Ness County Hospital

All Charges

Charge

Type

Setting

Price

SONO ABDOMEN COMPLETE

Facility

$632.00

Service Code	HCPCS 76700
Hospital Charge Code	3320004
Hospital Revenue Code	402
Min. Negotiated Rate	$151.50
Max. Negotiated Rate	$613.04
Rate for Payer: BCBS Commercial	$151.50
Rate for Payer: Cash Price	$474.00
Rate for Payer: Cash Price	$474.00
Rate for Payer: Celtic Commercial/Exchange	$291.98
Rate for Payer: Health Partners Plans Commercial	$600.40
Rate for Payer: UnitedHealthcare Commercial	$613.04
Rate for Payer: WPPA Commercial	$530.88

SONO ABI'S ANKLE/BRACHIAL

Facility

$700.00

Service Code	HCPCS 93922
Hospital Charge Code	3320040
Hospital Revenue Code	921
Min. Negotiated Rate	$574.00
Max. Negotiated Rate	$679.00
Rate for Payer: Cash Price	$525.00
Rate for Payer: Health Partners Plans Commercial	$665.00
Rate for Payer: UnitedHealthcare Commercial	$679.00
Rate for Payer: WPPA Commercial	$574.00

SONO ABI'S ANKLE/BRACHIAL

Facility

$700.00

Service Code	HCPCS 93922
Hospital Charge Code	3320040
Hospital Revenue Code	921
Min. Negotiated Rate	$323.40
Max. Negotiated Rate	$679.00
Rate for Payer: BCBS Commercial	$480.76
Rate for Payer: Cash Price	$525.00
Rate for Payer: Cash Price	$525.00
Rate for Payer: Celtic Commercial/Exchange	$323.40
Rate for Payer: Health Partners Plans Commercial	$665.00
Rate for Payer: UnitedHealthcare Commercial	$679.00
Rate for Payer: WPPA Commercial	$588.00

SONO AXILLA

Facility

$467.00

Service Code	HCPCS 76882
Hospital Charge Code	7688201
Hospital Revenue Code	402
Min. Negotiated Rate	$382.94
Max. Negotiated Rate	$452.99
Rate for Payer: Cash Price	$350.25
Rate for Payer: Health Partners Plans Commercial	$443.65
Rate for Payer: UnitedHealthcare Commercial	$452.99
Rate for Payer: WPPA Commercial	$382.94

SONO AXILLA

Facility

$467.00

Service Code	HCPCS 76882
Hospital Charge Code	7688201
Hospital Revenue Code	402
Min. Negotiated Rate	$132.93
Max. Negotiated Rate	$452.99
Rate for Payer: BCBS Commercial	$132.93
Rate for Payer: Cash Price	$350.25
Rate for Payer: Cash Price	$350.25
Rate for Payer: Celtic Commercial/Exchange	$215.75
Rate for Payer: Health Partners Plans Commercial	$443.65
Rate for Payer: UnitedHealthcare Commercial	$452.99
Rate for Payer: WPPA Commercial	$392.28

SONO BIL ARTERIAL LOWER EXT

Facility

$998.00

Service Code	HCPCS 93925
Hospital Charge Code	3320031
Hospital Revenue Code	921
Min. Negotiated Rate	$818.36
Max. Negotiated Rate	$968.06
Rate for Payer: Cash Price	$748.50
Rate for Payer: Health Partners Plans Commercial	$948.10
Rate for Payer: UnitedHealthcare Commercial	$968.06
Rate for Payer: WPPA Commercial	$818.36

SONO BIL ARTERIAL LOWER EXT

Facility

$998.00

Service Code	HCPCS 93925
Hospital Charge Code	3320031
Hospital Revenue Code	921
Min. Negotiated Rate	$461.08
Max. Negotiated Rate	$968.06
Rate for Payer: BCBS Commercial	$480.76
Rate for Payer: Cash Price	$748.50
Rate for Payer: Cash Price	$748.50
Rate for Payer: Celtic Commercial/Exchange	$461.08
Rate for Payer: Health Partners Plans Commercial	$948.10
Rate for Payer: UnitedHealthcare Commercial	$968.06
Rate for Payer: WPPA Commercial	$838.32

SONO BIL ARTERIAL UPPER EXT

Facility

$700.00

Service Code	HCPCS 93930
Hospital Charge Code	3320035
Hospital Revenue Code	921
Min. Negotiated Rate	$323.40
Max. Negotiated Rate	$679.00
Rate for Payer: BCBS Commercial	$480.76
Rate for Payer: Cash Price	$525.00
Rate for Payer: Cash Price	$525.00
Rate for Payer: Celtic Commercial/Exchange	$323.40
Rate for Payer: Health Partners Plans Commercial	$665.00
Rate for Payer: UnitedHealthcare Commercial	$679.00
Rate for Payer: WPPA Commercial	$588.00

SONO BIL ARTERIAL UPPER EXT

Facility

$700.00

Service Code	HCPCS 93930
Hospital Charge Code	3320035
Hospital Revenue Code	921
Min. Negotiated Rate	$574.00
Max. Negotiated Rate	$679.00
Rate for Payer: Cash Price	$525.00
Rate for Payer: Health Partners Plans Commercial	$665.00
Rate for Payer: UnitedHealthcare Commercial	$679.00
Rate for Payer: WPPA Commercial	$574.00

SONO BIL VENOUS LOWER EXT

Facility

$910.00

Service Code	HCPCS 93970
Hospital Charge Code	7111111
Hospital Revenue Code	402
Min. Negotiated Rate	$420.42
Max. Negotiated Rate	$882.70
Rate for Payer: BCBS Commercial	$480.76
Rate for Payer: Cash Price	$682.50
Rate for Payer: Cash Price	$682.50
Rate for Payer: Celtic Commercial/Exchange	$420.42
Rate for Payer: Health Partners Plans Commercial	$864.50
Rate for Payer: UnitedHealthcare Commercial	$882.70
Rate for Payer: WPPA Commercial	$764.40

SONO BIL VENOUS LOWER EXT

Facility

$910.00

Service Code	HCPCS 93970
Hospital Charge Code	7111111
Hospital Revenue Code	402
Min. Negotiated Rate	$746.20
Max. Negotiated Rate	$882.70
Rate for Payer: Cash Price	$682.50
Rate for Payer: Health Partners Plans Commercial	$864.50
Rate for Payer: UnitedHealthcare Commercial	$882.70
Rate for Payer: WPPA Commercial	$746.20

SONO BIL VENOUS UPPER EXT

Facility

$700.00

Service Code	HCPCS 93970
Hospital Charge Code	7111110
Hospital Revenue Code	402
Min. Negotiated Rate	$574.00
Max. Negotiated Rate	$679.00
Rate for Payer: Cash Price	$525.00
Rate for Payer: Health Partners Plans Commercial	$665.00
Rate for Payer: UnitedHealthcare Commercial	$679.00
Rate for Payer: WPPA Commercial	$574.00

SONO BIL VENOUS UPPER EXT

Facility

$700.00

Service Code	HCPCS 93970
Hospital Charge Code	7111110
Hospital Revenue Code	402
Min. Negotiated Rate	$323.40
Max. Negotiated Rate	$679.00
Rate for Payer: BCBS Commercial	$480.76
Rate for Payer: Cash Price	$525.00
Rate for Payer: Cash Price	$525.00
Rate for Payer: Celtic Commercial/Exchange	$323.40
Rate for Payer: Health Partners Plans Commercial	$665.00
Rate for Payer: UnitedHealthcare Commercial	$679.00
Rate for Payer: WPPA Commercial	$588.00

SONO BREAST LT

Facility

$436.00

Service Code	HCPCS 76641 LT
Hospital Charge Code	7664102
Hospital Revenue Code	402
Min. Negotiated Rate	$132.93
Max. Negotiated Rate	$422.92
Rate for Payer: BCBS Commercial	$132.93
Rate for Payer: Cash Price	$327.00
Rate for Payer: Cash Price	$327.00
Rate for Payer: Celtic Commercial/Exchange	$201.43
Rate for Payer: Health Partners Plans Commercial	$414.20
Rate for Payer: UnitedHealthcare Commercial	$422.92
Rate for Payer: WPPA Commercial	$366.24

SONO BREAST LT

Facility

$436.00

Service Code	HCPCS 76641 LT
Hospital Charge Code	7664102
Hospital Revenue Code	402
Min. Negotiated Rate	$357.52
Max. Negotiated Rate	$422.92
Rate for Payer: Cash Price	$327.00
Rate for Payer: Health Partners Plans Commercial	$414.20
Rate for Payer: UnitedHealthcare Commercial	$422.92
Rate for Payer: WPPA Commercial	$357.52

SONO BREAST RT

Facility

$436.00

Service Code	HCPCS 76641 RT
Hospital Charge Code	7664100
Hospital Revenue Code	402
Min. Negotiated Rate	$357.52
Max. Negotiated Rate	$422.92
Rate for Payer: Cash Price	$327.00
Rate for Payer: Health Partners Plans Commercial	$414.20
Rate for Payer: UnitedHealthcare Commercial	$422.92
Rate for Payer: WPPA Commercial	$357.52

SONO BREAST RT

Facility

$436.00

Service Code	HCPCS 76641 RT
Hospital Charge Code	7664100
Hospital Revenue Code	402
Min. Negotiated Rate	$132.93
Max. Negotiated Rate	$422.92
Rate for Payer: BCBS Commercial	$132.93
Rate for Payer: Cash Price	$327.00
Rate for Payer: Cash Price	$327.00
Rate for Payer: Celtic Commercial/Exchange	$201.43
Rate for Payer: Health Partners Plans Commercial	$414.20
Rate for Payer: UnitedHealthcare Commercial	$422.92
Rate for Payer: WPPA Commercial	$366.24

SONO CAROTID DOPPLER

Facility

$854.00

Service Code	HCPCS 93880
Hospital Charge Code	3320026
Hospital Revenue Code	921
Min. Negotiated Rate	$700.28
Max. Negotiated Rate	$828.38
Rate for Payer: Cash Price	$640.50
Rate for Payer: Health Partners Plans Commercial	$811.30
Rate for Payer: UnitedHealthcare Commercial	$828.38
Rate for Payer: WPPA Commercial	$700.28

SONO CAROTID DOPPLER

Facility

$854.00

Service Code	HCPCS 93880
Hospital Charge Code	3320026
Hospital Revenue Code	921
Min. Negotiated Rate	$394.55
Max. Negotiated Rate	$828.38
Rate for Payer: BCBS Commercial	$480.76
Rate for Payer: Cash Price	$640.50
Rate for Payer: Cash Price	$640.50
Rate for Payer: Celtic Commercial/Exchange	$394.55
Rate for Payer: Health Partners Plans Commercial	$811.30
Rate for Payer: UnitedHealthcare Commercial	$828.38
Rate for Payer: WPPA Commercial	$717.36

SONO CHEST

Facility

$448.00

Service Code	HCPCS 76604
Hospital Charge Code	3320105
Hospital Revenue Code	402
Min. Negotiated Rate	$132.93
Max. Negotiated Rate	$434.56
Rate for Payer: BCBS Commercial	$132.93
Rate for Payer: Cash Price	$336.00
Rate for Payer: Cash Price	$336.00
Rate for Payer: Celtic Commercial/Exchange	$206.98
Rate for Payer: Health Partners Plans Commercial	$425.60
Rate for Payer: UnitedHealthcare Commercial	$434.56
Rate for Payer: WPPA Commercial	$376.32

SONO CHEST

Facility

$448.00

Service Code	HCPCS 76604
Hospital Charge Code	3320105
Hospital Revenue Code	402
Min. Negotiated Rate	$367.36
Max. Negotiated Rate	$434.56
Rate for Payer: Cash Price	$336.00
Rate for Payer: Health Partners Plans Commercial	$425.60
Rate for Payer: UnitedHealthcare Commercial	$434.56
Rate for Payer: WPPA Commercial	$367.36

SONO COMPLETE DOPPLER

Facility

$968.00

Service Code	HCPCS 93975
Hospital Charge Code	3320007
Hospital Revenue Code	402
Min. Negotiated Rate	$793.76
Max. Negotiated Rate	$938.96
Rate for Payer: Cash Price	$726.00
Rate for Payer: Health Partners Plans Commercial	$919.60
Rate for Payer: UnitedHealthcare Commercial	$938.96
Rate for Payer: WPPA Commercial	$793.76

SONO COMPLETE DOPPLER

Facility

$968.00

Service Code	HCPCS 93975
Hospital Charge Code	3320007
Hospital Revenue Code	402
Min. Negotiated Rate	$447.22
Max. Negotiated Rate	$938.96
Rate for Payer: BCBS Commercial	$480.76
Rate for Payer: Cash Price	$726.00
Rate for Payer: Cash Price	$726.00
Rate for Payer: Celtic Commercial/Exchange	$447.22
Rate for Payer: Health Partners Plans Commercial	$919.60
Rate for Payer: UnitedHealthcare Commercial	$938.96
Rate for Payer: WPPA Commercial	$813.12

SONO DEFINITY INJECTION

Facility

$150.00

Service Code	HCPCS Q9957
Hospital Charge Code	Q995700
Hospital Revenue Code	636
Min. Negotiated Rate	$69.30
Max. Negotiated Rate	$145.50
Rate for Payer: BCBS Commercial	$96.86
Rate for Payer: Cash Price	$112.50
Rate for Payer: Cash Price	$112.50
Rate for Payer: Celtic Commercial/Exchange	$69.30
Rate for Payer: Health Partners Plans Commercial	$142.50
Rate for Payer: UnitedHealthcare Commercial	$145.50
Rate for Payer: WPPA Commercial	$126.00

SONO DEFINITY INJECTION

Facility

$150.00

Service Code	HCPCS Q9957
Hospital Charge Code	Q995700
Hospital Revenue Code	636
Min. Negotiated Rate	$123.00
Max. Negotiated Rate	$145.50
Rate for Payer: Cash Price	$112.50
Rate for Payer: Health Partners Plans Commercial	$142.50
Rate for Payer: UnitedHealthcare Commercial	$145.50
Rate for Payer: WPPA Commercial	$123.00

Know your out-of-pocket cost for care.

All Charges