Ness County Hospital

All Charges

Charge

Type

Setting

Price

SUB INFUSION, EA ADDTL HR

Facility

$134.00

Service Code	HCPCS 96370
Hospital Charge Code	9637000
Hospital Revenue Code	761
Min. Negotiated Rate	$61.91
Max. Negotiated Rate	$133.32
Rate for Payer: BCBS Commercial	$133.32
Rate for Payer: Cash Price	$100.50
Rate for Payer: Cash Price	$100.50
Rate for Payer: Celtic Commercial/Exchange	$61.91
Rate for Payer: Health Partners Plans Commercial	$127.30
Rate for Payer: UnitedHealthcare Commercial	$129.98
Rate for Payer: WPPA Commercial	$112.56

SUB INFUSION, EA ADDTL HR

Facility

$134.00

Service Code	HCPCS 96370
Hospital Charge Code	9637000
Hospital Revenue Code	761
Min. Negotiated Rate	$109.88
Max. Negotiated Rate	$129.98
Rate for Payer: Cash Price	$100.50
Rate for Payer: Health Partners Plans Commercial	$127.30
Rate for Payer: UnitedHealthcare Commercial	$129.98
Rate for Payer: WPPA Commercial	$109.88

SUB INFUSION, INITIAL UP 1 HR

Facility

$209.00

Service Code	HCPCS 96369
Hospital Charge Code	9636900
Hospital Revenue Code	761
Min. Negotiated Rate	$96.56
Max. Negotiated Rate	$202.73
Rate for Payer: BCBS Commercial	$133.32
Rate for Payer: Cash Price	$156.75
Rate for Payer: Cash Price	$156.75
Rate for Payer: Celtic Commercial/Exchange	$96.56
Rate for Payer: Health Partners Plans Commercial	$198.55
Rate for Payer: UnitedHealthcare Commercial	$202.73
Rate for Payer: WPPA Commercial	$175.56

SUB INFUSION, INITIAL UP 1 HR

Facility

$209.00

Service Code	HCPCS 96369
Hospital Charge Code	9636900
Hospital Revenue Code	761
Min. Negotiated Rate	$171.38
Max. Negotiated Rate	$202.73
Rate for Payer: Cash Price	$156.75
Rate for Payer: Health Partners Plans Commercial	$198.55
Rate for Payer: UnitedHealthcare Commercial	$202.73
Rate for Payer: WPPA Commercial	$171.38

SUBS ABUSE PANEL W/OPIATES,URI

Facility

$193.00

Service Code	HCPCS 80307
Hospital Charge Code	8030701
Hospital Revenue Code	300
Min. Negotiated Rate	$89.17
Max. Negotiated Rate	$187.21
Rate for Payer: BCBS Commercial	$150.08
Rate for Payer: Cash Price	$144.75
Rate for Payer: Cash Price	$144.75
Rate for Payer: Celtic Commercial/Exchange	$89.17
Rate for Payer: Health Partners Plans Commercial	$183.35
Rate for Payer: UnitedHealthcare Commercial	$187.21
Rate for Payer: WPPA Commercial	$162.12

SUBS ABUSE PANEL W/OPIATES,URI

Facility

$193.00

Service Code	HCPCS 80307
Hospital Charge Code	8030701
Hospital Revenue Code	300
Min. Negotiated Rate	$158.26
Max. Negotiated Rate	$187.21
Rate for Payer: Cash Price	$144.75
Rate for Payer: Health Partners Plans Commercial	$183.35
Rate for Payer: UnitedHealthcare Commercial	$187.21
Rate for Payer: WPPA Commercial	$158.26

SUBSEQUENT-NASAL HEMORRHAGE

Facility

$217.00

Service Code	HCPCS 30906
Hospital Charge Code	3090600
Hospital Revenue Code	450
Min. Negotiated Rate	$100.25
Max. Negotiated Rate	$210.49
Rate for Payer: BCBS Commercial	$210.08
Rate for Payer: Cash Price	$162.75
Rate for Payer: Cash Price	$162.75
Rate for Payer: Celtic Commercial/Exchange	$100.25
Rate for Payer: Health Partners Plans Commercial	$206.15
Rate for Payer: UnitedHealthcare Commercial	$210.49
Rate for Payer: WPPA Commercial	$182.28

SUBSEQUENT-NASAL HEMORRHAGE

Facility

$217.00

Service Code	HCPCS 30906
Hospital Charge Code	3090600
Hospital Revenue Code	450
Min. Negotiated Rate	$177.94
Max. Negotiated Rate	$210.49
Rate for Payer: Cash Price	$162.75
Rate for Payer: Health Partners Plans Commercial	$206.15
Rate for Payer: UnitedHealthcare Commercial	$210.49
Rate for Payer: WPPA Commercial	$177.94

Subsequent nursing facility care (HMC)

Facility

$279.00

Service Code	HCPCS 99309
Hospital Charge Code	9930900
Hospital Revenue Code	761
Min. Negotiated Rate	$228.78
Max. Negotiated Rate	$270.63
Rate for Payer: Cash Price	$209.25
Rate for Payer: Health Partners Plans Commercial	$265.05
Rate for Payer: UnitedHealthcare Commercial	$270.63
Rate for Payer: WPPA Commercial	$228.78

Subsequent nursing facility care (HMC)

Facility

$279.00

Service Code	HCPCS 99309
Hospital Charge Code	9930900
Hospital Revenue Code	761
Min. Negotiated Rate	$128.90
Max. Negotiated Rate	$270.63
Rate for Payer: Cash Price	$209.25
Rate for Payer: Celtic Commercial/Exchange	$128.90
Rate for Payer: Health Partners Plans Commercial	$265.05
Rate for Payer: UnitedHealthcare Commercial	$270.63
Rate for Payer: WPPA Commercial	$234.36

SUCTION CANISTER 3000CC

Facility

$24.00

Hospital Charge Code	2700650
Hospital Revenue Code	272
Min. Negotiated Rate	$19.68
Max. Negotiated Rate	$23.28
Rate for Payer: Cash Price	$18.00
Rate for Payer: Health Partners Plans Commercial	$22.80
Rate for Payer: UnitedHealthcare Commercial	$23.28
Rate for Payer: WPPA Commercial	$19.68

SUCTION CANISTER 3000CC

Facility

$24.00

Hospital Charge Code	2700650
Hospital Revenue Code	272
Min. Negotiated Rate	$11.09
Max. Negotiated Rate	$23.28
Rate for Payer: Cash Price	$18.00
Rate for Payer: Celtic Commercial/Exchange	$11.09
Rate for Payer: Health Partners Plans Commercial	$22.80
Rate for Payer: UnitedHealthcare Commercial	$23.28
Rate for Payer: WPPA Commercial	$20.16

SUCTION CANISTERS 2000CC

Facility

$24.00

Hospital Charge Code	2700649
Hospital Revenue Code	270
Min. Negotiated Rate	$11.09
Max. Negotiated Rate	$23.28
Rate for Payer: Cash Price	$18.00
Rate for Payer: Celtic Commercial/Exchange	$11.09
Rate for Payer: Health Partners Plans Commercial	$22.80
Rate for Payer: UnitedHealthcare Commercial	$23.28
Rate for Payer: WPPA Commercial	$20.16

SUCTION CANISTERS 2000CC

Facility

$24.00

Hospital Charge Code	2700649
Hospital Revenue Code	270
Min. Negotiated Rate	$19.68
Max. Negotiated Rate	$23.28
Rate for Payer: Cash Price	$18.00
Rate for Payer: Health Partners Plans Commercial	$22.80
Rate for Payer: UnitedHealthcare Commercial	$23.28
Rate for Payer: WPPA Commercial	$19.68

SUCTION CATHETER AIRLIFE 14FR

Facility

$10.00

Hospital Charge Code	2720382
Hospital Revenue Code	270
Min. Negotiated Rate	$8.20
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$7.69
Rate for Payer: Health Partners Plans Commercial	$9.50
Rate for Payer: UnitedHealthcare Commercial	$9.70
Rate for Payer: WPPA Commercial	$8.20

SUCTION CATHETER AIRLIFE 14FR

Facility

$10.00

Hospital Charge Code	2720382
Hospital Revenue Code	270
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$7.69
Rate for Payer: Celtic Commercial/Exchange	$4.62
Rate for Payer: Health Partners Plans Commercial	$9.50
Rate for Payer: UnitedHealthcare Commercial	$9.70
Rate for Payer: WPPA Commercial	$8.40

SUCTION POLYP TRAP

Facility

$33.00

Hospital Charge Code	2709467
Hospital Revenue Code	270
Min. Negotiated Rate	$15.25
Max. Negotiated Rate	$32.01
Rate for Payer: Cash Price	$24.75
Rate for Payer: Celtic Commercial/Exchange	$15.25
Rate for Payer: Health Partners Plans Commercial	$31.35
Rate for Payer: UnitedHealthcare Commercial	$32.01
Rate for Payer: WPPA Commercial	$27.72

SUCTION POLYP TRAP

Facility

$33.00

Hospital Charge Code	2709467
Hospital Revenue Code	270
Min. Negotiated Rate	$27.06
Max. Negotiated Rate	$32.01
Rate for Payer: Cash Price	$24.75
Rate for Payer: Health Partners Plans Commercial	$31.35
Rate for Payer: UnitedHealthcare Commercial	$32.01
Rate for Payer: WPPA Commercial	$27.06

SUCTION TUBING 6 X 1/4

Facility

$16.00

Hospital Charge Code	2700631
Hospital Revenue Code	270
Min. Negotiated Rate	$7.39
Max. Negotiated Rate	$15.52
Rate for Payer: Cash Price	$12.00
Rate for Payer: Celtic Commercial/Exchange	$7.39
Rate for Payer: Health Partners Plans Commercial	$15.20
Rate for Payer: UnitedHealthcare Commercial	$15.52
Rate for Payer: WPPA Commercial	$13.44

SUCTION TUBING 6 X 1/4

Facility

$16.00

Hospital Charge Code	2700631
Hospital Revenue Code	270
Min. Negotiated Rate	$13.12
Max. Negotiated Rate	$15.52
Rate for Payer: Cash Price	$12.00
Rate for Payer: Health Partners Plans Commercial	$15.20
Rate for Payer: UnitedHealthcare Commercial	$15.52
Rate for Payer: WPPA Commercial	$13.12

SUDAFED 12-HR 120 MG TAB (PSEUDOEPHEDRINE HCL ER)

Facility

$1.00

Service Code	NDC 45802010752
Hospital Charge Code	2508935
Hospital Revenue Code	250
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.90
Rate for Payer: Health Partners Plans Commercial	$0.95
Rate for Payer: UnitedHealthcare Commercial	$0.97
Rate for Payer: WPPA Commercial	$0.82

SUDAFED 12-HR 120 MG TAB (PSEUDOEPHEDRINE HCL ER)

Facility

$1.00

Service Code	NDC 45802010752
Hospital Charge Code	2508935
Hospital Revenue Code	250
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.90
Rate for Payer: Celtic Commercial/Exchange	$0.46
Rate for Payer: Health Partners Plans Commercial	$0.95
Rate for Payer: UnitedHealthcare Commercial	$0.97
Rate for Payer: WPPA Commercial	$0.84

SUDAFED LIQUID 15 MG/5 ML (PSEUDOEPHEDRINE HCL)

Facility

$1.00

Service Code	NDC 50580053604
Hospital Charge Code	2511772
Hospital Revenue Code	250
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.75
Rate for Payer: Celtic Commercial/Exchange	$0.46
Rate for Payer: Health Partners Plans Commercial	$0.95
Rate for Payer: UnitedHealthcare Commercial	$0.97
Rate for Payer: WPPA Commercial	$0.84

SUDAFED LIQUID 15 MG/5 ML (PSEUDOEPHEDRINE HCL)

Facility

$1.00

Service Code	NDC 50580053604
Hospital Charge Code	2511772
Hospital Revenue Code	250
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.75
Rate for Payer: Health Partners Plans Commercial	$0.95
Rate for Payer: UnitedHealthcare Commercial	$0.97
Rate for Payer: WPPA Commercial	$0.82

SUGARS SINGLE QUAL, EA SPECMN

Facility

$52.00

Service Code	HCPCS 84376
Hospital Charge Code	8437600
Hospital Revenue Code	301
Min. Negotiated Rate	$24.02
Max. Negotiated Rate	$50.44
Rate for Payer: BCBS Commercial	$40.80
Rate for Payer: Cash Price	$39.00
Rate for Payer: Cash Price	$39.00
Rate for Payer: Celtic Commercial/Exchange	$24.02
Rate for Payer: Health Partners Plans Commercial	$49.40
Rate for Payer: UnitedHealthcare Commercial	$50.44
Rate for Payer: WPPA Commercial	$43.68

Know your out-of-pocket cost for care.

All Charges