Ness County Hospital

All Charges

Charge

Type

Setting

Price

ALLERGEN SPEC. IGE (RICE)

Facility

$28.00

Service Code	HCPCS 86003
Hospital Charge Code	8600302
Hospital Revenue Code	302
Min. Negotiated Rate	$22.96
Max. Negotiated Rate	$27.16
Rate for Payer: Cash Price	$21.00
Rate for Payer: Health Partners Plans Commercial	$26.60
Rate for Payer: UnitedHealthcare Commercial	$27.16
Rate for Payer: WPPA Commercial	$22.96

ALLERGEN SPEC IGG QUAN OR SEMI

Facility

$101.00

Service Code	HCPCS 86001
Hospital Charge Code	8600100
Hospital Revenue Code	302
Min. Negotiated Rate	$14.99
Max. Negotiated Rate	$97.97
Rate for Payer: BCBS Commercial	$14.99
Rate for Payer: Cash Price	$75.75
Rate for Payer: Cash Price	$75.75
Rate for Payer: Celtic Commercial/Exchange	$46.66
Rate for Payer: Health Partners Plans Commercial	$95.95
Rate for Payer: UnitedHealthcare Commercial	$97.97
Rate for Payer: WPPA Commercial	$84.84

ALLERGEN SPEC IGG QUAN OR SEMI

Facility

$101.00

Service Code	HCPCS 86001
Hospital Charge Code	8600100
Hospital Revenue Code	302
Min. Negotiated Rate	$82.82
Max. Negotiated Rate	$97.97
Rate for Payer: Cash Price	$75.75
Rate for Payer: Health Partners Plans Commercial	$95.95
Rate for Payer: UnitedHealthcare Commercial	$97.97
Rate for Payer: WPPA Commercial	$82.82

ALLERGIC REACTIONS WITH MCC

Facility

$15,083.91

Service Code	MSDRG 915
Min. Negotiated Rate	$15,083.91
Max. Negotiated Rate	$15,083.91
Rate for Payer: BCBS Commercial	$15,083.91

ALLERGIC REACTIONS WITHOUT MCC

Facility

$5,843.61

Service Code	MSDRG 916
Min. Negotiated Rate	$5,843.61
Max. Negotiated Rate	$5,843.61
Rate for Payer: BCBS Commercial	$5,843.61

ALLERGY PANEL 18, NUT MIX GRP

Facility

$196.00

Service Code	HCPCS 86003
Hospital Charge Code	8888918
Hospital Revenue Code	302
Min. Negotiated Rate	$160.72
Max. Negotiated Rate	$190.12
Rate for Payer: Cash Price	$147.00
Rate for Payer: Health Partners Plans Commercial	$186.20
Rate for Payer: UnitedHealthcare Commercial	$190.12
Rate for Payer: WPPA Commercial	$160.72

ALLERGY PANEL 18, NUT MIX GRP

Facility

$196.00

Service Code	HCPCS 86003
Hospital Charge Code	8888918
Hospital Revenue Code	302
Min. Negotiated Rate	$15.51
Max. Negotiated Rate	$190.12
Rate for Payer: BCBS Commercial	$15.51
Rate for Payer: Cash Price	$147.00
Rate for Payer: Cash Price	$147.00
Rate for Payer: Celtic Commercial/Exchange	$90.55
Rate for Payer: Health Partners Plans Commercial	$186.20
Rate for Payer: UnitedHealthcare Commercial	$190.12
Rate for Payer: WPPA Commercial	$164.64

ALLOGENEIC BONE MARROW TRANSPLANT

Facility

$134,006.71

Service Code	MSDRG 014
Min. Negotiated Rate	$134,006.71
Max. Negotiated Rate	$134,006.71
Rate for Payer: BCBS Commercial	$134,006.71

ALL PURPOSE CATHETER 14 FR.

Facility

$34.00

Hospital Charge Code	2720464
Hospital Revenue Code	272
Min. Negotiated Rate	$27.88
Max. Negotiated Rate	$32.98
Rate for Payer: Cash Price	$25.69
Rate for Payer: Health Partners Plans Commercial	$32.30
Rate for Payer: UnitedHealthcare Commercial	$32.98
Rate for Payer: WPPA Commercial	$27.88

ALL PURPOSE CATHETER 14 FR.

Facility

$34.00

Hospital Charge Code	2720464
Hospital Revenue Code	272
Min. Negotiated Rate	$15.71
Max. Negotiated Rate	$32.98
Rate for Payer: Cash Price	$25.69
Rate for Payer: Celtic Commercial/Exchange	$15.71
Rate for Payer: Health Partners Plans Commercial	$32.30
Rate for Payer: UnitedHealthcare Commercial	$32.98
Rate for Payer: WPPA Commercial	$28.56

ALPHA-1-ANTITRYPSIN PHENOTYPE

Facility

$135.00

Service Code	HCPCS 82104
Hospital Charge Code	8210400
Hospital Revenue Code	301
Min. Negotiated Rate	$62.37
Max. Negotiated Rate	$130.95
Rate for Payer: BCBS Commercial	$82.51
Rate for Payer: Cash Price	$101.25
Rate for Payer: Cash Price	$101.25
Rate for Payer: Celtic Commercial/Exchange	$62.37
Rate for Payer: Health Partners Plans Commercial	$128.25
Rate for Payer: UnitedHealthcare Commercial	$130.95
Rate for Payer: WPPA Commercial	$113.40

ALPHA-1-ANTITRYPSIN PHENOTYPE

Facility

$135.00

Service Code	HCPCS 82104
Hospital Charge Code	8210400
Hospital Revenue Code	301
Min. Negotiated Rate	$110.70
Max. Negotiated Rate	$130.95
Rate for Payer: Cash Price	$101.25
Rate for Payer: Health Partners Plans Commercial	$128.25
Rate for Payer: UnitedHealthcare Commercial	$130.95
Rate for Payer: WPPA Commercial	$110.70

ALPHA-1-ANTITRYPSIN, TOTAL

Facility

$83.00

Service Code	HCPCS 82103
Hospital Charge Code	8210300
Hospital Revenue Code	301
Min. Negotiated Rate	$38.35
Max. Negotiated Rate	$80.51
Rate for Payer: BCBS Commercial	$50.80
Rate for Payer: Cash Price	$62.25
Rate for Payer: Cash Price	$62.25
Rate for Payer: Celtic Commercial/Exchange	$38.35
Rate for Payer: Health Partners Plans Commercial	$78.85
Rate for Payer: UnitedHealthcare Commercial	$80.51
Rate for Payer: WPPA Commercial	$69.72

ALPHA-1-ANTITRYPSIN, TOTAL

Facility

$83.00

Service Code	HCPCS 82103
Hospital Charge Code	8210300
Hospital Revenue Code	301
Min. Negotiated Rate	$68.06
Max. Negotiated Rate	$80.51
Rate for Payer: Cash Price	$62.25
Rate for Payer: Health Partners Plans Commercial	$78.85
Rate for Payer: UnitedHealthcare Commercial	$80.51
Rate for Payer: WPPA Commercial	$68.06

ALPHA-FETOPROTEIN (AFP)

Facility

$198.00

Service Code	HCPCS 82107
Hospital Charge Code	8210700
Hospital Revenue Code	301
Min. Negotiated Rate	$91.48
Max. Negotiated Rate	$192.06
Rate for Payer: BCBS Commercial	$138.19
Rate for Payer: Cash Price	$148.50
Rate for Payer: Cash Price	$148.50
Rate for Payer: Celtic Commercial/Exchange	$91.48
Rate for Payer: Health Partners Plans Commercial	$188.10
Rate for Payer: UnitedHealthcare Commercial	$192.06
Rate for Payer: WPPA Commercial	$166.32

ALPHA-FETOPROTEIN (AFP)

Facility

$198.00

Service Code	HCPCS 82107
Hospital Charge Code	8210700
Hospital Revenue Code	301
Min. Negotiated Rate	$162.36
Max. Negotiated Rate	$192.06
Rate for Payer: Cash Price	$148.50
Rate for Payer: Health Partners Plans Commercial	$188.10
Rate for Payer: UnitedHealthcare Commercial	$192.06
Rate for Payer: WPPA Commercial	$162.36

ALPHA-FETOPROTEIN (AFP) SERUM

Facility

$131.00

Service Code	HCPCS 82105
Hospital Charge Code	8210500
Hospital Revenue Code	301
Min. Negotiated Rate	$55.63
Max. Negotiated Rate	$127.07
Rate for Payer: BCBS Commercial	$55.63
Rate for Payer: Cash Price	$98.25
Rate for Payer: Cash Price	$98.25
Rate for Payer: Celtic Commercial/Exchange	$60.52
Rate for Payer: Health Partners Plans Commercial	$124.45
Rate for Payer: UnitedHealthcare Commercial	$127.07
Rate for Payer: WPPA Commercial	$110.04

ALPHA-FETOPROTEIN (AFP) SERUM

Facility

$131.00

Service Code	HCPCS 82105
Hospital Charge Code	8210500
Hospital Revenue Code	301
Min. Negotiated Rate	$107.42
Max. Negotiated Rate	$127.07
Rate for Payer: Cash Price	$98.25
Rate for Payer: Health Partners Plans Commercial	$124.45
Rate for Payer: UnitedHealthcare Commercial	$127.07
Rate for Payer: WPPA Commercial	$107.42

ALTACE 2.5 MG CAP (RAMIPRIL)

Facility

$5.00

Service Code	NDC 68001042900
Hospital Charge Code	2518496
Hospital Revenue Code	250
Min. Negotiated Rate	$4.10
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$4.35
Rate for Payer: Health Partners Plans Commercial	$4.75
Rate for Payer: UnitedHealthcare Commercial	$4.85
Rate for Payer: WPPA Commercial	$4.10

ALTACE 2.5 MG CAP (RAMIPRIL)

Facility

$5.00

Service Code	NDC 68001042900
Hospital Charge Code	2518496
Hospital Revenue Code	250
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$4.35
Rate for Payer: Celtic Commercial/Exchange	$2.31
Rate for Payer: Health Partners Plans Commercial	$4.75
Rate for Payer: UnitedHealthcare Commercial	$4.85
Rate for Payer: WPPA Commercial	$4.20

ALTERNAGEL PER 30ML

Facility

$1.00

Hospital Charge Code	2500262
Hospital Revenue Code	250
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$1.35
Rate for Payer: Health Partners Plans Commercial	$0.95
Rate for Payer: UnitedHealthcare Commercial	$0.97
Rate for Payer: WPPA Commercial	$0.82

ALTERNAGEL PER 30ML

Facility

$1.00

Hospital Charge Code	2500262
Hospital Revenue Code	250
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$1.35
Rate for Payer: Celtic Commercial/Exchange	$0.46
Rate for Payer: Health Partners Plans Commercial	$0.95
Rate for Payer: UnitedHealthcare Commercial	$0.97
Rate for Payer: WPPA Commercial	$0.84

AMBIEN 5MG TAB (ZOLPIDEM TARTRATE)

Facility

$26.00

Service Code	NDC 68084018911
Hospital Charge Code	2512556
Hospital Revenue Code	250
Min. Negotiated Rate	$21.32
Max. Negotiated Rate	$25.22
Rate for Payer: Cash Price	$19.61
Rate for Payer: Health Partners Plans Commercial	$24.70
Rate for Payer: UnitedHealthcare Commercial	$25.22
Rate for Payer: WPPA Commercial	$21.32

AMBIEN 5MG TAB (ZOLPIDEM TARTRATE)

Facility

$26.00

Service Code	NDC 68084018911
Hospital Charge Code	2512556
Hospital Revenue Code	250
Min. Negotiated Rate	$12.01
Max. Negotiated Rate	$25.22
Rate for Payer: Cash Price	$19.61
Rate for Payer: Celtic Commercial/Exchange	$12.01
Rate for Payer: Health Partners Plans Commercial	$24.70
Rate for Payer: UnitedHealthcare Commercial	$25.22
Rate for Payer: WPPA Commercial	$21.84

AMBU COLLAR ADULT

Facility

$37.00

Hospital Charge Code	2704319
Hospital Revenue Code	270
Min. Negotiated Rate	$17.09
Max. Negotiated Rate	$35.89
Rate for Payer: Cash Price	$28.05
Rate for Payer: Celtic Commercial/Exchange	$17.09
Rate for Payer: Health Partners Plans Commercial	$35.15
Rate for Payer: UnitedHealthcare Commercial	$35.89
Rate for Payer: WPPA Commercial	$31.08

Know your out-of-pocket cost for care.

All Charges