Ness County Hospital

All Charges

Charge

Type

Setting

Price

SONO EXTREMITY NONVASCULAR

Facility

$448.00

Service Code	HCPCS 76881
Hospital Charge Code	7688100
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 EXTREMITY NONVASCULAR

Facility

$448.00

Service Code	HCPCS 76881
Hospital Charge Code	7688100
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 FETAL BIOPHYSIC WO NST

Facility

$448.00

Service Code	HCPCS 76819
Hospital Charge Code	3320303
Hospital Revenue Code	402
Min. Negotiated Rate	$141.50
Max. Negotiated Rate	$434.56
Rate for Payer: BCBS Commercial	$141.50
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 FETAL BIOPHYSIC WO NST

Facility

$448.00

Service Code	HCPCS 76819
Hospital Charge Code	3320303
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 GUIDED NEEDLE PLACEMENT

Facility

$451.00

Service Code	HCPCS 76942
Hospital Charge Code	3320038
Hospital Revenue Code	402
Min. Negotiated Rate	$369.82
Max. Negotiated Rate	$437.47
Rate for Payer: Cash Price	$338.25
Rate for Payer: Health Partners Plans Commercial	$428.45
Rate for Payer: UnitedHealthcare Commercial	$437.47
Rate for Payer: WPPA Commercial	$369.82

SONO GUIDED NEEDLE PLACEMENT

Facility

$451.00

Service Code	HCPCS 76942
Hospital Charge Code	3320038
Hospital Revenue Code	402
Min. Negotiated Rate	$120.19
Max. Negotiated Rate	$437.47
Rate for Payer: BCBS Commercial	$120.19
Rate for Payer: Cash Price	$338.25
Rate for Payer: Cash Price	$338.25
Rate for Payer: Celtic Commercial/Exchange	$208.36
Rate for Payer: Health Partners Plans Commercial	$428.45
Rate for Payer: UnitedHealthcare Commercial	$437.47
Rate for Payer: WPPA Commercial	$378.84

SONO LIMITED BREAST LT

Facility

$409.00

Service Code	HCPCS 76642 LT
Hospital Charge Code	7664200
Hospital Revenue Code	402
Min. Negotiated Rate	$335.38
Max. Negotiated Rate	$396.73
Rate for Payer: Cash Price	$306.75
Rate for Payer: Health Partners Plans Commercial	$388.55
Rate for Payer: UnitedHealthcare Commercial	$396.73
Rate for Payer: WPPA Commercial	$335.38

SONO LIMITED BREAST LT

Facility

$409.00

Service Code	HCPCS 76642 LT
Hospital Charge Code	7664200
Hospital Revenue Code	402
Min. Negotiated Rate	$110.06
Max. Negotiated Rate	$396.73
Rate for Payer: BCBS Commercial	$110.06
Rate for Payer: Cash Price	$306.75
Rate for Payer: Cash Price	$306.75
Rate for Payer: Celtic Commercial/Exchange	$188.96
Rate for Payer: Health Partners Plans Commercial	$388.55
Rate for Payer: UnitedHealthcare Commercial	$396.73
Rate for Payer: WPPA Commercial	$343.56

SONO LIMITED BREAST RT

Facility

$409.00

Service Code	HCPCS 76642 RT
Hospital Charge Code	7664201
Hospital Revenue Code	402
Min. Negotiated Rate	$110.06
Max. Negotiated Rate	$396.73
Rate for Payer: BCBS Commercial	$110.06
Rate for Payer: Cash Price	$306.75
Rate for Payer: Cash Price	$306.75
Rate for Payer: Celtic Commercial/Exchange	$188.96
Rate for Payer: Health Partners Plans Commercial	$388.55
Rate for Payer: UnitedHealthcare Commercial	$396.73
Rate for Payer: WPPA Commercial	$343.56

SONO LIMITED BREAST RT

Facility

$409.00

Service Code	HCPCS 76642 RT
Hospital Charge Code	7664201
Hospital Revenue Code	402
Min. Negotiated Rate	$335.38
Max. Negotiated Rate	$396.73
Rate for Payer: Cash Price	$306.75
Rate for Payer: Health Partners Plans Commercial	$388.55
Rate for Payer: UnitedHealthcare Commercial	$396.73
Rate for Payer: WPPA Commercial	$335.38

SONO LT ARTERIAL LOWER EXT

Facility

$827.00

Service Code	HCPCS 93926 LT
Hospital Charge Code	7111115
Hospital Revenue Code	921
Min. Negotiated Rate	$382.07
Max. Negotiated Rate	$802.19
Rate for Payer: BCBS Commercial	$480.76
Rate for Payer: Cash Price	$620.25
Rate for Payer: Cash Price	$620.25
Rate for Payer: Celtic Commercial/Exchange	$382.07
Rate for Payer: Health Partners Plans Commercial	$785.65
Rate for Payer: UnitedHealthcare Commercial	$802.19
Rate for Payer: WPPA Commercial	$694.68

SONO LT ARTERIAL LOWER EXT

Facility

$827.00

Service Code	HCPCS 93926 LT
Hospital Charge Code	7111115
Hospital Revenue Code	921
Min. Negotiated Rate	$678.14
Max. Negotiated Rate	$802.19
Rate for Payer: Cash Price	$620.25
Rate for Payer: Health Partners Plans Commercial	$785.65
Rate for Payer: UnitedHealthcare Commercial	$802.19
Rate for Payer: WPPA Commercial	$678.14

SONO LT ARTERIAL UPPER EXT

Facility

$700.00

Service Code	HCPCS 93931 LT
Hospital Charge Code	7111113
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 LT ARTERIAL UPPER EXT

Facility

$700.00

Service Code	HCPCS 93931 LT
Hospital Charge Code	7111113
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 LTD ABDOMEN-LIVER, GB,

Facility

$618.00

Service Code	HCPCS 76705
Hospital Charge Code	3320006
Hospital Revenue Code	402
Min. Negotiated Rate	$506.76
Max. Negotiated Rate	$599.46
Rate for Payer: Cash Price	$463.50
Rate for Payer: Health Partners Plans Commercial	$587.10
Rate for Payer: UnitedHealthcare Commercial	$599.46
Rate for Payer: WPPA Commercial	$506.76

SONO LTD ABDOMEN-LIVER, GB,

Facility

$618.00

Service Code	HCPCS 76705
Hospital Charge Code	3320006
Hospital Revenue Code	402
Min. Negotiated Rate	$132.93
Max. Negotiated Rate	$599.46
Rate for Payer: BCBS Commercial	$132.93
Rate for Payer: Cash Price	$463.50
Rate for Payer: Cash Price	$463.50
Rate for Payer: Celtic Commercial/Exchange	$285.52
Rate for Payer: Health Partners Plans Commercial	$587.10
Rate for Payer: UnitedHealthcare Commercial	$599.46
Rate for Payer: WPPA Commercial	$519.12

SONO LTD DOPPLER

Facility

$843.00

Service Code	HCPCS 93976
Hospital Charge Code	3320021
Hospital Revenue Code	921
Min. Negotiated Rate	$389.47
Max. Negotiated Rate	$817.71
Rate for Payer: BCBS Commercial	$480.76
Rate for Payer: Cash Price	$632.25
Rate for Payer: Cash Price	$632.25
Rate for Payer: Celtic Commercial/Exchange	$389.47
Rate for Payer: Health Partners Plans Commercial	$800.85
Rate for Payer: UnitedHealthcare Commercial	$817.71
Rate for Payer: WPPA Commercial	$708.12

SONO LTD DOPPLER

Facility

$843.00

Service Code	HCPCS 93976
Hospital Charge Code	3320021
Hospital Revenue Code	921
Min. Negotiated Rate	$691.26
Max. Negotiated Rate	$817.71
Rate for Payer: Cash Price	$632.25
Rate for Payer: Health Partners Plans Commercial	$800.85
Rate for Payer: UnitedHealthcare Commercial	$817.71
Rate for Payer: WPPA Commercial	$691.26

SONO LT VENOUS LOWER EXT

Facility

$851.00

Service Code	HCPCS 93971 LT
Hospital Charge Code	7111109
Hospital Revenue Code	402
Min. Negotiated Rate	$393.16
Max. Negotiated Rate	$825.47
Rate for Payer: BCBS Commercial	$480.76
Rate for Payer: Cash Price	$638.25
Rate for Payer: Cash Price	$638.25
Rate for Payer: Celtic Commercial/Exchange	$393.16
Rate for Payer: Health Partners Plans Commercial	$808.45
Rate for Payer: UnitedHealthcare Commercial	$825.47
Rate for Payer: WPPA Commercial	$714.84

SONO LT VENOUS LOWER EXT

Facility

$851.00

Service Code	HCPCS 93971 LT
Hospital Charge Code	7111109
Hospital Revenue Code	402
Min. Negotiated Rate	$697.82
Max. Negotiated Rate	$825.47
Rate for Payer: Cash Price	$638.25
Rate for Payer: Health Partners Plans Commercial	$808.45
Rate for Payer: UnitedHealthcare Commercial	$825.47
Rate for Payer: WPPA Commercial	$697.82

SONO LT VENOUS UPPER EXT

Facility

$791.00

Service Code	HCPCS 93971 LT
Hospital Charge Code	7111107
Hospital Revenue Code	402
Min. Negotiated Rate	$365.44
Max. Negotiated Rate	$767.27
Rate for Payer: BCBS Commercial	$480.76
Rate for Payer: Cash Price	$593.25
Rate for Payer: Cash Price	$593.25
Rate for Payer: Celtic Commercial/Exchange	$365.44
Rate for Payer: Health Partners Plans Commercial	$751.45
Rate for Payer: UnitedHealthcare Commercial	$767.27
Rate for Payer: WPPA Commercial	$664.44

SONO LT VENOUS UPPER EXT

Facility

$791.00

Service Code	HCPCS 93971 LT
Hospital Charge Code	7111107
Hospital Revenue Code	402
Min. Negotiated Rate	$648.62
Max. Negotiated Rate	$767.27
Rate for Payer: Cash Price	$593.25
Rate for Payer: Health Partners Plans Commercial	$751.45
Rate for Payer: UnitedHealthcare Commercial	$767.27
Rate for Payer: WPPA Commercial	$648.62

SONO OB COMPLETE < 14 WEEKS

Facility

$474.00

Service Code	HCPCS 76801
Hospital Charge Code	3320109
Hospital Revenue Code	402
Min. Negotiated Rate	$388.68
Max. Negotiated Rate	$459.78
Rate for Payer: Cash Price	$355.50
Rate for Payer: Health Partners Plans Commercial	$450.30
Rate for Payer: UnitedHealthcare Commercial	$459.78
Rate for Payer: WPPA Commercial	$388.68

SONO OB COMPLETE < 14 WEEKS

Facility

$474.00

Service Code	HCPCS 76801
Hospital Charge Code	3320109
Hospital Revenue Code	402
Min. Negotiated Rate	$132.93
Max. Negotiated Rate	$459.78
Rate for Payer: BCBS Commercial	$132.93
Rate for Payer: Cash Price	$355.50
Rate for Payer: Cash Price	$355.50
Rate for Payer: Celtic Commercial/Exchange	$218.99
Rate for Payer: Health Partners Plans Commercial	$450.30
Rate for Payer: UnitedHealthcare Commercial	$459.78
Rate for Payer: WPPA Commercial	$398.16

SONO OB COMPLETE >14 WEEKS

Facility

$548.00

Service Code	HCPCS 76805
Hospital Charge Code	3320010
Hospital Revenue Code	402
Min. Negotiated Rate	$449.36
Max. Negotiated Rate	$531.56
Rate for Payer: Cash Price	$411.00
Rate for Payer: Health Partners Plans Commercial	$520.60
Rate for Payer: UnitedHealthcare Commercial	$531.56
Rate for Payer: WPPA Commercial	$449.36

Know your out-of-pocket cost for care.

All Charges