
Rate for Payer: UnitedHealthcare Commercial	$428.74
Rate for Payer: WPPA Commercial	$362.44

SHOWER TRANSFER

Facility

$442.00

Hospital Charge Code	5710199
Hospital Revenue Code	271
Min. Negotiated Rate	$204.20
Max. Negotiated Rate	$428.74
Rate for Payer: Cash Price	$332.06
Rate for Payer: Celtic Commercial/Exchange	$204.20
Rate for Payer: Health Partners Plans Commercial	$419.90
Rate for Payer: UnitedHealthcare Commercial	$428.74
Rate for Payer: WPPA Commercial	$371.28

SICKLE CELL SCREEN

Facility

$50.00

Service Code	HCPCS 85660
Hospital Charge Code	8566000
Hospital Revenue Code	305
Min. Negotiated Rate	$14.33
Max. Negotiated Rate	$48.50
Rate for Payer: BCBS Commercial	$14.33
Rate for Payer: Cash Price	$37.50
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

SICKLE CELL SCREEN

Facility

$50.00

Service Code	HCPCS 85660
Hospital Charge Code	8566000
Hospital Revenue Code	305
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

SIGNOID FLEX;W/DIR SUBMUC INJ

Facility

$832.00

Service Code	HCPCS 45335
Hospital Charge Code	4533500
Hospital Revenue Code	761
Min. Negotiated Rate	$384.38
Max. Negotiated Rate	$1,139.64
Rate for Payer: BCBS Commercial	$1,139.64
Rate for Payer: Cash Price	$624.00
Rate for Payer: Cash Price	$624.00
Rate for Payer: Celtic Commercial/Exchange	$384.38
Rate for Payer: Health Partners Plans Commercial	$790.40
Rate for Payer: UnitedHealthcare Commercial	$807.04
Rate for Payer: WPPA Commercial	$698.88

SIGNOID FLEX;W/DIR SUBMUC INJ

Facility

$832.00

Service Code	HCPCS 45335
Hospital Charge Code	4533500
Hospital Revenue Code	761
Min. Negotiated Rate	$682.24
Max. Negotiated Rate	$807.04
Rate for Payer: Cash Price	$624.00
Rate for Payer: Health Partners Plans Commercial	$790.40
Rate for Payer: UnitedHealthcare Commercial	$807.04
Rate for Payer: WPPA Commercial	$682.24

SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC

Facility

$12,146.11

Service Code	MSDRG 555
Min. Negotiated Rate	$12,146.11
Max. Negotiated Rate	$12,146.11
Rate for Payer: BCBS Commercial	$12,146.11

SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC

Facility

$5,692.41

Service Code	MSDRG 556
Min. Negotiated Rate	$5,692.41
Max. Negotiated Rate	$5,692.41
Rate for Payer: BCBS Commercial	$5,692.41

SIGNS AND SYMPTOMS WITH MCC

Facility

$10,705.70

Service Code	MSDRG 947
Min. Negotiated Rate	$10,705.70
Max. Negotiated Rate	$10,705.70
Rate for Payer: BCBS Commercial	$10,705.70

SIGNS AND SYMPTOMS WITHOUT MCC

Facility

$6,985.91

Service Code	MSDRG 948
Min. Negotiated Rate	$6,985.91
Max. Negotiated Rate	$6,985.91
Rate for Payer: BCBS Commercial	$6,985.91

SI JOINTS 3 OR MORE VIEWS

Facility

$389.00

Service Code	HCPCS 72202
Hospital Charge Code	3270026
Hospital Revenue Code	320
Min. Negotiated Rate	$144.96
Max. Negotiated Rate	$377.33
Rate for Payer: BCBS Commercial	$144.96
Rate for Payer: Cash Price	$291.75
Rate for Payer: Cash Price	$291.75
Rate for Payer: Celtic Commercial/Exchange	$179.72
Rate for Payer: Health Partners Plans Commercial	$369.55
Rate for Payer: UnitedHealthcare Commercial	$377.33
Rate for Payer: WPPA Commercial	$326.76

SI JOINTS 3 OR MORE VIEWS

Facility

$389.00

Service Code	HCPCS 72202
Hospital Charge Code	3270026
Hospital Revenue Code	320
Min. Negotiated Rate	$318.98
Max. Negotiated Rate	$377.33
Rate for Payer: Cash Price	$291.75
Rate for Payer: Health Partners Plans Commercial	$369.55
Rate for Payer: UnitedHealthcare Commercial	$377.33
Rate for Payer: WPPA Commercial	$318.98

Silvadene Cream 25 GM tube(silver sulfadiazine)

Facility

$32.00

Service Code	NDC 43598021025
Hospital Charge Code	2506319
Hospital Revenue Code	250
Min. Negotiated Rate	$26.24
Max. Negotiated Rate	$31.04
Rate for Payer: Cash Price	$24.08
Rate for Payer: Health Partners Plans Commercial	$30.40
Rate for Payer: UnitedHealthcare Commercial	$31.04
Rate for Payer: WPPA Commercial	$26.24

Silvadene Cream 25 GM tube(silver sulfadiazine)

Facility

$32.00

Service Code	NDC 43598021025
Hospital Charge Code	2506319
Hospital Revenue Code	250
Min. Negotiated Rate	$14.78
Max. Negotiated Rate	$31.04
Rate for Payer: Cash Price	$24.08
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

Silvadene Cream 50 GM (silver sulfadiazine)

Facility

$43.00

Service Code	NDC 43598021055
Hospital Charge Code	2506327
Hospital Revenue Code	250
Min. Negotiated Rate	$19.87
Max. Negotiated Rate	$41.71
Rate for Payer: Cash Price	$32.36
Rate for Payer: Celtic Commercial/Exchange	$19.87
Rate for Payer: Health Partners Plans Commercial	$40.85
Rate for Payer: UnitedHealthcare Commercial	$41.71
Rate for Payer: WPPA Commercial	$36.12

Silvadene Cream 50 GM (silver sulfadiazine)

Facility

$43.00

Service Code	NDC 43598021055
Hospital Charge Code	2506327
Hospital Revenue Code	250
Min. Negotiated Rate	$35.26
Max. Negotiated Rate	$41.71
Rate for Payer: Cash Price	$32.36
Rate for Payer: Health Partners Plans Commercial	$40.85
Rate for Payer: UnitedHealthcare Commercial	$41.71
Rate for Payer: WPPA Commercial	$35.26

SILVER ALGINATE

Facility

$19.00

Hospital Charge Code	2720788
Hospital Revenue Code	272
Min. Negotiated Rate	$15.58
Max. Negotiated Rate	$18.43
Rate for Payer: Cash Price	$14.25
Rate for Payer: Health Partners Plans Commercial	$18.05
Rate for Payer: UnitedHealthcare Commercial	$18.43
Rate for Payer: WPPA Commercial	$15.58

SILVER ALGINATE

Facility

$19.00

Hospital Charge Code	2720788
Hospital Revenue Code	272
Min. Negotiated Rate	$8.78
Max. Negotiated Rate	$18.43
Rate for Payer: Cash Price	$14.25
Rate for Payer: Celtic Commercial/Exchange	$8.78
Rate for Payer: Health Partners Plans Commercial	$18.05
Rate for Payer: UnitedHealthcare Commercial	$18.43
Rate for Payer: WPPA Commercial	$15.96

SILVERCEL 4X8

Facility

$31.00

Hospital Charge Code	2720790
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

SILVERCEL 4X8

Facility

$31.00

Hospital Charge Code	2720790
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

SILVERCEL DRESSING 4.25X4.25

Facility

$30.00

Hospital Charge Code	2720789
Hospital Revenue Code	272
Min. Negotiated Rate	$24.60
Max. Negotiated Rate	$29.10
Rate for Payer: Cash Price	$22.50
Rate for Payer: Health Partners Plans Commercial	$28.50
Rate for Payer: UnitedHealthcare Commercial	$29.10
Rate for Payer: WPPA Commercial	$24.60

SILVERCEL DRESSING 4.25X4.25

Facility

$30.00

Hospital Charge Code	2720789
Hospital Revenue Code	272
Min. Negotiated Rate	$13.86
Max. Negotiated Rate	$29.10
Rate for Payer: Cash Price	$22.50
Rate for Payer: Celtic Commercial/Exchange	$13.86
Rate for Payer: Health Partners Plans Commercial	$28.50
Rate for Payer: UnitedHealthcare Commercial	$29.10
Rate for Payer: WPPA Commercial	$25.20

Know your out-of-pocket cost for care.

All Charges