Ness County Hospital

All Charges

Charge

Type

Setting

Price

SKULL 4 VIEW MINIMUM

Facility

$410.00

Service Code	HCPCS 70260
Hospital Charge Code	3260004
Hospital Revenue Code	320
Min. Negotiated Rate	$336.20
Max. Negotiated Rate	$397.70
Rate for Payer: Cash Price	$307.50
Rate for Payer: Health Partners Plans Commercial	$389.50
Rate for Payer: UnitedHealthcare Commercial	$397.70
Rate for Payer: WPPA Commercial	$336.20

SKULL < 4 VIEWS

Facility

$265.00

Service Code	HCPCS 70250
Hospital Charge Code	3260002
Hospital Revenue Code	320
Min. Negotiated Rate	$217.30
Max. Negotiated Rate	$257.05
Rate for Payer: Cash Price	$198.75
Rate for Payer: Health Partners Plans Commercial	$251.75
Rate for Payer: UnitedHealthcare Commercial	$257.05
Rate for Payer: WPPA Commercial	$217.30

SKULL < 4 VIEWS

Facility

$265.00

Service Code	HCPCS 70250
Hospital Charge Code	3260002
Hospital Revenue Code	320
Min. Negotiated Rate	$122.43
Max. Negotiated Rate	$257.05
Rate for Payer: BCBS Commercial	$143.10
Rate for Payer: Cash Price	$198.75
Rate for Payer: Cash Price	$198.75
Rate for Payer: Celtic Commercial/Exchange	$122.43
Rate for Payer: Health Partners Plans Commercial	$251.75
Rate for Payer: UnitedHealthcare Commercial	$257.05
Rate for Payer: WPPA Commercial	$222.60

SLING & SWATH

Facility

$78.00

Hospital Charge Code	2702991
Hospital Revenue Code	270
Min. Negotiated Rate	$63.96
Max. Negotiated Rate	$75.66
Rate for Payer: Cash Price	$58.50
Rate for Payer: Health Partners Plans Commercial	$74.10
Rate for Payer: UnitedHealthcare Commercial	$75.66
Rate for Payer: WPPA Commercial	$63.96

SLING & SWATH

Facility

$78.00

Hospital Charge Code	2702991
Hospital Revenue Code	270
Min. Negotiated Rate	$36.04
Max. Negotiated Rate	$75.66
Rate for Payer: Cash Price	$58.50
Rate for Payer: Celtic Commercial/Exchange	$36.04
Rate for Payer: Health Partners Plans Commercial	$74.10
Rate for Payer: UnitedHealthcare Commercial	$75.66
Rate for Payer: WPPA Commercial	$65.52

SLING & SWATHE LG

Facility

$45.00

Hospital Charge Code	2702992
Hospital Revenue Code	270
Min. Negotiated Rate	$36.90
Max. Negotiated Rate	$43.65
Rate for Payer: Cash Price	$33.75
Rate for Payer: Health Partners Plans Commercial	$42.75
Rate for Payer: UnitedHealthcare Commercial	$43.65
Rate for Payer: WPPA Commercial	$36.90

SLING & SWATHE LG

Facility

$45.00

Hospital Charge Code	2702992
Hospital Revenue Code	270
Min. Negotiated Rate	$20.79
Max. Negotiated Rate	$43.65
Rate for Payer: Cash Price	$33.75
Rate for Payer: Celtic Commercial/Exchange	$20.79
Rate for Payer: Health Partners Plans Commercial	$42.75
Rate for Payer: UnitedHealthcare Commercial	$43.65
Rate for Payer: WPPA Commercial	$37.80

SLING & SWATHE MD

Facility

$45.00

Hospital Charge Code	2702993
Hospital Revenue Code	270
Min. Negotiated Rate	$20.79
Max. Negotiated Rate	$43.65
Rate for Payer: Cash Price	$33.75
Rate for Payer: Celtic Commercial/Exchange	$20.79
Rate for Payer: Health Partners Plans Commercial	$42.75
Rate for Payer: UnitedHealthcare Commercial	$43.65
Rate for Payer: WPPA Commercial	$37.80

SLING & SWATHE MD

Facility

$45.00

Hospital Charge Code	2702993
Hospital Revenue Code	270
Min. Negotiated Rate	$36.90
Max. Negotiated Rate	$43.65
Rate for Payer: Cash Price	$33.75
Rate for Payer: Health Partners Plans Commercial	$42.75
Rate for Payer: UnitedHealthcare Commercial	$43.65
Rate for Payer: WPPA Commercial	$36.90

SLING & SWATHE SM

Facility

$45.00

Hospital Charge Code	2702994
Hospital Revenue Code	270
Min. Negotiated Rate	$20.79
Max. Negotiated Rate	$43.65
Rate for Payer: Cash Price	$33.75
Rate for Payer: Celtic Commercial/Exchange	$20.79
Rate for Payer: Health Partners Plans Commercial	$42.75
Rate for Payer: UnitedHealthcare Commercial	$43.65
Rate for Payer: WPPA Commercial	$37.80

SLING & SWATHE SM

Facility

$45.00

Hospital Charge Code	2702994
Hospital Revenue Code	270
Min. Negotiated Rate	$36.90
Max. Negotiated Rate	$43.65
Rate for Payer: Cash Price	$33.75
Rate for Payer: Health Partners Plans Commercial	$42.75
Rate for Payer: UnitedHealthcare Commercial	$43.65
Rate for Payer: WPPA Commercial	$36.90

SMALL/MED GEL CUSHION

Facility

$84.00

Hospital Charge Code	2700442
Hospital Revenue Code	270
Min. Negotiated Rate	$68.88
Max. Negotiated Rate	$81.48
Rate for Payer: Cash Price	$63.00
Rate for Payer: Health Partners Plans Commercial	$79.80
Rate for Payer: UnitedHealthcare Commercial	$81.48
Rate for Payer: WPPA Commercial	$68.88

SMALL/MED GEL CUSHION

Facility

$84.00

Hospital Charge Code	2700442
Hospital Revenue Code	270
Min. Negotiated Rate	$38.81
Max. Negotiated Rate	$81.48
Rate for Payer: Cash Price	$63.00
Rate for Payer: Celtic Commercial/Exchange	$38.81
Rate for Payer: Health Partners Plans Commercial	$79.80
Rate for Payer: UnitedHealthcare Commercial	$81.48
Rate for Payer: WPPA Commercial	$70.56

SMARTCAP ENDOSCOPY TUBING

Facility

$50.00

Hospital Charge Code	2720986
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

SMARTCAP ENDOSCOPY TUBING

Facility

$50.00

Hospital Charge Code	2720986
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

SMEAR,PRIM SOURCE,COMPLX SPEC

Facility

$97.00

Service Code	HCPCS 87209
Hospital Charge Code	8720900
Hospital Revenue Code	306
Min. Negotiated Rate	$38.57
Max. Negotiated Rate	$94.09
Rate for Payer: BCBS Commercial	$38.57
Rate for Payer: Cash Price	$72.75
Rate for Payer: Cash Price	$72.75
Rate for Payer: Celtic Commercial/Exchange	$44.81
Rate for Payer: Health Partners Plans Commercial	$92.15
Rate for Payer: UnitedHealthcare Commercial	$94.09
Rate for Payer: WPPA Commercial	$81.48

SMEAR,PRIM SOURCE,COMPLX SPEC

Facility

$97.00

Service Code	HCPCS 87209
Hospital Charge Code	8720900
Hospital Revenue Code	306
Min. Negotiated Rate	$79.54
Max. Negotiated Rate	$94.09
Rate for Payer: Cash Price	$72.75
Rate for Payer: Health Partners Plans Commercial	$92.15
Rate for Payer: UnitedHealthcare Commercial	$94.09
Rate for Payer: WPPA Commercial	$79.54

SMEAR,PRIM SOURCE,WET MOUNT

Facility

$26.00

Service Code	HCPCS 87210
Hospital Charge Code	8721000
Hospital Revenue Code	306
Min. Negotiated Rate	$21.32
Max. Negotiated Rate	$25.22
Rate for Payer: Cash Price	$19.50
Rate for Payer: Health Partners Plans Commercial	$24.70
Rate for Payer: UnitedHealthcare Commercial	$25.22
Rate for Payer: WPPA Commercial	$21.32

SMEAR,PRIM SOURCE,WET MOUNT

Facility

$26.00

Service Code	HCPCS 87210
Hospital Charge Code	8721000
Hospital Revenue Code	306
Min. Negotiated Rate	$12.01
Max. Negotiated Rate	$25.22
Rate for Payer: BCBS Commercial	$16.38
Rate for Payer: Cash Price	$19.50
Rate for Payer: Cash Price	$19.50
Rate for Payer: Celtic Commercial/Exchange	$12.01
Rate for Payer: Health Partners Plans Commercial	$24.70
Rate for Payer: UnitedHealthcare Commercial	$25.22
Rate for Payer: WPPA Commercial	$21.84

SMEAR PRIM SOURCE W/INTERP

Facility

$51.00

Service Code	HCPCS 87206
Hospital Charge Code	8720600
Hospital Revenue Code	306
Min. Negotiated Rate	$23.56
Max. Negotiated Rate	$49.47
Rate for Payer: BCBS Commercial	$30.71
Rate for Payer: Cash Price	$38.25
Rate for Payer: Cash Price	$38.25
Rate for Payer: Celtic Commercial/Exchange	$23.56
Rate for Payer: Health Partners Plans Commercial	$48.45
Rate for Payer: UnitedHealthcare Commercial	$49.47
Rate for Payer: WPPA Commercial	$42.84

SMEAR PRIM SOURCE W/INTERP

Facility

$51.00

Service Code	HCPCS 87206
Hospital Charge Code	8720600
Hospital Revenue Code	306
Min. Negotiated Rate	$41.82
Max. Negotiated Rate	$49.47
Rate for Payer: Cash Price	$38.25
Rate for Payer: Health Partners Plans Commercial	$48.45
Rate for Payer: UnitedHealthcare Commercial	$49.47
Rate for Payer: WPPA Commercial	$41.82

SMEAR,PRIM SOURCE W/INTERP

Facility

$69.00

Service Code	HCPCS 87207
Hospital Charge Code	8720700
Hospital Revenue Code	306
Min. Negotiated Rate	$31.88
Max. Negotiated Rate	$66.93
Rate for Payer: BCBS Commercial	$36.23
Rate for Payer: Cash Price	$51.75
Rate for Payer: Cash Price	$51.75
Rate for Payer: Celtic Commercial/Exchange	$31.88
Rate for Payer: Health Partners Plans Commercial	$65.55
Rate for Payer: UnitedHealthcare Commercial	$66.93
Rate for Payer: WPPA Commercial	$57.96

SMEAR,PRIM SOURCE W/INTERP

Facility

$69.00

Service Code	HCPCS 87207
Hospital Charge Code	8720700
Hospital Revenue Code	306
Min. Negotiated Rate	$56.58
Max. Negotiated Rate	$66.93
Rate for Payer: Cash Price	$51.75
Rate for Payer: Health Partners Plans Commercial	$65.55
Rate for Payer: UnitedHealthcare Commercial	$66.93
Rate for Payer: WPPA Commercial	$56.58

SMEAR,PRIM SOURCE W/INTERP GRM

Facility

$49.00

Service Code	HCPCS 87205
Hospital Charge Code	8720500
Hospital Revenue Code	306
Min. Negotiated Rate	$14.54
Max. Negotiated Rate	$47.53
Rate for Payer: BCBS Commercial	$14.54
Rate for Payer: Cash Price	$36.75
Rate for Payer: Cash Price	$36.75
Rate for Payer: Celtic Commercial/Exchange	$22.64
Rate for Payer: Health Partners Plans Commercial	$46.55
Rate for Payer: UnitedHealthcare Commercial	$47.53
Rate for Payer: WPPA Commercial	$41.16

SMEAR,PRIM SOURCE W/INTERP GRM

Facility

$49.00

Service Code	HCPCS 87205
Hospital Charge Code	8720500
Hospital Revenue Code	306
Min. Negotiated Rate	$40.18
Max. Negotiated Rate	$47.53
Rate for Payer: Cash Price	$36.75
Rate for Payer: Health Partners Plans Commercial	$46.55
Rate for Payer: UnitedHealthcare Commercial	$47.53
Rate for Payer: WPPA Commercial	$40.18

Know your out-of-pocket cost for care.

All Charges