Ness County Hospital

All Charges

Charge

Type

Setting

Price

SMOOTH MUSC RFX/TIT

Facility

$49.00

Service Code	HCPCS 86015
Hospital Charge Code	8601500
Hospital Revenue Code	302
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

SMOOTH MUSC RFX/TIT

Facility

$49.00

Service Code	HCPCS 86015
Hospital Charge Code	8601500
Hospital Revenue Code	302
Min. Negotiated Rate	$21.62
Max. Negotiated Rate	$47.53
Rate for Payer: BCBS Commercial	$21.62
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

SM/RNP ANTIBODY

Facility

$368.00

Service Code	HCPCS 86235
Hospital Charge Code	8623503
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

SM/RNP ANTIBODY

Facility

$368.00

Service Code	HCPCS 86235
Hospital Charge Code	8623503
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

SNARE ELEC OLYMPUS

Facility

$37.00

Hospital Charge Code	2700685
Hospital Revenue Code	270
Min. Negotiated Rate	$17.09
Max. Negotiated Rate	$35.89
Rate for Payer: Cash Price	$27.94
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

SNARE ELEC OLYMPUS

Facility

$37.00

Hospital Charge Code	2700685
Hospital Revenue Code	270
Min. Negotiated Rate	$30.34
Max. Negotiated Rate	$35.89
Rate for Payer: Cash Price	$27.94
Rate for Payer: Health Partners Plans Commercial	$35.15
Rate for Payer: UnitedHealthcare Commercial	$35.89
Rate for Payer: WPPA Commercial	$30.34

SNUFFER NOSECLIP

Facility

$2.00

Hospital Charge Code	2700309
Hospital Revenue Code	272
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.50
Rate for Payer: Health Partners Plans Commercial	$1.90
Rate for Payer: UnitedHealthcare Commercial	$1.94
Rate for Payer: WPPA Commercial	$1.64

SNUFFER NOSECLIP

Facility

$2.00

Hospital Charge Code	2700309
Hospital Revenue Code	272
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.50
Rate for Payer: Celtic Commercial/Exchange	$0.92
Rate for Payer: Health Partners Plans Commercial	$1.90
Rate for Payer: UnitedHealthcare Commercial	$1.94
Rate for Payer: WPPA Commercial	$1.68

SOAP SUDS ENEMA

Facility

$12.00

Hospital Charge Code	2700953
Hospital Revenue Code	270
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$11.64
Rate for Payer: Cash Price	$9.00
Rate for Payer: Celtic Commercial/Exchange	$5.54
Rate for Payer: Health Partners Plans Commercial	$11.40
Rate for Payer: UnitedHealthcare Commercial	$11.64
Rate for Payer: WPPA Commercial	$10.08

SOAP SUDS ENEMA

Facility

$12.00

Hospital Charge Code	2700953
Hospital Revenue Code	270
Min. Negotiated Rate	$9.84
Max. Negotiated Rate	$11.64
Rate for Payer: Cash Price	$9.00
Rate for Payer: Health Partners Plans Commercial	$11.40
Rate for Payer: UnitedHealthcare Commercial	$11.64
Rate for Payer: WPPA Commercial	$9.84

SODIUM BICARBONATE 4.2% - 5 MEQ INFANT INJ.

Facility

$83.00

Service Code	NDC 00409553414
Hospital Charge Code	2506475
Hospital Revenue Code	250
Min. Negotiated Rate	$38.35
Max. Negotiated Rate	$80.51
Rate for Payer: Cash Price	$62.78
Rate for Payer: Celtic Commercial/Exchange	$38.35
Rate for Payer: Health Partners Plans Commercial	$78.85
Rate for Payer: UnitedHealthcare Commercial	$80.51
Rate for Payer: WPPA Commercial	$69.72

SODIUM BICARBONATE 4.2% - 5 MEQ INFANT INJ.

Facility

$83.00

Service Code	NDC 00409553414
Hospital Charge Code	2506475
Hospital Revenue Code	250
Min. Negotiated Rate	$68.06
Max. Negotiated Rate	$80.51
Rate for Payer: Cash Price	$62.78
Rate for Payer: Health Partners Plans Commercial	$78.85
Rate for Payer: UnitedHealthcare Commercial	$80.51
Rate for Payer: WPPA Commercial	$68.06

SODIUM BICARBONATE 4.2% 5 ML VIALS(for use to mix with xylocaine)

Facility

$27.00

Service Code	NDC 00409555502
Hospital Charge Code	2515906
Hospital Revenue Code	250
Min. Negotiated Rate	$12.47
Max. Negotiated Rate	$26.19
Rate for Payer: Cash Price	$20.62
Rate for Payer: Celtic Commercial/Exchange	$12.47
Rate for Payer: Health Partners Plans Commercial	$25.65
Rate for Payer: UnitedHealthcare Commercial	$26.19
Rate for Payer: WPPA Commercial	$22.68

SODIUM BICARBONATE 4.2% 5 ML VIALS(for use to mix with xylocaine)

Facility

$27.00

Service Code	NDC 00409555502
Hospital Charge Code	2515906
Hospital Revenue Code	250
Min. Negotiated Rate	$22.14
Max. Negotiated Rate	$26.19
Rate for Payer: Cash Price	$20.62
Rate for Payer: Health Partners Plans Commercial	$25.65
Rate for Payer: UnitedHealthcare Commercial	$26.19
Rate for Payer: WPPA Commercial	$22.14

SODIUM BICARBONATE 8.4% 50 MEQ INJ.

Facility

$242.00

Service Code	NDC 00409663714
Hospital Charge Code	2506467
Hospital Revenue Code	250
Min. Negotiated Rate	$111.80
Max. Negotiated Rate	$234.74
Rate for Payer: Cash Price	$181.80
Rate for Payer: Celtic Commercial/Exchange	$111.80
Rate for Payer: Health Partners Plans Commercial	$229.90
Rate for Payer: UnitedHealthcare Commercial	$234.74
Rate for Payer: WPPA Commercial	$203.28

SODIUM BICARBONATE 8.4% 50 MEQ INJ.

Facility

$242.00

Service Code	NDC 00409663714
Hospital Charge Code	2506467
Hospital Revenue Code	250
Min. Negotiated Rate	$198.44
Max. Negotiated Rate	$234.74
Rate for Payer: Cash Price	$181.80
Rate for Payer: Health Partners Plans Commercial	$229.90
Rate for Payer: UnitedHealthcare Commercial	$234.74
Rate for Payer: WPPA Commercial	$198.44

SODIUM CHLORIDE 0.9% 10 ML SINGLE DOSE VIAL

Facility

$10.00

Service Code	NDC 00409488810
Hospital Charge Code	2506459
Hospital Revenue Code	250
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$7.50
Rate for Payer: Celtic Commercial/Exchange	$4.62
Rate for Payer: Health Partners Plans Commercial	$9.50
Rate for Payer: UnitedHealthcare Commercial	$9.70
Rate for Payer: WPPA Commercial	$8.40

SODIUM CHLORIDE 0.9% 10 ML SINGLE DOSE VIAL

Facility

$10.00

Service Code	NDC 00409488810
Hospital Charge Code	2506459
Hospital Revenue Code	250
Min. Negotiated Rate	$8.20
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$7.50
Rate for Payer: Health Partners Plans Commercial	$9.50
Rate for Payer: UnitedHealthcare Commercial	$9.70
Rate for Payer: WPPA Commercial	$8.20

SODIUM CHLORIDE 1 GM TAB (NORMAL SALT TAB)

Facility

$1.00

Service Code	NDC 00223176001
Hospital Charge Code	2514693
Hospital Revenue Code	250
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.75
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

SODIUM CHLORIDE 1 GM TAB (NORMAL SALT TAB)

Facility

$1.00

Service Code	NDC 00223176001
Hospital Charge Code	2514693
Hospital Revenue Code	250
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.75
Rate for Payer: Health Partners Plans Commercial	$0.95
Rate for Payer: UnitedHealthcare Commercial	$0.97
Rate for Payer: WPPA Commercial	$0.82

SODIUM CHLORIDE BACTERIOSTATIC 0.9% 30 ML VIAL

Facility

$10.00

Service Code	NDC 63323092430
Hospital Charge Code	2505006
Hospital Revenue Code	250
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$7.50
Rate for Payer: Celtic Commercial/Exchange	$4.62
Rate for Payer: Health Partners Plans Commercial	$9.50
Rate for Payer: UnitedHealthcare Commercial	$9.70
Rate for Payer: WPPA Commercial	$8.40

SODIUM CHLORIDE BACTERIOSTATIC 0.9% 30 ML VIAL

Facility

$10.00

Service Code	NDC 63323092430
Hospital Charge Code	2505006
Hospital Revenue Code	250
Min. Negotiated Rate	$8.20
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$7.50
Rate for Payer: Health Partners Plans Commercial	$9.50
Rate for Payer: UnitedHealthcare Commercial	$9.70
Rate for Payer: WPPA Commercial	$8.20

SODIUM; OTHER SOURCE

Facility

$44.00

Service Code	HCPCS 84302
Hospital Charge Code	8430200
Hospital Revenue Code	301
Min. Negotiated Rate	$19.53
Max. Negotiated Rate	$42.68
Rate for Payer: BCBS Commercial	$19.53
Rate for Payer: Cash Price	$33.00
Rate for Payer: Cash Price	$33.00
Rate for Payer: Celtic Commercial/Exchange	$20.33
Rate for Payer: Health Partners Plans Commercial	$41.80
Rate for Payer: UnitedHealthcare Commercial	$42.68
Rate for Payer: WPPA Commercial	$36.96

SODIUM; OTHER SOURCE

Facility

$44.00

Service Code	HCPCS 84302
Hospital Charge Code	8430200
Hospital Revenue Code	301
Min. Negotiated Rate	$36.08
Max. Negotiated Rate	$42.68
Rate for Payer: Cash Price	$33.00
Rate for Payer: Health Partners Plans Commercial	$41.80
Rate for Payer: UnitedHealthcare Commercial	$42.68
Rate for Payer: WPPA Commercial	$36.08

SODIUM SERUM

Facility

$32.00

Service Code	HCPCS 84295
Hospital Charge Code	8429500
Hospital Revenue Code	301
Min. Negotiated Rate	$26.24
Max. Negotiated Rate	$31.04
Rate for Payer: Cash Price	$24.00
Rate for Payer: Health Partners Plans Commercial	$30.40
Rate for Payer: UnitedHealthcare Commercial	$31.04
Rate for Payer: WPPA Commercial	$26.24

Know your out-of-pocket cost for care.

All Charges