Ness County Hospital

All Charges

Charge

Type

Setting

Price

HIV WITH MAJOR RELATED CONDITION WITH MCC

Facility

$25,875.57

Service Code	MSDRG 974
Min. Negotiated Rate	$25,875.57
Max. Negotiated Rate	$25,875.57
Rate for Payer: BCBS Commercial	$25,875.57

HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC

Facility

$8,650.61

Service Code	MSDRG 976
Min. Negotiated Rate	$8,650.61
Max. Negotiated Rate	$8,650.61
Rate for Payer: BCBS Commercial	$8,650.61

HIV WITH OR WITHOUT OTHER RELATED CONDITION

Facility

$12,216.64

Service Code	MSDRG 977
Min. Negotiated Rate	$12,216.64
Max. Negotiated Rate	$12,216.64
Rate for Payer: BCBS Commercial	$12,216.64

HLA-B27 ANTIGEN

Facility

$118.00

Service Code	HCPCS 86812
Hospital Charge Code	8681201
Hospital Revenue Code	302
Min. Negotiated Rate	$54.52
Max. Negotiated Rate	$114.46
Rate for Payer: BCBS Commercial	$55.39
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

HLA-B27 ANTIGEN

Facility

$118.00

Service Code	HCPCS 86812
Hospital Charge Code	8681201
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

HLA CLASS TYPING

Facility

$300.00

Service Code	HCPCS 81382
Hospital Charge Code	8138200
Hospital Revenue Code	300
Min. Negotiated Rate	$246.00
Max. Negotiated Rate	$291.00
Rate for Payer: Cash Price	$225.00
Rate for Payer: Health Partners Plans Commercial	$285.00
Rate for Payer: UnitedHealthcare Commercial	$291.00
Rate for Payer: WPPA Commercial	$246.00

HLA CLASS TYPING

Facility

$300.00

Service Code	HCPCS 81382
Hospital Charge Code	8138200
Hospital Revenue Code	300
Min. Negotiated Rate	$138.60
Max. Negotiated Rate	$291.00
Rate for Payer: BCBS Commercial	$278.78
Rate for Payer: Cash Price	$225.00
Rate for Payer: Cash Price	$225.00
Rate for Payer: Celtic Commercial/Exchange	$138.60
Rate for Payer: Health Partners Plans Commercial	$285.00
Rate for Payer: UnitedHealthcare Commercial	$291.00
Rate for Payer: WPPA Commercial	$252.00

HLA TYPING A,B,OR C SNGL ANTGN

Facility

$118.00

Service Code	HCPCS 86812
Hospital Charge Code	8681200
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

HLA TYPING A,B,OR C SNGL ANTGN

Facility

$118.00

Service Code	HCPCS 86812
Hospital Charge Code	8681200
Hospital Revenue Code	302
Min. Negotiated Rate	$54.52
Max. Negotiated Rate	$114.46
Rate for Payer: BCBS Commercial	$55.39
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

HLA TYPING CELIAC DISEASE

Facility

$275.00

Service Code	HCPCS 81376
Hospital Charge Code	8137600
Hospital Revenue Code	300
Min. Negotiated Rate	$127.05
Max. Negotiated Rate	$266.75
Rate for Payer: BCBS Commercial	$258.03
Rate for Payer: Cash Price	$206.25
Rate for Payer: Cash Price	$206.25
Rate for Payer: Celtic Commercial/Exchange	$127.05
Rate for Payer: Health Partners Plans Commercial	$261.25
Rate for Payer: UnitedHealthcare Commercial	$266.75
Rate for Payer: WPPA Commercial	$231.00

HLA TYPING CELIAC DISEASE

Facility

$275.00

Service Code	HCPCS 81376
Hospital Charge Code	8137600
Hospital Revenue Code	300
Min. Negotiated Rate	$225.50
Max. Negotiated Rate	$266.75
Rate for Payer: Cash Price	$206.25
Rate for Payer: Health Partners Plans Commercial	$261.25
Rate for Payer: UnitedHealthcare Commercial	$266.75
Rate for Payer: WPPA Commercial	$225.50

HOLD-N-PLACE ADH PATCH

Facility

$35.00

Hospital Charge Code	2700715
Hospital Revenue Code	272
Min. Negotiated Rate	$16.17
Max. Negotiated Rate	$33.95
Rate for Payer: Cash Price	$26.25
Rate for Payer: Celtic Commercial/Exchange	$16.17
Rate for Payer: Health Partners Plans Commercial	$33.25
Rate for Payer: UnitedHealthcare Commercial	$33.95
Rate for Payer: WPPA Commercial	$29.40

HOLD-N-PLACE ADH PATCH

Facility

$35.00

Hospital Charge Code	2700715
Hospital Revenue Code	272
Min. Negotiated Rate	$28.70
Max. Negotiated Rate	$33.95
Rate for Payer: Cash Price	$26.25
Rate for Payer: Health Partners Plans Commercial	$33.25
Rate for Payer: UnitedHealthcare Commercial	$33.95
Rate for Payer: WPPA Commercial	$28.70

HOMATROPINE 5% OPTH SOL 5ML

Facility

$133.00

Hospital Charge Code	2511525
Hospital Revenue Code	250
Min. Negotiated Rate	$109.06
Max. Negotiated Rate	$129.01
Rate for Payer: Cash Price	$99.79
Rate for Payer: Health Partners Plans Commercial	$126.35
Rate for Payer: UnitedHealthcare Commercial	$129.01
Rate for Payer: WPPA Commercial	$109.06

HOMATROPINE 5% OPTH SOL 5ML

Facility

$133.00

Hospital Charge Code	2511525
Hospital Revenue Code	250
Min. Negotiated Rate	$61.45
Max. Negotiated Rate	$129.01
Rate for Payer: Cash Price	$99.79
Rate for Payer: Celtic Commercial/Exchange	$61.45
Rate for Payer: Health Partners Plans Commercial	$126.35
Rate for Payer: UnitedHealthcare Commercial	$129.01
Rate for Payer: WPPA Commercial	$111.72

HOME HEALTH-AIDE/VISIT

Facility

$104.00

Service Code	HCPCS G0156
Hospital Charge Code	5710009
Hospital Revenue Code	571
Min. Negotiated Rate	$85.28
Max. Negotiated Rate	$100.88
Rate for Payer: Cash Price	$78.00
Rate for Payer: Health Partners Plans Commercial	$98.80
Rate for Payer: UnitedHealthcare Commercial	$100.88
Rate for Payer: WPPA Commercial	$85.28

HOME HEALTH-AIDE/VISIT

Facility

$104.00

Service Code	HCPCS G0156
Hospital Charge Code	5710009
Hospital Revenue Code	571
Min. Negotiated Rate	$48.05
Max. Negotiated Rate	$100.88
Rate for Payer: Cash Price	$78.00
Rate for Payer: Celtic Commercial/Exchange	$48.05
Rate for Payer: Health Partners Plans Commercial	$98.80
Rate for Payer: UnitedHealthcare Commercial	$100.88
Rate for Payer: WPPA Commercial	$87.36

HOME HEALTH IV ADMINISTRATION

Facility

$14.00

Hospital Charge Code	5710001
Hospital Revenue Code	550
Min. Negotiated Rate	$6.47
Max. Negotiated Rate	$13.58
Rate for Payer: Cash Price	$10.50
Rate for Payer: Celtic Commercial/Exchange	$6.47
Rate for Payer: Health Partners Plans Commercial	$13.30
Rate for Payer: UnitedHealthcare Commercial	$13.58
Rate for Payer: WPPA Commercial	$11.76

HOME HEALTH IV ADMINISTRATION

Facility

$14.00

Hospital Charge Code	5710001
Hospital Revenue Code	550
Min. Negotiated Rate	$11.48
Max. Negotiated Rate	$13.58
Rate for Payer: Cash Price	$10.50
Rate for Payer: Health Partners Plans Commercial	$13.30
Rate for Payer: UnitedHealthcare Commercial	$13.58
Rate for Payer: WPPA Commercial	$11.48

HOME HEALTH NUTRITION CONSULT

Facility

$80.00

Hospital Charge Code	5710405
Hospital Revenue Code	581
Min. Negotiated Rate	$36.96
Max. Negotiated Rate	$77.60
Rate for Payer: Cash Price	$60.00
Rate for Payer: Celtic Commercial/Exchange	$36.96
Rate for Payer: Health Partners Plans Commercial	$76.00
Rate for Payer: UnitedHealthcare Commercial	$77.60
Rate for Payer: WPPA Commercial	$67.20

HOME HEALTH NUTRITION CONSULT

Facility

$80.00

Hospital Charge Code	5710405
Hospital Revenue Code	581
Min. Negotiated Rate	$65.60
Max. Negotiated Rate	$77.60
Rate for Payer: Cash Price	$60.00
Rate for Payer: Health Partners Plans Commercial	$76.00
Rate for Payer: UnitedHealthcare Commercial	$77.60
Rate for Payer: WPPA Commercial	$65.60

HOME SUPPORT-AIDE VISIT 1/4 HR

Facility

$7.00

Service Code	HCPCS G0156
Hospital Charge Code	5710010
Hospital Revenue Code	570
Min. Negotiated Rate	$5.74
Max. Negotiated Rate	$6.79
Rate for Payer: Cash Price	$5.25
Rate for Payer: Health Partners Plans Commercial	$6.65
Rate for Payer: UnitedHealthcare Commercial	$6.79
Rate for Payer: WPPA Commercial	$5.74

HOME SUPPORT-AIDE VISIT 1/4 HR

Facility

$7.00

Service Code	HCPCS G0156
Hospital Charge Code	5710010
Hospital Revenue Code	570
Min. Negotiated Rate	$3.23
Max. Negotiated Rate	$6.79
Rate for Payer: Cash Price	$5.25
Rate for Payer: Celtic Commercial/Exchange	$3.23
Rate for Payer: Health Partners Plans Commercial	$6.65
Rate for Payer: UnitedHealthcare Commercial	$6.79
Rate for Payer: WPPA Commercial	$5.88

HOME SUPPORT-PT EVAL EA 1/4 HR

Facility

$49.00

Service Code	HCPCS G0151
Hospital Charge Code	4208811
Hospital Revenue Code	421
Min. Negotiated Rate	$22.64
Max. Negotiated Rate	$47.53
Rate for Payer: Cash Price	$36.75
Rate for Payer: Celtic Commercial/Exchange	$22.64
Rate for Payer: Health Partners Plans Commercial	$46.55
Rate for Payer: UnitedHealthcare Commercial	$47.53
Rate for Payer: WPPA Commercial	$41.16

HOME SUPPORT-PT EVAL EA 1/4 HR

Facility

$49.00

Service Code	HCPCS G0151
Hospital Charge Code	4208811
Hospital Revenue Code	421
Min. Negotiated Rate	$40.18
Max. Negotiated Rate	$47.53
Rate for Payer: Cash Price	$36.75
Rate for Payer: Health Partners Plans Commercial	$46.55
Rate for Payer: UnitedHealthcare Commercial	$47.53
Rate for Payer: WPPA Commercial	$40.18

Know your out-of-pocket cost for care.

All Charges