Ness County Hospital

All Charges

Charge

Type

Setting

Price

SONO OB COMPLETE >14 WEEKS

Facility

$548.00

Service Code	HCPCS 76805
Hospital Charge Code	3320010
Hospital Revenue Code	402
Min. Negotiated Rate	$132.93
Max. Negotiated Rate	$531.56
Rate for Payer: BCBS Commercial	$132.93
Rate for Payer: Cash Price	$411.00
Rate for Payer: Cash Price	$411.00
Rate for Payer: Celtic Commercial/Exchange	$253.18
Rate for Payer: Health Partners Plans Commercial	$520.60
Rate for Payer: UnitedHealthcare Commercial	$531.56
Rate for Payer: WPPA Commercial	$460.32

SONO OB COMPLETE + FETAL ANATO

Facility

$448.00

Service Code	HCPCS 76812
Hospital Charge Code	3320208
Hospital Revenue Code	402
Min. Negotiated Rate	$108.07
Max. Negotiated Rate	$434.56
Rate for Payer: BCBS Commercial	$108.07
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 OB COMPLETE + FETAL ANATO

Facility

$448.00

Service Code	HCPCS 76812
Hospital Charge Code	3320208
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 OB COMPLETE + FETAL ANATO

Facility

$554.00

Service Code	HCPCS 76811
Hospital Charge Code	3320206
Hospital Revenue Code	402
Min. Negotiated Rate	$454.28
Max. Negotiated Rate	$537.38
Rate for Payer: Cash Price	$415.50
Rate for Payer: Health Partners Plans Commercial	$526.30
Rate for Payer: UnitedHealthcare Commercial	$537.38
Rate for Payer: WPPA Commercial	$454.28

SONO OB COMPLETE + FETAL ANATO

Facility

$554.00

Service Code	HCPCS 76811
Hospital Charge Code	3320206
Hospital Revenue Code	402
Min. Negotiated Rate	$255.95
Max. Negotiated Rate	$537.38
Rate for Payer: BCBS Commercial	$302.15
Rate for Payer: Cash Price	$415.50
Rate for Payer: Cash Price	$415.50
Rate for Payer: Celtic Commercial/Exchange	$255.95
Rate for Payer: Health Partners Plans Commercial	$526.30
Rate for Payer: UnitedHealthcare Commercial	$537.38
Rate for Payer: WPPA Commercial	$465.36

SONO OB FOLLOW-UP SIZE

Facility

$470.00

Service Code	HCPCS 76816
Hospital Charge Code	3320014
Hospital Revenue Code	402
Min. Negotiated Rate	$385.40
Max. Negotiated Rate	$455.90
Rate for Payer: Cash Price	$352.50
Rate for Payer: Health Partners Plans Commercial	$446.50
Rate for Payer: UnitedHealthcare Commercial	$455.90
Rate for Payer: WPPA Commercial	$385.40

SONO OB FOLLOW-UP SIZE

Facility

$470.00

Service Code	HCPCS 76816
Hospital Charge Code	3320014
Hospital Revenue Code	402
Min. Negotiated Rate	$141.50
Max. Negotiated Rate	$455.90
Rate for Payer: BCBS Commercial	$141.50
Rate for Payer: Cash Price	$352.50
Rate for Payer: Cash Price	$352.50
Rate for Payer: Celtic Commercial/Exchange	$217.14
Rate for Payer: Health Partners Plans Commercial	$446.50
Rate for Payer: UnitedHealthcare Commercial	$455.90
Rate for Payer: WPPA Commercial	$394.80

SONO OB LTD-PLACENTA & POSITIO

Facility

$448.00

Service Code	HCPCS 76815
Hospital Charge Code	3320012
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 OB LTD-PLACENTA & POSITIO

Facility

$448.00

Service Code	HCPCS 76815
Hospital Charge Code	3320012
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 OB MULTIGEST <14 WEEKS

Facility

$448.00

Service Code	HCPCS 76802
Hospital Charge Code	3320202
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 OB MULTIGEST <14 WEEKS

Facility

$448.00

Service Code	HCPCS 76802
Hospital Charge Code	3320202
Hospital Revenue Code	402
Min. Negotiated Rate	$77.77
Max. Negotiated Rate	$434.56
Rate for Payer: BCBS Commercial	$77.77
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 OB MULTIPLE GESTATION

Facility

$448.00

Service Code	HCPCS 76810
Hospital Charge Code	3320204
Hospital Revenue Code	402
Min. Negotiated Rate	$73.73
Max. Negotiated Rate	$434.56
Rate for Payer: BCBS Commercial	$73.73
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 OB MULTIPLE GESTATION

Facility

$448.00

Service Code	HCPCS 76810
Hospital Charge Code	3320204
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 PELVIC FOLLOW-UP/LTD

Facility

$448.00

Service Code	HCPCS 76857
Hospital Charge Code	3320018
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 PELVIC FOLLOW-UP/LTD

Facility

$448.00

Service Code	HCPCS 76857
Hospital Charge Code	3320018
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 PELVIC-TRANSABDOMINAL

Facility

$661.00

Service Code	HCPCS 76856
Hospital Charge Code	3320016
Hospital Revenue Code	402
Min. Negotiated Rate	$542.02
Max. Negotiated Rate	$641.17
Rate for Payer: Cash Price	$495.75
Rate for Payer: Health Partners Plans Commercial	$627.95
Rate for Payer: UnitedHealthcare Commercial	$641.17
Rate for Payer: WPPA Commercial	$542.02

SONO PELVIC-TRANSABDOMINAL

Facility

$661.00

Service Code	HCPCS 76856
Hospital Charge Code	3320016
Hospital Revenue Code	402
Min. Negotiated Rate	$132.93
Max. Negotiated Rate	$641.17
Rate for Payer: BCBS Commercial	$132.93
Rate for Payer: Cash Price	$495.75
Rate for Payer: Cash Price	$495.75
Rate for Payer: Celtic Commercial/Exchange	$305.38
Rate for Payer: Health Partners Plans Commercial	$627.95
Rate for Payer: UnitedHealthcare Commercial	$641.17
Rate for Payer: WPPA Commercial	$555.24

SONO PELVIC-TRANSVAGINAL

Facility

$606.00

Service Code	HCPCS 76830
Hospital Charge Code	3320090
Hospital Revenue Code	402
Min. Negotiated Rate	$496.92
Max. Negotiated Rate	$587.82
Rate for Payer: Cash Price	$454.50
Rate for Payer: Health Partners Plans Commercial	$575.70
Rate for Payer: UnitedHealthcare Commercial	$587.82
Rate for Payer: WPPA Commercial	$496.92

SONO PELVIC-TRANSVAGINAL

Facility

$606.00

Service Code	HCPCS 76830
Hospital Charge Code	3320090
Hospital Revenue Code	402
Min. Negotiated Rate	$132.93
Max. Negotiated Rate	$587.82
Rate for Payer: BCBS Commercial	$132.93
Rate for Payer: Cash Price	$454.50
Rate for Payer: Cash Price	$454.50
Rate for Payer: Celtic Commercial/Exchange	$279.97
Rate for Payer: Health Partners Plans Commercial	$575.70
Rate for Payer: UnitedHealthcare Commercial	$587.82
Rate for Payer: WPPA Commercial	$509.04

SONO PROSTATE-TRANSRECTAL

Facility

$448.00

Service Code	HCPCS 76872
Hospital Charge Code	3320022
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 PROSTATE-TRANSRECTAL

Facility

$448.00

Service Code	HCPCS 76872
Hospital Charge Code	3320022
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 REPEAT (SPECIFY)

Facility

$448.00

Service Code	HCPCS 76970
Hospital Charge Code	3320400
Hospital Revenue Code	402
Min. Negotiated Rate	$206.98
Max. Negotiated Rate	$434.56
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 REPEAT (SPECIFY)

Facility

$448.00

Service Code	HCPCS 76970
Hospital Charge Code	3320400
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 RETRO LTD

Facility

$491.00

Service Code	HCPCS 76775
Hospital Charge Code	7677500
Hospital Revenue Code	402
Min. Negotiated Rate	$402.62
Max. Negotiated Rate	$476.27
Rate for Payer: Cash Price	$368.25
Rate for Payer: Health Partners Plans Commercial	$466.45
Rate for Payer: UnitedHealthcare Commercial	$476.27
Rate for Payer: WPPA Commercial	$402.62

SONO RETRO LTD

Facility

$491.00

Service Code	HCPCS 76775
Hospital Charge Code	7677500
Hospital Revenue Code	402
Min. Negotiated Rate	$132.93
Max. Negotiated Rate	$476.27
Rate for Payer: BCBS Commercial	$132.93
Rate for Payer: Cash Price	$368.25
Rate for Payer: Cash Price	$368.25
Rate for Payer: Celtic Commercial/Exchange	$226.84
Rate for Payer: Health Partners Plans Commercial	$466.45
Rate for Payer: UnitedHealthcare Commercial	$476.27
Rate for Payer: WPPA Commercial	$412.44

Know your out-of-pocket cost for care.

All Charges