Ness County Hospital

All Charges

Charge

Type

Setting

Price

SUSC STUDY,ANTIMICRO AGENT

Facility

$260.00

Service Code	HCPCS 87181
Hospital Charge Code	8718100
Hospital Revenue Code	306
Min. Negotiated Rate	$213.20
Max. Negotiated Rate	$252.20
Rate for Payer: Cash Price	$195.00
Rate for Payer: Health Partners Plans Commercial	$247.00
Rate for Payer: UnitedHealthcare Commercial	$252.20
Rate for Payer: WPPA Commercial	$213.20

SUSC STUDY,ANTIMICRO AGENT

Facility

$260.00

Service Code	HCPCS 87181
Hospital Charge Code	8718100
Hospital Revenue Code	306
Min. Negotiated Rate	$18.42
Max. Negotiated Rate	$252.20
Rate for Payer: BCBS Commercial	$18.42
Rate for Payer: Cash Price	$195.00
Rate for Payer: Cash Price	$195.00
Rate for Payer: Celtic Commercial/Exchange	$120.12
Rate for Payer: Health Partners Plans Commercial	$247.00
Rate for Payer: UnitedHealthcare Commercial	$252.20
Rate for Payer: WPPA Commercial	$218.40

SUTURE ETHILON 1667G

Facility

$13.00

Hospital Charge Code	2702421
Hospital Revenue Code	270
Min. Negotiated Rate	$6.01
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$10.12
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

SUTURE ETHILON 1667G

Facility

$13.00

Hospital Charge Code	2702421
Hospital Revenue Code	270
Min. Negotiated Rate	$10.66
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$10.12
Rate for Payer: Health Partners Plans Commercial	$12.35
Rate for Payer: UnitedHealthcare Commercial	$12.61
Rate for Payer: WPPA Commercial	$10.66

SUTURE MONOCRYL UD MONO 4-0

Facility

$25.00

Hospital Charge Code	2701780
Hospital Revenue Code	270
Min. Negotiated Rate	$20.50
Max. Negotiated Rate	$24.25
Rate for Payer: Cash Price	$18.75
Rate for Payer: Health Partners Plans Commercial	$23.75
Rate for Payer: UnitedHealthcare Commercial	$24.25
Rate for Payer: WPPA Commercial	$20.50

SUTURE MONOCRYL UD MONO 4-0

Facility

$25.00

Hospital Charge Code	2701780
Hospital Revenue Code	270
Min. Negotiated Rate	$11.55
Max. Negotiated Rate	$24.25
Rate for Payer: Cash Price	$18.75
Rate for Payer: Celtic Commercial/Exchange	$11.55
Rate for Payer: Health Partners Plans Commercial	$23.75
Rate for Payer: UnitedHealthcare Commercial	$24.25
Rate for Payer: WPPA Commercial	$21.00

SUTURE REMOVAL KIT

Facility

$12.00

Hospital Charge Code	2700318LTC
Hospital Revenue Code	272
Min. Negotiated Rate	$9.84
Max. Negotiated Rate	$11.64
Rate for Payer: Cash Price	$9.00
Rate for Payer: Health Partners Plans Commercial	$11.40
Rate for Payer: UnitedHealthcare Commercial	$11.64
Rate for Payer: WPPA Commercial	$9.84

SUTURE REMOVAL KIT

Facility

$12.00

Hospital Charge Code	2700318LTC
Hospital Revenue Code	272
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$11.64
Rate for Payer: Cash Price	$9.00
Rate for Payer: Celtic Commercial/Exchange	$5.54
Rate for Payer: Health Partners Plans Commercial	$11.40
Rate for Payer: UnitedHealthcare Commercial	$11.64
Rate for Payer: WPPA Commercial	$10.08

SUTURE REPAIR 12.06CM TO 20.00

Facility

$380.00

Service Code	HCPCS 12035
Hospital Charge Code	1203500
Hospital Revenue Code	450
Min. Negotiated Rate	$175.56
Max. Negotiated Rate	$1,824.06
Rate for Payer: BCBS Commercial	$1,824.06
Rate for Payer: Cash Price	$285.00
Rate for Payer: Cash Price	$285.00
Rate for Payer: Celtic Commercial/Exchange	$175.56
Rate for Payer: Health Partners Plans Commercial	$361.00
Rate for Payer: UnitedHealthcare Commercial	$368.60
Rate for Payer: WPPA Commercial	$319.20

SUTURE REPAIR 12.06CM TO 20.00

Facility

$380.00

Service Code	HCPCS 12035
Hospital Charge Code	1203500
Hospital Revenue Code	450
Min. Negotiated Rate	$311.60
Max. Negotiated Rate	$368.60
Rate for Payer: Cash Price	$285.00
Rate for Payer: Health Partners Plans Commercial	$361.00
Rate for Payer: UnitedHealthcare Commercial	$368.60
Rate for Payer: WPPA Commercial	$311.60

SUTURE VICRYL VL 3-0

Facility

$18.00

Hospital Charge Code	2722400
Hospital Revenue Code	270
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

SUTURE VICRYL VL 3-0

Facility

$18.00

Hospital Charge Code	2722400
Hospital Revenue Code	270
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

SWAB CAP

Facility

$4.00

Hospital Charge Code	2510097
Hospital Revenue Code	270
Min. Negotiated Rate	$3.28
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$3.00
Rate for Payer: Health Partners Plans Commercial	$3.80
Rate for Payer: UnitedHealthcare Commercial	$3.88
Rate for Payer: WPPA Commercial	$3.28

SWAB CAP

Facility

$4.00

Hospital Charge Code	2510097
Hospital Revenue Code	270
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$3.00
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

SWALLOW &/OR ORAL FUNC. -EVAL

Facility

$350.00

Service Code	HCPCS 92610 GN
Hospital Charge Code	5850046
Hospital Revenue Code	444
Min. Negotiated Rate	$128.71
Max. Negotiated Rate	$339.50
Rate for Payer: BCBS Commercial	$128.71
Rate for Payer: Cash Price	$262.50
Rate for Payer: Cash Price	$262.50
Rate for Payer: Celtic Commercial/Exchange	$161.70
Rate for Payer: Health Partners Plans Commercial	$332.50
Rate for Payer: UnitedHealthcare Commercial	$339.50
Rate for Payer: WPPA Commercial	$294.00

SWALLOW &/OR ORAL FUNC. -EVAL

Facility

$350.00

Service Code	HCPCS 92610 GN
Hospital Charge Code	5850046
Hospital Revenue Code	444
Min. Negotiated Rate	$287.00
Max. Negotiated Rate	$339.50
Rate for Payer: Cash Price	$262.50
Rate for Payer: Health Partners Plans Commercial	$332.50
Rate for Payer: UnitedHealthcare Commercial	$339.50
Rate for Payer: WPPA Commercial	$287.00

SWALLOW &/OR ORAL FUNC. EVAL.

Facility

$200.00

Service Code	HCPCS 92610 GN
Hospital Charge Code	9252500
Hospital Revenue Code	444
Min. Negotiated Rate	$164.00
Max. Negotiated Rate	$194.00
Rate for Payer: Cash Price	$150.00
Rate for Payer: Health Partners Plans Commercial	$190.00
Rate for Payer: UnitedHealthcare Commercial	$194.00
Rate for Payer: WPPA Commercial	$164.00

SWALLOW &/OR ORAL FUNC. EVAL.

Facility

$200.00

Service Code	HCPCS 92610 GN
Hospital Charge Code	9252500
Hospital Revenue Code	444
Min. Negotiated Rate	$92.40
Max. Negotiated Rate	$194.00
Rate for Payer: BCBS Commercial	$128.71
Rate for Payer: Cash Price	$150.00
Rate for Payer: Cash Price	$150.00
Rate for Payer: Celtic Commercial/Exchange	$92.40
Rate for Payer: Health Partners Plans Commercial	$190.00
Rate for Payer: UnitedHealthcare Commercial	$194.00
Rate for Payer: WPPA Commercial	$168.00

SWALLOW &/OR ORAL FUNC THERAPY

Facility

$350.00

Service Code	HCPCS 92526 GN
Hospital Charge Code	9252604
Hospital Revenue Code	441
Min. Negotiated Rate	$65.44
Max. Negotiated Rate	$339.50
Rate for Payer: BCBS Commercial	$65.44
Rate for Payer: Cash Price	$262.50
Rate for Payer: Cash Price	$262.50
Rate for Payer: Celtic Commercial/Exchange	$161.70
Rate for Payer: Health Partners Plans Commercial	$332.50
Rate for Payer: UnitedHealthcare Commercial	$339.50
Rate for Payer: WPPA Commercial	$294.00

SWALLOW &/OR ORAL FUNC THERAPY

Facility

$350.00

Service Code	HCPCS 92526 GN
Hospital Charge Code	9252604
Hospital Revenue Code	441
Min. Negotiated Rate	$287.00
Max. Negotiated Rate	$339.50
Rate for Payer: Cash Price	$262.50
Rate for Payer: Health Partners Plans Commercial	$332.50
Rate for Payer: UnitedHealthcare Commercial	$339.50
Rate for Payer: WPPA Commercial	$287.00

SYMMETREL 100 MG CAP (AMANTADINE HCL)

Facility

$10.00

Service Code	NDC 50268006915
Hospital Charge Code	2506772
Hospital Revenue Code	250
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$7.88
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

SYMMETREL 100 MG CAP (AMANTADINE HCL)

Facility

$10.00

Service Code	NDC 50268006915
Hospital Charge Code	2506772
Hospital Revenue Code	250
Min. Negotiated Rate	$8.20
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$7.88
Rate for Payer: Health Partners Plans Commercial	$9.50
Rate for Payer: UnitedHealthcare Commercial	$9.70
Rate for Payer: WPPA Commercial	$8.20

SYNCOPE AND COLLAPSE

Facility

$7,519.98

Service Code	MSDRG 312
Min. Negotiated Rate	$7,519.98
Max. Negotiated Rate	$7,519.98
Rate for Payer: BCBS Commercial	$7,519.98

SYNTHROID 100 MCG (LEVOTHYROXINE)

Facility

$4.00

Service Code	NDC 60687049711
Hospital Charge Code	2510949
Hospital Revenue Code	250
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$3.30
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

SYNTHROID 100 MCG (LEVOTHYROXINE)

Facility

$4.00

Service Code	NDC 60687049711
Hospital Charge Code	2510949
Hospital Revenue Code	250
Min. Negotiated Rate	$3.28
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$3.30
Rate for Payer: Health Partners Plans Commercial	$3.80
Rate for Payer: UnitedHealthcare Commercial	$3.88
Rate for Payer: WPPA Commercial	$3.28

Know your out-of-pocket cost for care.

All Charges