Ness County Hospital

All Charges

Charge

Type

Setting

Price

HEPARIN PREMIX 25,000 UNITS/250 ML

Facility

$36.00

Service Code	NDC 00409765062
Hospital Charge Code	2519122
Hospital Revenue Code	250
Min. Negotiated Rate	$16.63
Max. Negotiated Rate	$34.92
Rate for Payer: Cash Price	$27.19
Rate for Payer: Celtic Commercial/Exchange	$16.63
Rate for Payer: Health Partners Plans Commercial	$34.20
Rate for Payer: UnitedHealthcare Commercial	$34.92
Rate for Payer: WPPA Commercial	$30.24

HEPARIN PREMIX 25,000 UNITS/250 ML

Facility

$36.00

Service Code	NDC 00409765062
Hospital Charge Code	2519122
Hospital Revenue Code	250
Min. Negotiated Rate	$29.52
Max. Negotiated Rate	$34.92
Rate for Payer: Cash Price	$27.19
Rate for Payer: Health Partners Plans Commercial	$34.20
Rate for Payer: UnitedHealthcare Commercial	$34.92
Rate for Payer: WPPA Commercial	$29.52

HEPATIC FUNCTION PANEL

Facility

$134.00

Service Code	HCPCS 80076
Hospital Charge Code	8007600
Hospital Revenue Code	301
Min. Negotiated Rate	$31.88
Max. Negotiated Rate	$129.98
Rate for Payer: BCBS Commercial	$31.88
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

HEPATIC FUNCTION PANEL

Facility

$134.00

Service Code	HCPCS 80076
Hospital Charge Code	8007600
Hospital Revenue Code	301
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

HEPATITIS A ANTIB IGM ANTIB.

Facility

$124.00

Service Code	HCPCS 86709
Hospital Charge Code	8670900
Hospital Revenue Code	302
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

HEPATITIS A ANTIB IGM ANTIB.

Facility

$124.00

Service Code	HCPCS 86709
Hospital Charge Code	8670900
Hospital Revenue Code	302
Min. Negotiated Rate	$49.95
Max. Negotiated Rate	$120.28
Rate for Payer: BCBS Commercial	$49.95
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

HEPATITIS A ANTIBODY TOTAL

Facility

$110.00

Service Code	HCPCS 86708
Hospital Charge Code	8670800
Hospital Revenue Code	302
Min. Negotiated Rate	$45.93
Max. Negotiated Rate	$106.70
Rate for Payer: BCBS Commercial	$45.93
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

HEPATITIS A ANTIBODY TOTAL

Facility

$110.00

Service Code	HCPCS 86708
Hospital Charge Code	8670800
Hospital Revenue Code	302
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

Hepatitis B 20 mcg/ml inj. (adult)

Facility

$203.00

Service Code	NDC 58160082152
Hospital Charge Code	2511723
Hospital Revenue Code	250
Min. Negotiated Rate	$166.46
Max. Negotiated Rate	$196.91
Rate for Payer: Cash Price	$152.55
Rate for Payer: Health Partners Plans Commercial	$192.85
Rate for Payer: UnitedHealthcare Commercial	$196.91
Rate for Payer: WPPA Commercial	$166.46

Hepatitis B 20 mcg/ml inj. (adult)

Facility

$203.00

Service Code	NDC 58160082152
Hospital Charge Code	2511723
Hospital Revenue Code	250
Min. Negotiated Rate	$93.79
Max. Negotiated Rate	$196.91
Rate for Payer: Cash Price	$152.55
Rate for Payer: Celtic Commercial/Exchange	$93.79
Rate for Payer: Health Partners Plans Commercial	$192.85
Rate for Payer: UnitedHealthcare Commercial	$196.91
Rate for Payer: WPPA Commercial	$170.52

HEPATITIS B CORE ANTIBODY,IGM

Facility

$114.00

Service Code	HCPCS 86705
Hospital Charge Code	8670500
Hospital Revenue Code	302
Min. Negotiated Rate	$93.48
Max. Negotiated Rate	$110.58
Rate for Payer: Cash Price	$85.50
Rate for Payer: Health Partners Plans Commercial	$108.30
Rate for Payer: UnitedHealthcare Commercial	$110.58
Rate for Payer: WPPA Commercial	$93.48

HEPATITIS B CORE ANTIBODY,IGM

Facility

$114.00

Service Code	HCPCS 86705
Hospital Charge Code	8670500
Hospital Revenue Code	302
Min. Negotiated Rate	$34.09
Max. Negotiated Rate	$110.58
Rate for Payer: BCBS Commercial	$34.09
Rate for Payer: Cash Price	$85.50
Rate for Payer: Cash Price	$85.50
Rate for Payer: Celtic Commercial/Exchange	$52.67
Rate for Payer: Health Partners Plans Commercial	$108.30
Rate for Payer: UnitedHealthcare Commercial	$110.58
Rate for Payer: WPPA Commercial	$95.76

HEPATITIS B CORE ANTIB,TOTAL

Facility

$118.00

Service Code	HCPCS 86704
Hospital Charge Code	8670400
Hospital Revenue Code	302
Min. Negotiated Rate	$44.24
Max. Negotiated Rate	$114.46
Rate for Payer: BCBS Commercial	$44.24
Rate for Payer: Cash Price	$88.50
Rate for Payer: Cash Price	$88.50
Rate for Payer: Celtic Commercial/Exchange	$54.52
Rate for Payer: Health Partners Plans Commercial	$112.10
Rate for Payer: UnitedHealthcare Commercial	$114.46
Rate for Payer: WPPA Commercial	$99.12

HEPATITIS B CORE ANTIB,TOTAL

Facility

$118.00

Service Code	HCPCS 86704
Hospital Charge Code	8670400
Hospital Revenue Code	302
Min. Negotiated Rate	$96.76
Max. Negotiated Rate	$114.46
Rate for Payer: Cash Price	$88.50
Rate for Payer: Health Partners Plans Commercial	$112.10
Rate for Payer: UnitedHealthcare Commercial	$114.46
Rate for Payer: WPPA Commercial	$96.76

HEPATITIS BE ANTIBODY

Facility

$77.00

Service Code	HCPCS 86707
Hospital Charge Code	8670700
Hospital Revenue Code	302
Min. Negotiated Rate	$63.14
Max. Negotiated Rate	$74.69
Rate for Payer: Cash Price	$57.75
Rate for Payer: Health Partners Plans Commercial	$73.15
Rate for Payer: UnitedHealthcare Commercial	$74.69
Rate for Payer: WPPA Commercial	$63.14

HEPATITIS BE ANTIBODY

Facility

$77.00

Service Code	HCPCS 86707
Hospital Charge Code	8670700
Hospital Revenue Code	302
Min. Negotiated Rate	$35.57
Max. Negotiated Rate	$74.69
Rate for Payer: BCBS Commercial	$43.38
Rate for Payer: Cash Price	$57.75
Rate for Payer: Cash Price	$57.75
Rate for Payer: Celtic Commercial/Exchange	$35.57
Rate for Payer: Health Partners Plans Commercial	$73.15
Rate for Payer: UnitedHealthcare Commercial	$74.69
Rate for Payer: WPPA Commercial	$64.68

HEPATITIS B SURFACE ANTIBODY

Facility

$122.00

Service Code	HCPCS 86706
Hospital Charge Code	8670600
Hospital Revenue Code	302
Min. Negotiated Rate	$46.36
Max. Negotiated Rate	$118.34
Rate for Payer: BCBS Commercial	$46.36
Rate for Payer: Cash Price	$91.50
Rate for Payer: Cash Price	$91.50
Rate for Payer: Celtic Commercial/Exchange	$56.36
Rate for Payer: Health Partners Plans Commercial	$115.90
Rate for Payer: UnitedHealthcare Commercial	$118.34
Rate for Payer: WPPA Commercial	$102.48

HEPATITIS B SURFACE ANTIBODY

Facility

$122.00

Service Code	HCPCS 86706
Hospital Charge Code	8670600
Hospital Revenue Code	302
Min. Negotiated Rate	$100.04
Max. Negotiated Rate	$118.34
Rate for Payer: Cash Price	$91.50
Rate for Payer: Health Partners Plans Commercial	$115.90
Rate for Payer: UnitedHealthcare Commercial	$118.34
Rate for Payer: WPPA Commercial	$100.04

HEPATITIS C ANTIBODY

Facility

$134.00

Service Code	HCPCS 86803
Hospital Charge Code	8680300
Hospital Revenue Code	302
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

HEPATITIS C ANTIBODY

Facility

$134.00

Service Code	HCPCS 86803
Hospital Charge Code	8680300
Hospital Revenue Code	302
Min. Negotiated Rate	$45.09
Max. Negotiated Rate	$129.98
Rate for Payer: BCBS Commercial	$45.09
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

HEPATITIS C VIRAL RNA,QUANT

Facility

$194.00

Service Code	HCPCS 87522
Hospital Charge Code	8752201
Hospital Revenue Code	306
Min. Negotiated Rate	$89.63
Max. Negotiated Rate	$188.18
Rate for Payer: BCBS Commercial	$91.91
Rate for Payer: Cash Price	$145.50
Rate for Payer: Cash Price	$145.50
Rate for Payer: Celtic Commercial/Exchange	$89.63
Rate for Payer: Health Partners Plans Commercial	$184.30
Rate for Payer: UnitedHealthcare Commercial	$188.18
Rate for Payer: WPPA Commercial	$162.96

HEPATITIS C VIRAL RNA,QUANT

Facility

$194.00

Service Code	HCPCS 87522
Hospital Charge Code	8752201
Hospital Revenue Code	306
Min. Negotiated Rate	$159.08
Max. Negotiated Rate	$188.18
Rate for Payer: Cash Price	$145.50
Rate for Payer: Health Partners Plans Commercial	$184.30
Rate for Payer: UnitedHealthcare Commercial	$188.18
Rate for Payer: WPPA Commercial	$159.08

HEPATITIS D VIRUS (HDV) ANTIBO

Facility

$90.00

Service Code	HCPCS 86692
Hospital Charge Code	8669201
Hospital Revenue Code	302
Min. Negotiated Rate	$73.80
Max. Negotiated Rate	$87.30
Rate for Payer: Cash Price	$67.50
Rate for Payer: Health Partners Plans Commercial	$85.50
Rate for Payer: UnitedHealthcare Commercial	$87.30
Rate for Payer: WPPA Commercial	$73.80

HEPATITIS D VIRUS (HDV) ANTIBO

Facility

$90.00

Service Code	HCPCS 86692
Hospital Charge Code	8669201
Hospital Revenue Code	302
Min. Negotiated Rate	$41.58
Max. Negotiated Rate	$87.30
Rate for Payer: BCBS Commercial	$65.51
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cash Price	$67.50
Rate for Payer: Celtic Commercial/Exchange	$41.58
Rate for Payer: Health Partners Plans Commercial	$85.50
Rate for Payer: UnitedHealthcare Commercial	$87.30
Rate for Payer: WPPA Commercial	$75.60

HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC

Facility

$14,990.75

Service Code	MSDRG 421
Min. Negotiated Rate	$14,990.75
Max. Negotiated Rate	$14,990.75
Rate for Payer: BCBS Commercial	$14,990.75

Know your out-of-pocket cost for care.

All Charges