Ness County Hospital

All Charges

Charge

Type

Setting

Price

HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC

Facility

$29,844.76

Service Code	MSDRG 521
Min. Negotiated Rate	$29,844.76
Max. Negotiated Rate	$29,844.76
Rate for Payer: BCBS Commercial	$29,844.76

HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC

Facility

$21,327.00

Service Code	MSDRG 522
Min. Negotiated Rate	$21,327.00
Max. Negotiated Rate	$21,327.00
Rate for Payer: BCBS Commercial	$21,327.00

HIP RT 1V

Facility

$160.00

Service Code	HCPCS 73501 RT
Hospital Charge Code	3290030
Hospital Revenue Code	320
Min. Negotiated Rate	$131.20
Max. Negotiated Rate	$155.20
Rate for Payer: Cash Price	$120.45
Rate for Payer: Health Partners Plans Commercial	$152.00
Rate for Payer: UnitedHealthcare Commercial	$155.20
Rate for Payer: WPPA Commercial	$131.20

HIP RT 1V

Facility

$160.00

Service Code	HCPCS 73501 RT
Hospital Charge Code	3290030
Hospital Revenue Code	320
Min. Negotiated Rate	$73.92
Max. Negotiated Rate	$155.20
Rate for Payer: BCBS Commercial	$142.01
Rate for Payer: Cash Price	$120.45
Rate for Payer: Cash Price	$120.45
Rate for Payer: Celtic Commercial/Exchange	$73.92
Rate for Payer: Health Partners Plans Commercial	$152.00
Rate for Payer: UnitedHealthcare Commercial	$155.20
Rate for Payer: WPPA Commercial	$134.40

HIP RT 1V W PELVIS

Facility

$243.00

Service Code	HCPCS 73501 RT
Hospital Charge Code	3290031
Hospital Revenue Code	320
Min. Negotiated Rate	$112.27
Max. Negotiated Rate	$235.71
Rate for Payer: BCBS Commercial	$142.01
Rate for Payer: Cash Price	$182.25
Rate for Payer: Cash Price	$182.25
Rate for Payer: Celtic Commercial/Exchange	$112.27
Rate for Payer: Health Partners Plans Commercial	$230.85
Rate for Payer: UnitedHealthcare Commercial	$235.71
Rate for Payer: WPPA Commercial	$204.12

HIP RT 1V W PELVIS

Facility

$243.00

Service Code	HCPCS 73501 RT
Hospital Charge Code	3290031
Hospital Revenue Code	320
Min. Negotiated Rate	$199.26
Max. Negotiated Rate	$235.71
Rate for Payer: Cash Price	$182.25
Rate for Payer: Health Partners Plans Commercial	$230.85
Rate for Payer: UnitedHealthcare Commercial	$235.71
Rate for Payer: WPPA Commercial	$199.26

HIP RT 2V

Facility

$332.00

Service Code	HCPCS 73502 RT
Hospital Charge Code	3290032
Hospital Revenue Code	320
Min. Negotiated Rate	$153.38
Max. Negotiated Rate	$322.04
Rate for Payer: BCBS Commercial	$173.25
Rate for Payer: Cash Price	$249.00
Rate for Payer: Cash Price	$249.00
Rate for Payer: Celtic Commercial/Exchange	$153.38
Rate for Payer: Health Partners Plans Commercial	$315.40
Rate for Payer: UnitedHealthcare Commercial	$322.04
Rate for Payer: WPPA Commercial	$278.88

HIP RT 2V

Facility

$332.00

Service Code	HCPCS 73502 RT
Hospital Charge Code	3290032
Hospital Revenue Code	320
Min. Negotiated Rate	$272.24
Max. Negotiated Rate	$322.04
Rate for Payer: Cash Price	$249.00
Rate for Payer: Health Partners Plans Commercial	$315.40
Rate for Payer: UnitedHealthcare Commercial	$322.04
Rate for Payer: WPPA Commercial	$272.24

HIP RT 2V W PELVIS

Facility

$357.00

Service Code	HCPCS 73502 RT
Hospital Charge Code	3290033
Hospital Revenue Code	320
Min. Negotiated Rate	$292.74
Max. Negotiated Rate	$346.29
Rate for Payer: Cash Price	$267.75
Rate for Payer: Health Partners Plans Commercial	$339.15
Rate for Payer: UnitedHealthcare Commercial	$346.29
Rate for Payer: WPPA Commercial	$292.74

HIP RT 2V W PELVIS

Facility

$357.00

Service Code	HCPCS 73502 RT
Hospital Charge Code	3290033
Hospital Revenue Code	320
Min. Negotiated Rate	$164.93
Max. Negotiated Rate	$346.29
Rate for Payer: BCBS Commercial	$173.25
Rate for Payer: Cash Price	$267.75
Rate for Payer: Cash Price	$267.75
Rate for Payer: Celtic Commercial/Exchange	$164.93
Rate for Payer: Health Partners Plans Commercial	$339.15
Rate for Payer: UnitedHealthcare Commercial	$346.29
Rate for Payer: WPPA Commercial	$299.88

HIPS BIL 2 VIEW W AP PELVIS

Facility

$339.00

Service Code	HCPCS 73521
Hospital Charge Code	3290036
Hospital Revenue Code	320
Min. Negotiated Rate	$277.98
Max. Negotiated Rate	$328.83
Rate for Payer: Cash Price	$254.92
Rate for Payer: Health Partners Plans Commercial	$322.05
Rate for Payer: UnitedHealthcare Commercial	$328.83
Rate for Payer: WPPA Commercial	$277.98

HIPS BIL 2 VIEW W AP PELVIS

Facility

$339.00

Service Code	HCPCS 73521
Hospital Charge Code	3290036
Hospital Revenue Code	320
Min. Negotiated Rate	$132.93
Max. Negotiated Rate	$328.83
Rate for Payer: BCBS Commercial	$132.93
Rate for Payer: Cash Price	$254.92
Rate for Payer: Cash Price	$254.92
Rate for Payer: Celtic Commercial/Exchange	$156.62
Rate for Payer: Health Partners Plans Commercial	$322.05
Rate for Payer: UnitedHealthcare Commercial	$328.83
Rate for Payer: WPPA Commercial	$284.76

HIPS BIL W/PELVIS 3-4 VIEWS

Facility

$465.00

Service Code	HCPCS 73522
Hospital Charge Code	3293239
Hospital Revenue Code	320
Min. Negotiated Rate	$132.93
Max. Negotiated Rate	$451.05
Rate for Payer: BCBS Commercial	$132.93
Rate for Payer: Cash Price	$348.75
Rate for Payer: Cash Price	$348.75
Rate for Payer: Celtic Commercial/Exchange	$214.83
Rate for Payer: Health Partners Plans Commercial	$441.75
Rate for Payer: UnitedHealthcare Commercial	$451.05
Rate for Payer: WPPA Commercial	$390.60

HIPS BIL W/PELVIS 3-4 VIEWS

Facility

$465.00

Service Code	HCPCS 73522
Hospital Charge Code	3293239
Hospital Revenue Code	320
Min. Negotiated Rate	$381.30
Max. Negotiated Rate	$451.05
Rate for Payer: Cash Price	$348.75
Rate for Payer: Health Partners Plans Commercial	$441.75
Rate for Payer: UnitedHealthcare Commercial	$451.05
Rate for Payer: WPPA Commercial	$381.30

HIPS BIL W/PELVIS MIN 5 VIEWS

Facility

$500.00

Service Code	HCPCS 73523
Hospital Charge Code	3294572
Hospital Revenue Code	320
Min. Negotiated Rate	$132.93
Max. Negotiated Rate	$485.00
Rate for Payer: BCBS Commercial	$132.93
Rate for Payer: Cash Price	$375.00
Rate for Payer: Cash Price	$375.00
Rate for Payer: Celtic Commercial/Exchange	$231.00
Rate for Payer: Health Partners Plans Commercial	$475.00
Rate for Payer: UnitedHealthcare Commercial	$485.00
Rate for Payer: WPPA Commercial	$420.00

HIPS BIL W/PELVIS MIN 5 VIEWS

Facility

$500.00

Service Code	HCPCS 73523
Hospital Charge Code	3294572
Hospital Revenue Code	320
Min. Negotiated Rate	$410.00
Max. Negotiated Rate	$485.00
Rate for Payer: Cash Price	$375.00
Rate for Payer: Health Partners Plans Commercial	$475.00
Rate for Payer: UnitedHealthcare Commercial	$485.00
Rate for Payer: WPPA Commercial	$410.00

HISTONE ANTIBODIES

Facility

$151.00

Service Code	HCPCS 83516
Hospital Charge Code	8351601
Hospital Revenue Code	301
Min. Negotiated Rate	$123.82
Max. Negotiated Rate	$146.47
Rate for Payer: Cash Price	$113.25
Rate for Payer: Health Partners Plans Commercial	$143.45
Rate for Payer: UnitedHealthcare Commercial	$146.47
Rate for Payer: WPPA Commercial	$123.82

HISTONE ANTIBODIES

Facility

$151.00

Service Code	HCPCS 83516
Hospital Charge Code	8351601
Hospital Revenue Code	301
Min. Negotiated Rate	$45.34
Max. Negotiated Rate	$146.47
Rate for Payer: BCBS Commercial	$45.34
Rate for Payer: Cash Price	$113.25
Rate for Payer: Cash Price	$113.25
Rate for Payer: Celtic Commercial/Exchange	$69.76
Rate for Payer: Health Partners Plans Commercial	$143.45
Rate for Payer: UnitedHealthcare Commercial	$146.47
Rate for Payer: WPPA Commercial	$126.84

HISTOPLASMA GALACTOMANNAN ANTG

Facility

$227.00

Service Code	HCPCS 87385
Hospital Charge Code	8738501
Hospital Revenue Code	306
Min. Negotiated Rate	$54.84
Max. Negotiated Rate	$220.19
Rate for Payer: BCBS Commercial	$54.84
Rate for Payer: Cash Price	$170.25
Rate for Payer: Cash Price	$170.25
Rate for Payer: Celtic Commercial/Exchange	$104.87
Rate for Payer: Health Partners Plans Commercial	$215.65
Rate for Payer: UnitedHealthcare Commercial	$220.19
Rate for Payer: WPPA Commercial	$190.68

HISTOPLASMA GALACTOMANNAN ANTG

Facility

$227.00

Service Code	HCPCS 87385
Hospital Charge Code	8738501
Hospital Revenue Code	306
Min. Negotiated Rate	$186.14
Max. Negotiated Rate	$220.19
Rate for Payer: Cash Price	$170.25
Rate for Payer: Health Partners Plans Commercial	$215.65
Rate for Payer: UnitedHealthcare Commercial	$220.19
Rate for Payer: WPPA Commercial	$186.14

HIV 1/2 AG/AB, 4 W/RFL

Facility

$113.00

Service Code	HCPCS 87389
Hospital Charge Code	8738900
Hospital Revenue Code	306
Min. Negotiated Rate	$92.66
Max. Negotiated Rate	$109.61
Rate for Payer: Cash Price	$84.75
Rate for Payer: Health Partners Plans Commercial	$107.35
Rate for Payer: UnitedHealthcare Commercial	$109.61
Rate for Payer: WPPA Commercial	$92.66

HIV 1/2 AG/AB, 4 W/RFL

Facility

$113.00

Service Code	HCPCS 87389
Hospital Charge Code	8738900
Hospital Revenue Code	306
Min. Negotiated Rate	$52.21
Max. Negotiated Rate	$109.61
Rate for Payer: BCBS Commercial	$60.02
Rate for Payer: Cash Price	$84.75
Rate for Payer: Cash Price	$84.75
Rate for Payer: Celtic Commercial/Exchange	$52.21
Rate for Payer: Health Partners Plans Commercial	$107.35
Rate for Payer: UnitedHealthcare Commercial	$109.61
Rate for Payer: WPPA Commercial	$94.92

HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC

Facility

$57,008.32

Service Code	MSDRG 969
Min. Negotiated Rate	$57,008.32
Max. Negotiated Rate	$57,008.32
Rate for Payer: BCBS Commercial	$57,008.32

HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC

Facility

$25,088.33

Service Code	MSDRG 970
Min. Negotiated Rate	$25,088.33
Max. Negotiated Rate	$25,088.33
Rate for Payer: BCBS Commercial	$25,088.33

HIV WITH MAJOR RELATED CONDITION WITH CC

Facility

$12,349.85

Service Code	MSDRG 975
Min. Negotiated Rate	$12,349.85
Max. Negotiated Rate	$12,349.85
Rate for Payer: BCBS Commercial	$12,349.85

Know your out-of-pocket cost for care.

All Charges