Ness County Hospital

All Charges

Charge

Type

Setting

Price

SPONGE IV 2" X 2"

Facility

$9.00

Hospital Charge Code	2720796
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

SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITH CC/MCC

Facility

$7,851.93

Service Code	MSDRG 537
Min. Negotiated Rate	$7,851.93
Max. Negotiated Rate	$7,851.93
Rate for Payer: BCBS Commercial	$7,851.93

SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITHOUT CC/MCC

Facility

$5,488.45

Service Code	MSDRG 538
Min. Negotiated Rate	$5,488.45
Max. Negotiated Rate	$5,488.45
Rate for Payer: BCBS Commercial	$5,488.45

SQ/IM INJ-THER/PROPHYL/DIAG

Facility

$110.00

Service Code	HCPCS 96372
Hospital Charge Code	9637200
Hospital Revenue Code	761
Min. Negotiated Rate	$90.20
Max. Negotiated Rate	$106.70
Rate for Payer: Cash Price	$82.50
Rate for Payer: Health Partners Plans Commercial	$104.50
Rate for Payer: UnitedHealthcare Commercial	$106.70
Rate for Payer: WPPA Commercial	$90.20

SQ/IM INJ-THER/PROPHYL/DIAG

Facility

$110.00

Service Code	HCPCS 96372
Hospital Charge Code	9637200
Hospital Revenue Code	761
Min. Negotiated Rate	$50.82
Max. Negotiated Rate	$106.70
Rate for Payer: BCBS Commercial	$83.90
Rate for Payer: Cash Price	$82.50
Rate for Payer: Cash Price	$82.50
Rate for Payer: Celtic Commercial/Exchange	$50.82
Rate for Payer: Health Partners Plans Commercial	$104.50
Rate for Payer: UnitedHealthcare Commercial	$106.70
Rate for Payer: WPPA Commercial	$92.40

SRCARE-ATTENDENT SERV, 1/4 HR

Facility

$6.00

Hospital Charge Code	5910005
Hospital Revenue Code	271
Min. Negotiated Rate	$4.92
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$4.50
Rate for Payer: Health Partners Plans Commercial	$5.70
Rate for Payer: UnitedHealthcare Commercial	$5.82
Rate for Payer: WPPA Commercial	$4.92

SRCARE-ATTENDENT SERV, 1/4 HR

Facility

$6.00

Hospital Charge Code	5910005
Hospital Revenue Code	271
Min. Negotiated Rate	$2.77
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$4.50
Rate for Payer: Celtic Commercial/Exchange	$2.77
Rate for Payer: Health Partners Plans Commercial	$5.70
Rate for Payer: UnitedHealthcare Commercial	$5.82
Rate for Payer: WPPA Commercial	$5.04

SRCARE-HOMEMAKER SERV, 1/4 HR

Facility

$6.00

Hospital Charge Code	5910013
Hospital Revenue Code	271
Min. Negotiated Rate	$2.77
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$4.50
Rate for Payer: Celtic Commercial/Exchange	$2.77
Rate for Payer: Health Partners Plans Commercial	$5.70
Rate for Payer: UnitedHealthcare Commercial	$5.82
Rate for Payer: WPPA Commercial	$5.04

SRCARE-HOMEMAKER SERV, 1/4 HR

Facility

$6.00

Hospital Charge Code	5910013
Hospital Revenue Code	271
Min. Negotiated Rate	$4.92
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$4.50
Rate for Payer: Health Partners Plans Commercial	$5.70
Rate for Payer: UnitedHealthcare Commercial	$5.82
Rate for Payer: WPPA Commercial	$4.92

STACHYBOTRYS CHARTARUM/ATRA

Facility

$28.00

Service Code	HCPCS 86003
Hospital Charge Code	8600307
Hospital Revenue Code	302
Min. Negotiated Rate	$22.96
Max. Negotiated Rate	$27.16
Rate for Payer: Cash Price	$21.00
Rate for Payer: Health Partners Plans Commercial	$26.60
Rate for Payer: UnitedHealthcare Commercial	$27.16
Rate for Payer: WPPA Commercial	$22.96

STACHYBOTRYS CHARTARUM/ATRA

Facility

$28.00

Service Code	HCPCS 86003
Hospital Charge Code	8600307
Hospital Revenue Code	302
Min. Negotiated Rate	$12.94
Max. Negotiated Rate	$27.16
Rate for Payer: BCBS Commercial	$15.51
Rate for Payer: Cash Price	$21.00
Rate for Payer: Cash Price	$21.00
Rate for Payer: Celtic Commercial/Exchange	$12.94
Rate for Payer: Health Partners Plans Commercial	$26.60
Rate for Payer: UnitedHealthcare Commercial	$27.16
Rate for Payer: WPPA Commercial	$23.52

STAT-PADZ ELECTRODES

Facility

$156.00

Hospital Charge Code	2704769
Hospital Revenue Code	270
Min. Negotiated Rate	$72.07
Max. Negotiated Rate	$151.32
Rate for Payer: Cash Price	$117.00
Rate for Payer: Celtic Commercial/Exchange	$72.07
Rate for Payer: Health Partners Plans Commercial	$148.20
Rate for Payer: UnitedHealthcare Commercial	$151.32
Rate for Payer: WPPA Commercial	$131.04

STAT-PADZ ELECTRODES

Facility

$156.00

Hospital Charge Code	2704769
Hospital Revenue Code	270
Min. Negotiated Rate	$127.92
Max. Negotiated Rate	$151.32
Rate for Payer: Cash Price	$117.00
Rate for Payer: Health Partners Plans Commercial	$148.20
Rate for Payer: UnitedHealthcare Commercial	$151.32
Rate for Payer: WPPA Commercial	$127.92

STERILE BASINS

Facility

$4.00

Hospital Charge Code	2702280
Hospital Revenue Code	270
Min. Negotiated Rate	$3.28
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$3.19
Rate for Payer: Health Partners Plans Commercial	$3.80
Rate for Payer: UnitedHealthcare Commercial	$3.88
Rate for Payer: WPPA Commercial	$3.28

STERILE BASINS

Facility

$4.00

Hospital Charge Code	2702280
Hospital Revenue Code	270
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$3.19
Rate for Payer: Celtic Commercial/Exchange	$1.85
Rate for Payer: Health Partners Plans Commercial	$3.80
Rate for Payer: UnitedHealthcare Commercial	$3.88
Rate for Payer: WPPA Commercial	$3.36

STERILE INSTRUMENTS

Facility

$5.00

Hospital Charge Code	2702496
Hospital Revenue Code	270
Min. Negotiated Rate	$4.10
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$4.31
Rate for Payer: Health Partners Plans Commercial	$4.75
Rate for Payer: UnitedHealthcare Commercial	$4.85
Rate for Payer: WPPA Commercial	$4.10

STERILE INSTRUMENTS

Facility

$5.00

Hospital Charge Code	2702496
Hospital Revenue Code	270
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$4.31
Rate for Payer: Celtic Commercial/Exchange	$2.31
Rate for Payer: Health Partners Plans Commercial	$4.75
Rate for Payer: UnitedHealthcare Commercial	$4.85
Rate for Payer: WPPA Commercial	$4.20

STERILE KERLIX DRESSINGS

Facility

$9.00

Hospital Charge Code	2720944
Hospital Revenue Code	272
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$6.75
Rate for Payer: Celtic Commercial/Exchange	$4.16
Rate for Payer: Health Partners Plans Commercial	$8.55
Rate for Payer: UnitedHealthcare Commercial	$8.73
Rate for Payer: WPPA Commercial	$7.56

STERILE KERLIX DRESSINGS

Facility

$9.00

Hospital Charge Code	2720944
Hospital Revenue Code	272
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

STERILE WATER IRRIGATION 250 ML

Facility

$18.00

Service Code	NDC 00338000402
Hospital Charge Code	2511657
Hospital Revenue Code	250
Min. Negotiated Rate	$8.32
Max. Negotiated Rate	$17.46
Rate for Payer: Cash Price	$13.50
Rate for Payer: Celtic Commercial/Exchange	$8.32
Rate for Payer: Health Partners Plans Commercial	$17.10
Rate for Payer: UnitedHealthcare Commercial	$17.46
Rate for Payer: WPPA Commercial	$15.12

STERILE WATER IRRIGATION 250 ML

Facility

$18.00

Service Code	NDC 00338000402
Hospital Charge Code	2511657
Hospital Revenue Code	250
Min. Negotiated Rate	$14.76
Max. Negotiated Rate	$17.46
Rate for Payer: Cash Price	$13.50
Rate for Payer: Health Partners Plans Commercial	$17.10
Rate for Payer: UnitedHealthcare Commercial	$17.46
Rate for Payer: WPPA Commercial	$14.76

STERI STRIP

Facility

$9.00

Hospital Charge Code	2722023
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

STERI STRIP

Facility

$9.00

Hospital Charge Code	2722023
Hospital Revenue Code	270
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$6.75
Rate for Payer: Celtic Commercial/Exchange	$4.16
Rate for Payer: Health Partners Plans Commercial	$8.55
Rate for Payer: UnitedHealthcare Commercial	$8.73
Rate for Payer: WPPA Commercial	$7.56

STERI STRIP 1/2 X 4 LTC

Facility

$9.00

Hospital Charge Code	2722023LTC
Hospital Revenue Code	272
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$6.75
Rate for Payer: Celtic Commercial/Exchange	$4.16
Rate for Payer: Health Partners Plans Commercial	$8.55
Rate for Payer: UnitedHealthcare Commercial	$8.73
Rate for Payer: WPPA Commercial	$7.56

STERI STRIP 1/2 X 4 LTC

Facility

$9.00

Hospital Charge Code	2722023LTC
Hospital Revenue Code	272
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