Ness County Hospital

All Charges

Charge

Type

Setting

Price

IMMUNIZATION ADM 1 VACCINE

Facility

$88.00

Service Code	HCPCS 90471
Hospital Charge Code	9047100
Hospital Revenue Code	771
Min. Negotiated Rate	$8.08
Max. Negotiated Rate	$85.36
Rate for Payer: BCBS Commercial	$8.08
Rate for Payer: Cash Price	$66.00
Rate for Payer: Cash Price	$66.00
Rate for Payer: Celtic Commercial/Exchange	$40.66
Rate for Payer: Health Partners Plans Commercial	$83.60
Rate for Payer: UnitedHealthcare Commercial	$85.36
Rate for Payer: WPPA Commercial	$73.92

IMMUNIZATION ADM 1 VACCINE

Facility

$88.00

Service Code	HCPCS 90471
Hospital Charge Code	9047100
Hospital Revenue Code	771
Min. Negotiated Rate	$72.16
Max. Negotiated Rate	$85.36
Rate for Payer: Cash Price	$66.00
Rate for Payer: Health Partners Plans Commercial	$83.60
Rate for Payer: UnitedHealthcare Commercial	$85.36
Rate for Payer: WPPA Commercial	$72.16

IMMUNIZATION ADM, EA ADDTL VAC

Facility

$70.00

Service Code	HCPCS 90472
Hospital Charge Code	9047200
Hospital Revenue Code	761
Min. Negotiated Rate	$57.40
Max. Negotiated Rate	$67.90
Rate for Payer: Cash Price	$52.50
Rate for Payer: Health Partners Plans Commercial	$66.50
Rate for Payer: UnitedHealthcare Commercial	$67.90
Rate for Payer: WPPA Commercial	$57.40

IMMUNIZATION ADM, EA ADDTL VAC

Facility

$70.00

Service Code	HCPCS 90472
Hospital Charge Code	9047200
Hospital Revenue Code	761
Min. Negotiated Rate	$8.08
Max. Negotiated Rate	$67.90
Rate for Payer: BCBS Commercial	$8.08
Rate for Payer: Cash Price	$52.50
Rate for Payer: Cash Price	$52.50
Rate for Payer: Celtic Commercial/Exchange	$32.34
Rate for Payer: Health Partners Plans Commercial	$66.50
Rate for Payer: UnitedHealthcare Commercial	$67.90
Rate for Payer: WPPA Commercial	$58.80

IMMUNO ANALYTE,NON INFECT AGNT

Facility

$84.00

Service Code	HCPCS 83518
Hospital Charge Code	8351800
Hospital Revenue Code	301
Min. Negotiated Rate	$38.81
Max. Negotiated Rate	$81.48
Rate for Payer: BCBS Commercial	$44.66
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cash Price	$63.00
Rate for Payer: Celtic Commercial/Exchange	$38.81
Rate for Payer: Health Partners Plans Commercial	$79.80
Rate for Payer: UnitedHealthcare Commercial	$81.48
Rate for Payer: WPPA Commercial	$70.56

IMMUNO ANALYTE,NON INFECT AGNT

Facility

$84.00

Service Code	HCPCS 83518
Hospital Charge Code	8351800
Hospital Revenue Code	301
Min. Negotiated Rate	$68.88
Max. Negotiated Rate	$81.48
Rate for Payer: Cash Price	$63.00
Rate for Payer: Health Partners Plans Commercial	$79.80
Rate for Payer: UnitedHealthcare Commercial	$81.48
Rate for Payer: WPPA Commercial	$68.88

IMMUNO ANALYTE,NON INFECT AGNT

Facility

$151.00

Service Code	HCPCS 83516
Hospital Charge Code	8351600
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

IMMUNO ANALYTE,NON INFECT AGNT

Facility

$151.00

Service Code	HCPCS 83516
Hospital Charge Code	8351600
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

IMMUNO ANALYTE,QUANT BY RADIO-

Facility

$81.00

Service Code	HCPCS 83519
Hospital Charge Code	8351900
Hospital Revenue Code	301
Min. Negotiated Rate	$66.42
Max. Negotiated Rate	$78.57
Rate for Payer: Cash Price	$60.75
Rate for Payer: Health Partners Plans Commercial	$76.95
Rate for Payer: UnitedHealthcare Commercial	$78.57
Rate for Payer: WPPA Commercial	$66.42

IMMUNO ANALYTE,QUANT BY RADIO-

Facility

$81.00

Service Code	HCPCS 83519
Hospital Charge Code	8351900
Hospital Revenue Code	301
Min. Negotiated Rate	$36.48
Max. Negotiated Rate	$78.57
Rate for Payer: BCBS Commercial	$36.48
Rate for Payer: Cash Price	$60.75
Rate for Payer: Cash Price	$60.75
Rate for Payer: Celtic Commercial/Exchange	$37.42
Rate for Payer: Health Partners Plans Commercial	$76.95
Rate for Payer: UnitedHealthcare Commercial	$78.57
Rate for Payer: WPPA Commercial	$68.04

IMMUNO ANALYTE,QUANT NOS

Facility

$200.00

Service Code	HCPCS 83520
Hospital Charge Code	8352000
Hospital Revenue Code	301
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

IMMUNO ANALYTE,QUANT NOS

Facility

$200.00

Service Code	HCPCS 83520
Hospital Charge Code	8352000
Hospital Revenue Code	301
Min. Negotiated Rate	$36.48
Max. Negotiated Rate	$194.00
Rate for Payer: BCBS Commercial	$36.48
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

IMMUNODIFFUSION: GEL DIFFUSION

Facility

$114.00

Service Code	HCPCS 86331
Hospital Charge Code	8633100
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

IMMUNODIFFUSION: GEL DIFFUSION

Facility

$114.00

Service Code	HCPCS 86331
Hospital Charge Code	8633100
Hospital Revenue Code	302
Min. Negotiated Rate	$52.67
Max. Negotiated Rate	$110.58
Rate for Payer: BCBS Commercial	$90.17
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

IMMUNODIFFUSION NES

Facility

$130.00

Service Code	HCPCS 86329
Hospital Charge Code	8632900
Hospital Revenue Code	302
Min. Negotiated Rate	$106.60
Max. Negotiated Rate	$126.10
Rate for Payer: Cash Price	$97.50
Rate for Payer: Health Partners Plans Commercial	$123.50
Rate for Payer: UnitedHealthcare Commercial	$126.10
Rate for Payer: WPPA Commercial	$106.60

IMMUNODIFFUSION NES

Facility

$130.00

Service Code	HCPCS 86329
Hospital Charge Code	8632900
Hospital Revenue Code	302
Min. Negotiated Rate	$36.59
Max. Negotiated Rate	$126.10
Rate for Payer: BCBS Commercial	$36.59
Rate for Payer: Cash Price	$97.50
Rate for Payer: Cash Price	$97.50
Rate for Payer: Celtic Commercial/Exchange	$60.06
Rate for Payer: Health Partners Plans Commercial	$123.50
Rate for Payer: UnitedHealthcare Commercial	$126.10
Rate for Payer: WPPA Commercial	$109.20

IMMUNOELECTROPHORESIS, SERUM

Facility

$155.00

Service Code	HCPCS 86320
Hospital Charge Code	8632000
Hospital Revenue Code	302
Min. Negotiated Rate	$127.10
Max. Negotiated Rate	$150.35
Rate for Payer: Cash Price	$116.25
Rate for Payer: Health Partners Plans Commercial	$147.25
Rate for Payer: UnitedHealthcare Commercial	$150.35
Rate for Payer: WPPA Commercial	$127.10

IMMUNOELECTROPHORESIS, SERUM

Facility

$155.00

Service Code	HCPCS 86320
Hospital Charge Code	8632000
Hospital Revenue Code	302
Min. Negotiated Rate	$71.61
Max. Negotiated Rate	$150.35
Rate for Payer: BCBS Commercial	$83.29
Rate for Payer: Cash Price	$116.25
Rate for Payer: Cash Price	$116.25
Rate for Payer: Celtic Commercial/Exchange	$71.61
Rate for Payer: Health Partners Plans Commercial	$147.25
Rate for Payer: UnitedHealthcare Commercial	$150.35
Rate for Payer: WPPA Commercial	$130.20

IMMUNOELECTTROPHOR.,OTHR FLUID

Facility

$142.00

Service Code	HCPCS 86325
Hospital Charge Code	8632500
Hospital Revenue Code	302
Min. Negotiated Rate	$65.60
Max. Negotiated Rate	$137.74
Rate for Payer: BCBS Commercial	$80.77
Rate for Payer: Cash Price	$106.50
Rate for Payer: Cash Price	$106.50
Rate for Payer: Celtic Commercial/Exchange	$65.60
Rate for Payer: Health Partners Plans Commercial	$134.90
Rate for Payer: UnitedHealthcare Commercial	$137.74
Rate for Payer: WPPA Commercial	$119.28

IMMUNOELECTTROPHOR.,OTHR FLUID

Facility

$142.00

Service Code	HCPCS 86325
Hospital Charge Code	8632500
Hospital Revenue Code	302
Min. Negotiated Rate	$116.44
Max. Negotiated Rate	$137.74
Rate for Payer: Cash Price	$106.50
Rate for Payer: Health Partners Plans Commercial	$134.90
Rate for Payer: UnitedHealthcare Commercial	$137.74
Rate for Payer: WPPA Commercial	$116.44

IMMUNOFIXATION ELECTROPHORESIS

Facility

$171.00

Service Code	HCPCS 86335
Hospital Charge Code	8633500
Hospital Revenue Code	302
Min. Negotiated Rate	$140.22
Max. Negotiated Rate	$165.87
Rate for Payer: Cash Price	$128.25
Rate for Payer: Health Partners Plans Commercial	$162.45
Rate for Payer: UnitedHealthcare Commercial	$165.87
Rate for Payer: WPPA Commercial	$140.22

IMMUNOFIXATION ELECTROPHORESIS

Facility

$171.00

Service Code	HCPCS 86335
Hospital Charge Code	8633500
Hospital Revenue Code	302
Min. Negotiated Rate	$64.18
Max. Negotiated Rate	$165.87
Rate for Payer: BCBS Commercial	$64.18
Rate for Payer: Cash Price	$128.25
Rate for Payer: Cash Price	$128.25
Rate for Payer: Celtic Commercial/Exchange	$79.00
Rate for Payer: Health Partners Plans Commercial	$162.45
Rate for Payer: UnitedHealthcare Commercial	$165.87
Rate for Payer: WPPA Commercial	$143.64

IMMUNOFIXATION ELECTROPH,SERUM

Facility

$186.00

Service Code	HCPCS 86334
Hospital Charge Code	8633400
Hospital Revenue Code	302
Min. Negotiated Rate	$152.52
Max. Negotiated Rate	$180.42
Rate for Payer: Cash Price	$139.50
Rate for Payer: Health Partners Plans Commercial	$176.70
Rate for Payer: UnitedHealthcare Commercial	$180.42
Rate for Payer: WPPA Commercial	$152.52

IMMUNOFIXATION ELECTROPH,SERUM

Facility

$186.00

Service Code	HCPCS 86334
Hospital Charge Code	8633400
Hospital Revenue Code	302
Min. Negotiated Rate	$85.93
Max. Negotiated Rate	$180.42
Rate for Payer: BCBS Commercial	$97.05
Rate for Payer: Cash Price	$139.50
Rate for Payer: Cash Price	$139.50
Rate for Payer: Celtic Commercial/Exchange	$85.93
Rate for Payer: Health Partners Plans Commercial	$176.70
Rate for Payer: UnitedHealthcare Commercial	$180.42
Rate for Payer: WPPA Commercial	$156.24

IMMUNOGLOBULIN G SUBCLASS 4

Facility

$81.00

Service Code	HCPCS 82787
Hospital Charge Code	8278701
Hospital Revenue Code	301
Min. Negotiated Rate	$66.42
Max. Negotiated Rate	$78.57
Rate for Payer: Cash Price	$60.75
Rate for Payer: Health Partners Plans Commercial	$76.95
Rate for Payer: UnitedHealthcare Commercial	$78.57
Rate for Payer: WPPA Commercial	$66.42

Know your out-of-pocket cost for care.

All Charges