Ness County Hospital

All Charges

Charge

Type

Setting

Price

SINUSES < 3 VIEWS

Facility

$160.00

Service Code	HCPCS 70210
Hospital Charge Code	3260018
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

SINUSES < 3 VIEWS

Facility

$160.00

Service Code	HCPCS 70210
Hospital Charge Code	3260018
Hospital Revenue Code	320
Min. Negotiated Rate	$73.92
Max. Negotiated Rate	$155.20
Rate for Payer: BCBS Commercial	$110.06
Rate for Payer: Cash Price	$120.45
Rate for Payer: Cash Price	$120.45
Rate for Payer: Celtic Commercial/Exchange	$73.92
Rate for Payer: Health Partners Plans Commercial	$152.00
Rate for Payer: UnitedHealthcare Commercial	$155.20
Rate for Payer: WPPA Commercial	$134.40

SITZ BATH

Facility

$16.00

Hospital Charge Code	2700243
Hospital Revenue Code	270
Min. Negotiated Rate	$13.12
Max. Negotiated Rate	$15.52
Rate for Payer: Cash Price	$12.00
Rate for Payer: Health Partners Plans Commercial	$15.20
Rate for Payer: UnitedHealthcare Commercial	$15.52
Rate for Payer: WPPA Commercial	$13.12

SITZ BATH

Facility

$16.00

Hospital Charge Code	2700243
Hospital Revenue Code	270
Min. Negotiated Rate	$7.39
Max. Negotiated Rate	$15.52
Rate for Payer: Cash Price	$12.00
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

SJOGREN'S ANTIBODY (SS-A)

Facility

$368.00

Service Code	HCPCS 86235
Hospital Charge Code	8623506
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

SJOGREN'S ANTIBODY (SS-A)

Facility

$368.00

Service Code	HCPCS 86235
Hospital Charge Code	8623506
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

SJOGREN'S ANTIBODY (SS-B)

Facility

$368.00

Service Code	HCPCS 86235
Hospital Charge Code	8623505
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

SJOGREN'S ANTIBODY (SS-B)

Facility

$368.00

Service Code	HCPCS 86235
Hospital Charge Code	8623505
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

SKELETAL SURVEY COMPLETE

Facility

$750.00

Service Code	HCPCS 77075
Hospital Charge Code	7707500
Hospital Revenue Code	320
Min. Negotiated Rate	$346.50
Max. Negotiated Rate	$727.50
Rate for Payer: BCBS Commercial	$506.41
Rate for Payer: Cash Price	$562.50
Rate for Payer: Cash Price	$562.50
Rate for Payer: Celtic Commercial/Exchange	$346.50
Rate for Payer: Health Partners Plans Commercial	$712.50
Rate for Payer: UnitedHealthcare Commercial	$727.50
Rate for Payer: WPPA Commercial	$630.00

SKELETAL SURVEY COMPLETE

Facility

$750.00

Service Code	HCPCS 77075
Hospital Charge Code	7707500
Hospital Revenue Code	320
Min. Negotiated Rate	$615.00
Max. Negotiated Rate	$727.50
Rate for Payer: Cash Price	$562.50
Rate for Payer: Health Partners Plans Commercial	$712.50
Rate for Payer: UnitedHealthcare Commercial	$727.50
Rate for Payer: WPPA Commercial	$615.00

SKELETAL SURVEY, LIMITED

Facility

$600.00

Service Code	HCPCS 77074
Hospital Charge Code	7707400
Hospital Revenue Code	320
Min. Negotiated Rate	$492.00
Max. Negotiated Rate	$582.00
Rate for Payer: Cash Price	$450.00
Rate for Payer: Health Partners Plans Commercial	$570.00
Rate for Payer: UnitedHealthcare Commercial	$582.00
Rate for Payer: WPPA Commercial	$492.00

SKELETAL SURVEY, LIMITED

Facility

$600.00

Service Code	HCPCS 77074
Hospital Charge Code	7707400
Hospital Revenue Code	320
Min. Negotiated Rate	$132.93
Max. Negotiated Rate	$582.00
Rate for Payer: BCBS Commercial	$132.93
Rate for Payer: Cash Price	$450.00
Rate for Payer: Cash Price	$450.00
Rate for Payer: Celtic Commercial/Exchange	$277.20
Rate for Payer: Health Partners Plans Commercial	$570.00
Rate for Payer: UnitedHealthcare Commercial	$582.00
Rate for Payer: WPPA Commercial	$504.00

SKEL MUSC RELAXANT 3+ SCREEN

Facility

$271.00

Service Code	HCPCS 80370
Hospital Charge Code	8037000
Hospital Revenue Code	300
Min. Negotiated Rate	$90.65
Max. Negotiated Rate	$262.87
Rate for Payer: BCBS Commercial	$90.65
Rate for Payer: Cash Price	$203.25
Rate for Payer: Cash Price	$203.25
Rate for Payer: Celtic Commercial/Exchange	$125.20
Rate for Payer: Health Partners Plans Commercial	$257.45
Rate for Payer: UnitedHealthcare Commercial	$262.87
Rate for Payer: WPPA Commercial	$227.64

SKEL MUSC RELAXANT 3+ SCREEN

Facility

$271.00

Service Code	HCPCS 80370
Hospital Charge Code	8037000
Hospital Revenue Code	300
Min. Negotiated Rate	$222.22
Max. Negotiated Rate	$262.87
Rate for Payer: Cash Price	$203.25
Rate for Payer: Health Partners Plans Commercial	$257.45
Rate for Payer: UnitedHealthcare Commercial	$262.87
Rate for Payer: WPPA Commercial	$222.22

SKILLED MED BOX SET-UP 1/4 HR

Facility

$15.00

Service Code	HCPCS G0164
Hospital Charge Code	5710502
Hospital Revenue Code	550
Min. Negotiated Rate	$6.93
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$11.25
Rate for Payer: Celtic Commercial/Exchange	$6.93
Rate for Payer: Health Partners Plans Commercial	$14.25
Rate for Payer: UnitedHealthcare Commercial	$14.55
Rate for Payer: WPPA Commercial	$12.60

SKILLED MED BOX SET-UP 1/4 HR

Facility

$15.00

Service Code	HCPCS G0164
Hospital Charge Code	5710502
Hospital Revenue Code	550
Min. Negotiated Rate	$12.30
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$11.25
Rate for Payer: Health Partners Plans Commercial	$14.25
Rate for Payer: UnitedHealthcare Commercial	$14.55
Rate for Payer: WPPA Commercial	$12.30

SKILLED NURSE VISIT

Facility

$50.00

Service Code	HCPCS S0316
Hospital Charge Code	5712683
Hospital Revenue Code	551
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

SKILLED NURSE VISIT

Facility

$50.00

Service Code	HCPCS S0316
Hospital Charge Code	5712683
Hospital Revenue Code	551
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

SKILLED NURSING VISIT

Facility

$50.00

Service Code	HCPCS G0299
Hospital Charge Code	5910033
Hospital Revenue Code	550
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

SKILLED NURSING VISIT

Facility

$50.00

Service Code	HCPCS G0299
Hospital Charge Code	5910033
Hospital Revenue Code	550
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

SKIN DEBRIDEMENT WITH CC

Facility

$14,515.00

Service Code	MSDRG 571
Min. Negotiated Rate	$14,515.00
Max. Negotiated Rate	$14,515.00
Rate for Payer: BCBS Commercial	$14,515.00

SKIN DEBRIDEMENT WITH MCC

Facility

$25,479.39

Service Code	MSDRG 570
Min. Negotiated Rate	$25,479.39
Max. Negotiated Rate	$25,479.39
Rate for Payer: BCBS Commercial	$25,479.39

SKIN DEBRIDEMENT WITHOUT CC/MCC

Facility

$9,902.31

Service Code	MSDRG 572
Min. Negotiated Rate	$9,902.31
Max. Negotiated Rate	$9,902.31
Rate for Payer: BCBS Commercial	$9,902.31

SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC

Facility

$16,024.44

Service Code	MSDRG 577
Min. Negotiated Rate	$16,024.44
Max. Negotiated Rate	$16,024.44
Rate for Payer: BCBS Commercial	$16,024.44

SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC

Facility

$33,504.03

Service Code	MSDRG 576
Min. Negotiated Rate	$33,504.03
Max. Negotiated Rate	$33,504.03
Rate for Payer: BCBS Commercial	$33,504.03

Know your out-of-pocket cost for care.

All Charges