Ness County Hospital

All Charges

Charge

Type

Setting

Price

SIMPL REPR SCLP/TRUNK >30.0CM

Facility

$1,539.00

Service Code	HCPCS 12007
Hospital Charge Code	1200700
Hospital Revenue Code	450
Min. Negotiated Rate	$711.02
Max. Negotiated Rate	$1,538.23
Rate for Payer: BCBS Commercial	$1,538.23
Rate for Payer: Cash Price	$1,154.25
Rate for Payer: Cash Price	$1,154.25
Rate for Payer: Celtic Commercial/Exchange	$711.02
Rate for Payer: Health Partners Plans Commercial	$1,462.05
Rate for Payer: UnitedHealthcare Commercial	$1,492.83
Rate for Payer: WPPA Commercial	$1,292.76

SIMPL REPR SCLP/TRUNK >30.0CM

Facility

$1,539.00

Service Code	HCPCS 12007
Hospital Charge Code	1200700
Hospital Revenue Code	450
Min. Negotiated Rate	$1,261.98
Max. Negotiated Rate	$1,492.83
Rate for Payer: Cash Price	$1,154.25
Rate for Payer: Health Partners Plans Commercial	$1,462.05
Rate for Payer: UnitedHealthcare Commercial	$1,492.83
Rate for Payer: WPPA Commercial	$1,261.98

SIMPL REPR SCLP/TRUNK 7.6-12.5

Facility

$578.00

Service Code	HCPCS 12004
Hospital Charge Code	1200400
Hospital Revenue Code	761
Min. Negotiated Rate	$473.96
Max. Negotiated Rate	$560.66
Rate for Payer: Cash Price	$433.50
Rate for Payer: Health Partners Plans Commercial	$549.10
Rate for Payer: UnitedHealthcare Commercial	$560.66
Rate for Payer: WPPA Commercial	$473.96

SIMPL REPR SCLP/TRUNK 7.6-12.5

Facility

$578.00

Service Code	HCPCS 12004
Hospital Charge Code	1200400
Hospital Revenue Code	761
Min. Negotiated Rate	$267.04
Max. Negotiated Rate	$577.72
Rate for Payer: BCBS Commercial	$577.72
Rate for Payer: Cash Price	$433.50
Rate for Payer: Cash Price	$433.50
Rate for Payer: Celtic Commercial/Exchange	$267.04
Rate for Payer: Health Partners Plans Commercial	$549.10
Rate for Payer: UnitedHealthcare Commercial	$560.66
Rate for Payer: WPPA Commercial	$485.52

Simponi ARIA (golimumab) IV solution

Facility

$7,197.00

Service Code	NDC 57894035001
Hospital Charge Code	2510204
Hospital Revenue Code	250
Min. Negotiated Rate	$5,901.54
Max. Negotiated Rate	$6,981.09
Rate for Payer: Cash Price	$5,397.83
Rate for Payer: Health Partners Plans Commercial	$6,837.15
Rate for Payer: UnitedHealthcare Commercial	$6,981.09
Rate for Payer: WPPA Commercial	$5,901.54

Simponi ARIA (golimumab) IV solution

Facility

$7,197.00

Service Code	NDC 57894035001
Hospital Charge Code	2510204
Hospital Revenue Code	250
Min. Negotiated Rate	$3,325.01
Max. Negotiated Rate	$6,981.09
Rate for Payer: Cash Price	$5,397.83
Rate for Payer: Celtic Commercial/Exchange	$3,325.01
Rate for Payer: Health Partners Plans Commercial	$6,837.15
Rate for Payer: UnitedHealthcare Commercial	$6,981.09
Rate for Payer: WPPA Commercial	$6,045.48

SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT

Facility

$61,498.50

Service Code	MSDRG 008
Min. Negotiated Rate	$61,498.50
Max. Negotiated Rate	$61,498.50
Rate for Payer: BCBS Commercial	$61,498.50

SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS

Facility

$84,330.66

Service Code	MSDRG 019
Min. Negotiated Rate	$84,330.66
Max. Negotiated Rate	$84,330.66
Rate for Payer: BCBS Commercial	$84,330.66

SINEMET 10/100 MG TAB (CARBIDOPA + LEVODOPA)

Facility

$3.00

Service Code	NDC 51862085501
Hospital Charge Code	2506350
Hospital Revenue Code	250
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.90
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

SINEMET 10/100 MG TAB (CARBIDOPA + LEVODOPA)

Facility

$3.00

Service Code	NDC 51862085501
Hospital Charge Code	2506350
Hospital Revenue Code	250
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.90
Rate for Payer: Health Partners Plans Commercial	$2.85
Rate for Payer: UnitedHealthcare Commercial	$2.91
Rate for Payer: WPPA Commercial	$2.46

SINEMET 25/100 MG TAB (CARBIDOPA + LEVODOPA)

Facility

$4.00

Service Code	NDC 60687066111
Hospital Charge Code	2506368
Hospital Revenue Code	250
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

SINEMET 25/100 MG TAB (CARBIDOPA + LEVODOPA)

Facility

$4.00

Service Code	NDC 60687066111
Hospital Charge Code	2506368
Hospital Revenue Code	250
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

SINEMET 25/250 MG TAB (CARBIDOPA + LEVODOPA)

Facility

$3.00

Service Code	NDC 68084009401
Hospital Charge Code	2517894
Hospital Revenue Code	250
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.33
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

SINEMET 25/250 MG TAB (CARBIDOPA + LEVODOPA)

Facility

$3.00

Service Code	NDC 68084009401
Hospital Charge Code	2517894
Hospital Revenue Code	250
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.33
Rate for Payer: Health Partners Plans Commercial	$2.85
Rate for Payer: UnitedHealthcare Commercial	$2.91
Rate for Payer: WPPA Commercial	$2.46

SINEQUAN 10 MG CAP (DOXEPIN HCL)

Facility

$1.00

Service Code	NDC 51079043620
Hospital Charge Code	2510154
Hospital Revenue Code	250
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$1.42
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

SINEQUAN 10 MG CAP (DOXEPIN HCL)

Facility

$1.00

Service Code	NDC 51079043620
Hospital Charge Code	2510154
Hospital Revenue Code	250
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$1.42
Rate for Payer: Health Partners Plans Commercial	$0.95
Rate for Payer: UnitedHealthcare Commercial	$0.97
Rate for Payer: WPPA Commercial	$0.82

SINGLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL

Facility

$41,169.70

Service Code	MSDRG 402
Min. Negotiated Rate	$41,169.70
Max. Negotiated Rate	$41,169.70
Rate for Payer: BCBS Commercial	$41,169.70

SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE

Facility

$45,257.61

Service Code	MSDRG 450
Min. Negotiated Rate	$45,257.61
Max. Negotiated Rate	$45,257.61
Rate for Payer: BCBS Commercial	$45,257.61

SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC

Facility

$31,396.13

Service Code	MSDRG 451
Min. Negotiated Rate	$31,396.13
Max. Negotiated Rate	$31,396.13
Rate for Payer: BCBS Commercial	$31,396.13

SINGULAIR 5 MG CHEWABLE TAB (MONTELUKAST SODIUM)

Facility

$17.00

Service Code	NDC 50268057411
Hospital Charge Code	2505485
Hospital Revenue Code	250
Min. Negotiated Rate	$13.94
Max. Negotiated Rate	$16.49
Rate for Payer: Cash Price	$12.86
Rate for Payer: Health Partners Plans Commercial	$16.15
Rate for Payer: UnitedHealthcare Commercial	$16.49
Rate for Payer: WPPA Commercial	$13.94

SINGULAIR 5 MG CHEWABLE TAB (MONTELUKAST SODIUM)

Facility

$17.00

Service Code	NDC 50268057411
Hospital Charge Code	2505485
Hospital Revenue Code	250
Min. Negotiated Rate	$7.85
Max. Negotiated Rate	$16.49
Rate for Payer: Cash Price	$12.86
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

SINUS AND MASTOID PROCEDURES WITH CC/MCC

Facility

$15,489.02

Service Code	MSDRG 135
Min. Negotiated Rate	$15,489.02
Max. Negotiated Rate	$15,489.02
Rate for Payer: BCBS Commercial	$15,489.02

SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC

Facility

$8,258.45

Service Code	MSDRG 136
Min. Negotiated Rate	$8,258.45
Max. Negotiated Rate	$8,258.45
Rate for Payer: BCBS Commercial	$8,258.45

SINUSES 3 OR MORE VIEWS

Facility

$250.00

Service Code	HCPCS 70220
Hospital Charge Code	3260020
Hospital Revenue Code	320
Min. Negotiated Rate	$205.00
Max. Negotiated Rate	$242.50
Rate for Payer: Cash Price	$187.50
Rate for Payer: Health Partners Plans Commercial	$237.50
Rate for Payer: UnitedHealthcare Commercial	$242.50
Rate for Payer: WPPA Commercial	$205.00

SINUSES 3 OR MORE VIEWS

Facility

$250.00

Service Code	HCPCS 70220
Hospital Charge Code	3260020
Hospital Revenue Code	320
Min. Negotiated Rate	$115.50
Max. Negotiated Rate	$242.50
Rate for Payer: BCBS Commercial	$194.20
Rate for Payer: Cash Price	$187.50
Rate for Payer: Cash Price	$187.50
Rate for Payer: Celtic Commercial/Exchange	$115.50
Rate for Payer: Health Partners Plans Commercial	$237.50
Rate for Payer: UnitedHealthcare Commercial	$242.50
Rate for Payer: WPPA Commercial	$210.00

Know your out-of-pocket cost for care.

All Charges