Ness County Hospital

All Charges

Charge

Type

Setting

Price

SONO RETRO LTD-ONLY ONE AREA

Facility

$448.00

Service Code	HCPCS 76775
Hospital Charge Code	7667501
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 RETRO LTD-ONLY ONE AREA

Facility

$448.00

Service Code	HCPCS 76775
Hospital Charge Code	7667501
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-RENAL, AORTA, NODES

Facility

$586.00

Service Code	HCPCS 76770 59
Hospital Charge Code	3320008
Hospital Revenue Code	402
Min. Negotiated Rate	$151.50
Max. Negotiated Rate	$568.42
Rate for Payer: BCBS Commercial	$151.50
Rate for Payer: Cash Price	$439.50
Rate for Payer: Cash Price	$439.50
Rate for Payer: Celtic Commercial/Exchange	$270.73
Rate for Payer: Health Partners Plans Commercial	$556.70
Rate for Payer: UnitedHealthcare Commercial	$568.42
Rate for Payer: WPPA Commercial	$492.24

SONO RETRO-RENAL, AORTA, NODES

Facility

$586.00

Service Code	HCPCS 76770 59
Hospital Charge Code	3320008
Hospital Revenue Code	402
Min. Negotiated Rate	$480.52
Max. Negotiated Rate	$568.42
Rate for Payer: Cash Price	$439.50
Rate for Payer: Health Partners Plans Commercial	$556.70
Rate for Payer: UnitedHealthcare Commercial	$568.42
Rate for Payer: WPPA Commercial	$480.52

SONO RT ARTERIAL LOWER EXT

Facility

$827.00

Service Code	HCPCS 93926 RT
Hospital Charge Code	7111114
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 RT ARTERIAL LOWER EXT

Facility

$827.00

Service Code	HCPCS 93926 RT
Hospital Charge Code	7111114
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 RT ARTERIAL UPPER EXT

Facility

$700.00

Service Code	HCPCS 93931 RT
Hospital Charge Code	7111112
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 RT ARTERIAL UPPER EXT

Facility

$700.00

Service Code	HCPCS 93931 RT
Hospital Charge Code	7111112
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 RT VENOUS LOWER EXT

Facility

$851.00

Service Code	HCPCS 93971 RT
Hospital Charge Code	7111108
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 RT VENOUS LOWER EXT

Facility

$851.00

Service Code	HCPCS 93971 RT
Hospital Charge Code	7111108
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 RT VENOUS UPPER EXT

Facility

$791.00

Service Code	HCPCS 93971 RT
Hospital Charge Code	7111106
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 RT VENOUS UPPER EXT

Facility

$791.00

Service Code	HCPCS 93971 RT
Hospital Charge Code	7111106
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 SCROTUM

Facility

$470.00

Service Code	HCPCS 76870
Hospital Charge Code	3320020
Hospital Revenue Code	402
Min. Negotiated Rate	$132.93
Max. Negotiated Rate	$455.90
Rate for Payer: Cash Price	$352.50
Rate for Payer: BCBS Commercial	$132.93
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 SCROTUM

Facility

$470.00

Service Code	HCPCS 76870
Hospital Charge Code	3320020
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 SOFT TISSUE HEAD/NECK

Facility

$753.00

Service Code	HCPCS 76536
Hospital Charge Code	3320002
Hospital Revenue Code	402
Min. Negotiated Rate	$617.46
Max. Negotiated Rate	$730.41
Rate for Payer: Cash Price	$564.75
Rate for Payer: Health Partners Plans Commercial	$715.35
Rate for Payer: UnitedHealthcare Commercial	$730.41
Rate for Payer: WPPA Commercial	$617.46

SONO SOFT TISSUE HEAD/NECK

Facility

$753.00

Service Code	HCPCS 76536
Hospital Charge Code	3320002
Hospital Revenue Code	402
Min. Negotiated Rate	$347.89
Max. Negotiated Rate	$730.41
Rate for Payer: BCBS Commercial	$480.76
Rate for Payer: Cash Price	$564.75
Rate for Payer: Cash Price	$564.75
Rate for Payer: Celtic Commercial/Exchange	$347.89
Rate for Payer: Health Partners Plans Commercial	$715.35
Rate for Payer: UnitedHealthcare Commercial	$730.41
Rate for Payer: WPPA Commercial	$632.52

SONO THYROID

Facility

$753.00

Service Code	HCPCS 76536
Hospital Charge Code	3320536
Hospital Revenue Code	402
Min. Negotiated Rate	$347.89
Max. Negotiated Rate	$730.41
Rate for Payer: BCBS Commercial	$480.76
Rate for Payer: Cash Price	$564.75
Rate for Payer: Cash Price	$564.75
Rate for Payer: Celtic Commercial/Exchange	$347.89
Rate for Payer: Health Partners Plans Commercial	$715.35
Rate for Payer: UnitedHealthcare Commercial	$730.41
Rate for Payer: WPPA Commercial	$632.52

SONO THYROID

Facility

$753.00

Service Code	HCPCS 76536
Hospital Charge Code	3320536
Hospital Revenue Code	402
Min. Negotiated Rate	$617.46
Max. Negotiated Rate	$730.41
Rate for Payer: Cash Price	$564.75
Rate for Payer: Health Partners Plans Commercial	$715.35
Rate for Payer: UnitedHealthcare Commercial	$730.41
Rate for Payer: WPPA Commercial	$617.46

SONO TRANSVAGINAL PREGNANT

Facility

$477.00

Service Code	HCPCS 76817
Hospital Charge Code	3320210
Hospital Revenue Code	402
Min. Negotiated Rate	$141.50
Max. Negotiated Rate	$462.69
Rate for Payer: BCBS Commercial	$141.50
Rate for Payer: Cash Price	$357.75
Rate for Payer: Cash Price	$357.75
Rate for Payer: Celtic Commercial/Exchange	$220.37
Rate for Payer: Health Partners Plans Commercial	$453.15
Rate for Payer: UnitedHealthcare Commercial	$462.69
Rate for Payer: WPPA Commercial	$400.68

SONO TRANSVAGINAL PREGNANT

Facility

$477.00

Service Code	HCPCS 76817
Hospital Charge Code	3320210
Hospital Revenue Code	402
Min. Negotiated Rate	$391.14
Max. Negotiated Rate	$462.69
Rate for Payer: Cash Price	$357.75
Rate for Payer: Health Partners Plans Commercial	$453.15
Rate for Payer: UnitedHealthcare Commercial	$462.69
Rate for Payer: WPPA Commercial	$391.14

SONO UNLISTED (BUTT,MIDBACK)

Facility

$448.00

Service Code	HCPCS 76999
Hospital Charge Code	3320405
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 UNLISTED (BUTT,MIDBACK)

Facility

$448.00

Service Code	HCPCS 76999
Hospital Charge Code	3320405
Hospital Revenue Code	402
Min. Negotiated Rate	$110.06
Max. Negotiated Rate	$434.56
Rate for Payer: BCBS Commercial	$110.06
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 UNLISTED VASCULAR NONINVA

Facility

$448.00

Service Code	HCPCS 93998
Hospital Charge Code	9399800
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 UNLISTED VASCULAR NONINVA

Facility

$448.00

Service Code	HCPCS 93998
Hospital Charge Code	9399800
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

SORBAVIEW SHIELD

Facility

$9.00

Hospital Charge Code	2725044
Hospital Revenue Code	270
Min. Negotiated Rate	$7.38
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$6.75
Rate for Payer: Health Partners Plans Commercial	$8.55
Rate for Payer: UnitedHealthcare Commercial	$8.73
Rate for Payer: WPPA Commercial	$7.38

Know your out-of-pocket cost for care.

All Charges