Ness County Hospital

All Charges

Charge

Type

Setting

Price

SUGARS SINGLE QUAL, EA SPECMN

Facility

$52.00

Service Code	HCPCS 84376
Hospital Charge Code	8437600
Hospital Revenue Code	301
Min. Negotiated Rate	$42.64
Max. Negotiated Rate	$50.44
Rate for Payer: Cash Price	$39.00
Rate for Payer: Health Partners Plans Commercial	$49.40
Rate for Payer: UnitedHealthcare Commercial	$50.44
Rate for Payer: WPPA Commercial	$42.64

Sulfacetamide 10% ophth. solu'n 15 ml

Facility

$183.00

Service Code	NDC 61314070101
Hospital Charge Code	2505725
Hospital Revenue Code	250
Min. Negotiated Rate	$150.06
Max. Negotiated Rate	$177.51
Rate for Payer: Cash Price	$137.25
Rate for Payer: Health Partners Plans Commercial	$173.85
Rate for Payer: UnitedHealthcare Commercial	$177.51
Rate for Payer: WPPA Commercial	$150.06

Sulfacetamide 10% ophth. solu'n 15 ml

Facility

$183.00

Service Code	NDC 61314070101
Hospital Charge Code	2505725
Hospital Revenue Code	250
Min. Negotiated Rate	$84.55
Max. Negotiated Rate	$177.51
Rate for Payer: Cash Price	$137.25
Rate for Payer: Celtic Commercial/Exchange	$84.55
Rate for Payer: Health Partners Plans Commercial	$173.85
Rate for Payer: UnitedHealthcare Commercial	$177.51
Rate for Payer: WPPA Commercial	$153.72

SUPENSORY

Facility

$30.00

Hospital Charge Code	2700284
Hospital Revenue Code	270
Min. Negotiated Rate	$13.86
Max. Negotiated Rate	$29.10
Rate for Payer: Cash Price	$22.88
Rate for Payer: Celtic Commercial/Exchange	$13.86
Rate for Payer: Health Partners Plans Commercial	$28.50
Rate for Payer: UnitedHealthcare Commercial	$29.10
Rate for Payer: WPPA Commercial	$25.20

SUPENSORY

Facility

$30.00

Hospital Charge Code	2700284
Hospital Revenue Code	270
Min. Negotiated Rate	$24.60
Max. Negotiated Rate	$29.10
Rate for Payer: Cash Price	$22.88
Rate for Payer: Health Partners Plans Commercial	$28.50
Rate for Payer: UnitedHealthcare Commercial	$29.10
Rate for Payer: WPPA Commercial	$24.60

SUPERABSORBER NON ADHESIVE

Facility

$13.00

Hospital Charge Code	2704197
Hospital Revenue Code	272
Min. Negotiated Rate	$6.01
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$9.75
Rate for Payer: Celtic Commercial/Exchange	$6.01
Rate for Payer: Health Partners Plans Commercial	$12.35
Rate for Payer: UnitedHealthcare Commercial	$12.61
Rate for Payer: WPPA Commercial	$10.92

SUPERABSORBER NON ADHESIVE

Facility

$13.00

Hospital Charge Code	2704197
Hospital Revenue Code	272
Min. Negotiated Rate	$10.66
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$9.75
Rate for Payer: Health Partners Plans Commercial	$12.35
Rate for Payer: UnitedHealthcare Commercial	$12.61
Rate for Payer: WPPA Commercial	$10.66

SUPERSORB G-GELL 20X20

Facility

$27.00

Hospital Charge Code	2704198
Hospital Revenue Code	272
Min. Negotiated Rate	$12.47
Max. Negotiated Rate	$26.19
Rate for Payer: Cash Price	$20.25
Rate for Payer: Celtic Commercial/Exchange	$12.47
Rate for Payer: Health Partners Plans Commercial	$25.65
Rate for Payer: UnitedHealthcare Commercial	$26.19
Rate for Payer: WPPA Commercial	$22.68

SUPERSORB G-GELL 20X20

Facility

$27.00

Hospital Charge Code	2704198
Hospital Revenue Code	272
Min. Negotiated Rate	$22.14
Max. Negotiated Rate	$26.19
Rate for Payer: Cash Price	$20.25
Rate for Payer: Health Partners Plans Commercial	$25.65
Rate for Payer: UnitedHealthcare Commercial	$26.19
Rate for Payer: WPPA Commercial	$22.14

SUPPER GUEST TRAY

Facility

$3.00

Hospital Charge Code	9910027
Hospital Revenue Code	990
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.81
Rate for Payer: Celtic Commercial/Exchange	$1.39
Rate for Payer: Health Partners Plans Commercial	$2.85
Rate for Payer: UnitedHealthcare Commercial	$2.91
Rate for Payer: WPPA Commercial	$2.52

SUPPER GUEST TRAY

Facility

$3.00

Hospital Charge Code	9910027
Hospital Revenue Code	990
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.81
Rate for Payer: Health Partners Plans Commercial	$2.85
Rate for Payer: UnitedHealthcare Commercial	$2.91
Rate for Payer: WPPA Commercial	$2.46

SUREPRESS BANDAGES

Facility

$29.00

Hospital Charge Code	2704199
Hospital Revenue Code	270
Min. Negotiated Rate	$23.78
Max. Negotiated Rate	$28.13
Rate for Payer: Cash Price	$21.75
Rate for Payer: Health Partners Plans Commercial	$27.55
Rate for Payer: UnitedHealthcare Commercial	$28.13
Rate for Payer: WPPA Commercial	$23.78

SUREPRESS BANDAGES

Facility

$29.00

Hospital Charge Code	2704199
Hospital Revenue Code	270
Min. Negotiated Rate	$13.40
Max. Negotiated Rate	$28.13
Rate for Payer: Cash Price	$21.75
Rate for Payer: Celtic Commercial/Exchange	$13.40
Rate for Payer: Health Partners Plans Commercial	$27.55
Rate for Payer: UnitedHealthcare Commercial	$28.13
Rate for Payer: WPPA Commercial	$24.36

SURE VENTLINE SET CO2 SAMPLING

Facility

$65.00

Hospital Charge Code	2720383
Hospital Revenue Code	270
Min. Negotiated Rate	$30.03
Max. Negotiated Rate	$63.05
Rate for Payer: Cash Price	$48.75
Rate for Payer: Celtic Commercial/Exchange	$30.03
Rate for Payer: Health Partners Plans Commercial	$61.75
Rate for Payer: UnitedHealthcare Commercial	$63.05
Rate for Payer: WPPA Commercial	$54.60

SURE VENTLINE SET CO2 SAMPLING

Facility

$65.00

Hospital Charge Code	2720383
Hospital Revenue Code	270
Min. Negotiated Rate	$53.30
Max. Negotiated Rate	$63.05
Rate for Payer: Cash Price	$48.75
Rate for Payer: Health Partners Plans Commercial	$61.75
Rate for Payer: UnitedHealthcare Commercial	$63.05
Rate for Payer: WPPA Commercial	$53.30

SURG PREP-FACE/HNDS/FT 100SQCM

Facility

$700.00

Service Code	HCPCS 15004
Hospital Charge Code	1500423
Hospital Revenue Code	761
Min. Negotiated Rate	$323.40
Max. Negotiated Rate	$1,025.15
Rate for Payer: BCBS Commercial	$1,025.15
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

SURG PREP-FACE/HNDS/FT 100SQCM

Facility

$700.00

Service Code	HCPCS 15004
Hospital Charge Code	1500423
Hospital Revenue Code	761
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

SURG PREP-TRNK/ARM/LEG 100SQCM

Facility

$1,750.00

Service Code	HCPCS 15002
Hospital Charge Code	1500223
Hospital Revenue Code	761
Min. Negotiated Rate	$808.50
Max. Negotiated Rate	$1,697.50
Rate for Payer: BCBS Commercial	$809.01
Rate for Payer: Cash Price	$1,312.50
Rate for Payer: Cash Price	$1,312.50
Rate for Payer: Celtic Commercial/Exchange	$808.50
Rate for Payer: Health Partners Plans Commercial	$1,662.50
Rate for Payer: UnitedHealthcare Commercial	$1,697.50
Rate for Payer: WPPA Commercial	$1,470.00

SURG PREP-TRNK/ARM/LEG 100SQCM

Facility

$1,750.00

Service Code	HCPCS 15002
Hospital Charge Code	1500223
Hospital Revenue Code	761
Min. Negotiated Rate	$1,435.00
Max. Negotiated Rate	$1,697.50
Rate for Payer: Cash Price	$1,312.50
Rate for Payer: Health Partners Plans Commercial	$1,662.50
Rate for Payer: UnitedHealthcare Commercial	$1,697.50
Rate for Payer: WPPA Commercial	$1,435.00

SUSCEPT STUD,ANTIMICROB AGENT

Facility

$124.00

Service Code	HCPCS 87186
Hospital Charge Code	8718600
Hospital Revenue Code	306
Min. Negotiated Rate	$101.68
Max. Negotiated Rate	$120.28
Rate for Payer: Cash Price	$93.00
Rate for Payer: Health Partners Plans Commercial	$117.80
Rate for Payer: UnitedHealthcare Commercial	$120.28
Rate for Payer: WPPA Commercial	$101.68

SUSCEPT STUD,ANTIMICROB AGENT

Facility

$55.00

Service Code	HCPCS 87185
Hospital Charge Code	8718500
Hospital Revenue Code	306
Min. Negotiated Rate	$18.54
Max. Negotiated Rate	$53.35
Rate for Payer: BCBS Commercial	$18.54
Rate for Payer: Cash Price	$41.25
Rate for Payer: Cash Price	$41.25
Rate for Payer: Celtic Commercial/Exchange	$25.41
Rate for Payer: Health Partners Plans Commercial	$52.25
Rate for Payer: UnitedHealthcare Commercial	$53.35
Rate for Payer: WPPA Commercial	$46.20

SUSCEPT STUD,ANTIMICROB AGENT

Facility

$124.00

Service Code	HCPCS 87186
Hospital Charge Code	8718600
Hospital Revenue Code	306
Min. Negotiated Rate	$32.94
Max. Negotiated Rate	$120.28
Rate for Payer: BCBS Commercial	$32.94
Rate for Payer: Cash Price	$93.00
Rate for Payer: Cash Price	$93.00
Rate for Payer: Celtic Commercial/Exchange	$57.29
Rate for Payer: Health Partners Plans Commercial	$117.80
Rate for Payer: UnitedHealthcare Commercial	$120.28
Rate for Payer: WPPA Commercial	$104.16

SUSCEPT STUD,ANTIMICROB AGENT

Facility

$55.00

Service Code	HCPCS 87185
Hospital Charge Code	8718500
Hospital Revenue Code	306
Min. Negotiated Rate	$45.10
Max. Negotiated Rate	$53.35
Rate for Payer: Cash Price	$41.25
Rate for Payer: Health Partners Plans Commercial	$52.25
Rate for Payer: UnitedHealthcare Commercial	$53.35
Rate for Payer: WPPA Commercial	$45.10

SUSCEPT STUDY,ANTIMICROB AGENT

Facility

$46.00

Service Code	HCPCS 87184
Hospital Charge Code	8718400
Hospital Revenue Code	306
Min. Negotiated Rate	$21.25
Max. Negotiated Rate	$44.62
Rate for Payer: BCBS Commercial	$25.79
Rate for Payer: Cash Price	$34.50
Rate for Payer: Cash Price	$34.50
Rate for Payer: Celtic Commercial/Exchange	$21.25
Rate for Payer: Health Partners Plans Commercial	$43.70
Rate for Payer: UnitedHealthcare Commercial	$44.62
Rate for Payer: WPPA Commercial	$38.64

SUSCEPT STUDY,ANTIMICROB AGENT

Facility

$46.00

Service Code	HCPCS 87184
Hospital Charge Code	8718400
Hospital Revenue Code	306
Min. Negotiated Rate	$37.72
Max. Negotiated Rate	$44.62
Rate for Payer: Cash Price	$34.50
Rate for Payer: Health Partners Plans Commercial	$43.70
Rate for Payer: UnitedHealthcare Commercial	$44.62
Rate for Payer: WPPA Commercial	$37.72

Know your out-of-pocket cost for care.

All Charges