Ness County Hospital

All Charges

Charge

Type

Setting

Price

IMMUNOGLOBULIN G SUBCLASS 4

Facility

$81.00

Service Code	HCPCS 82787
Hospital Charge Code	8278701
Hospital Revenue Code	301
Min. Negotiated Rate	$33.74
Max. Negotiated Rate	$78.57
Rate for Payer: BCBS Commercial	$33.74
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

IMMUNOHISTOCHEMISTRY EA ADDTL

Facility

$300.00

Service Code	HCPCS 88341
Hospital Charge Code	8834100
Hospital Revenue Code	310
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

IMMUNOHISTOCHEMISTRY EA ADDTL

Facility

$300.00

Service Code	HCPCS 88341
Hospital Charge Code	8834100
Hospital Revenue Code	310
Min. Negotiated Rate	$138.60
Max. Negotiated Rate	$291.00
Rate for Payer: BCBS Commercial	$287.85
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

IMMUNOHISTOCHEMISTRY, EA ANTIB

Facility

$158.00

Service Code	HCPCS 88342
Hospital Charge Code	8834200
Hospital Revenue Code	310
Min. Negotiated Rate	$129.56
Max. Negotiated Rate	$153.26
Rate for Payer: Cash Price	$118.50
Rate for Payer: Health Partners Plans Commercial	$150.10
Rate for Payer: UnitedHealthcare Commercial	$153.26
Rate for Payer: WPPA Commercial	$129.56

IMMUNOHISTOCHEMISTRY, EA ANTIB

Facility

$158.00

Service Code	HCPCS 88342
Hospital Charge Code	8834200
Hospital Revenue Code	310
Min. Negotiated Rate	$73.00
Max. Negotiated Rate	$287.85
Rate for Payer: BCBS Commercial	$287.85
Rate for Payer: Cash Price	$118.50
Rate for Payer: Cash Price	$118.50
Rate for Payer: Celtic Commercial/Exchange	$73.00
Rate for Payer: Health Partners Plans Commercial	$150.10
Rate for Payer: UnitedHealthcare Commercial	$153.26
Rate for Payer: WPPA Commercial	$132.72

IMMUNO INF AGNT ANTIB,QUAN NOS

Facility

$387.00

Service Code	HCPCS 86317
Hospital Charge Code	8631700
Hospital Revenue Code	302
Min. Negotiated Rate	$44.56
Max. Negotiated Rate	$375.39
Rate for Payer: Celtic Commercial/Exchange	$178.79
Rate for Payer: BCBS Commercial	$44.56
Rate for Payer: Cash Price	$290.25
Rate for Payer: Cash Price	$290.25
Rate for Payer: Health Partners Plans Commercial	$367.65
Rate for Payer: UnitedHealthcare Commercial	$375.39
Rate for Payer: WPPA Commercial	$325.08

IMMUNO INF AGNT ANTIB,QUAN NOS

Facility

$387.00

Service Code	HCPCS 86317
Hospital Charge Code	8631700
Hospital Revenue Code	302
Min. Negotiated Rate	$317.34
Max. Negotiated Rate	$375.39
Rate for Payer: Cash Price	$290.25
Rate for Payer: Health Partners Plans Commercial	$367.65
Rate for Payer: UnitedHealthcare Commercial	$375.39
Rate for Payer: WPPA Commercial	$317.34

IMMUNO INFEC AGNT ANTIB, QUAL.

Facility

$58.00

Service Code	HCPCS 86318
Hospital Charge Code	8631800
Hospital Revenue Code	302
Min. Negotiated Rate	$47.56
Max. Negotiated Rate	$56.26
Rate for Payer: Cash Price	$43.50
Rate for Payer: Health Partners Plans Commercial	$55.10
Rate for Payer: UnitedHealthcare Commercial	$56.26
Rate for Payer: WPPA Commercial	$47.56

IMMUNO INFEC AGNT ANTIB, QUAL.

Facility

$58.00

Service Code	HCPCS 86318
Hospital Charge Code	8631800
Hospital Revenue Code	302
Min. Negotiated Rate	$26.80
Max. Negotiated Rate	$56.26
Rate for Payer: BCBS Commercial	$33.20
Rate for Payer: Cash Price	$43.50
Rate for Payer: Cash Price	$43.50
Rate for Payer: Celtic Commercial/Exchange	$26.80
Rate for Payer: Health Partners Plans Commercial	$55.10
Rate for Payer: UnitedHealthcare Commercial	$56.26
Rate for Payer: WPPA Commercial	$48.72

IMMUNO TUMOR ANTIG,OTHER ANTIG

Facility

$137.00

Service Code	HCPCS 86316
Hospital Charge Code	8631600
Hospital Revenue Code	302
Min. Negotiated Rate	$112.34
Max. Negotiated Rate	$132.89
Rate for Payer: Cash Price	$102.75
Rate for Payer: Health Partners Plans Commercial	$130.15
Rate for Payer: UnitedHealthcare Commercial	$132.89
Rate for Payer: WPPA Commercial	$112.34

IMMUNO TUMOR ANTIG,OTHER ANTIG

Facility

$137.00

Service Code	HCPCS 86316
Hospital Charge Code	8631600
Hospital Revenue Code	302
Min. Negotiated Rate	$54.49
Max. Negotiated Rate	$132.89
Rate for Payer: BCBS Commercial	$54.49
Rate for Payer: Cash Price	$102.75
Rate for Payer: Cash Price	$102.75
Rate for Payer: Celtic Commercial/Exchange	$63.29
Rate for Payer: Health Partners Plans Commercial	$130.15
Rate for Payer: UnitedHealthcare Commercial	$132.89
Rate for Payer: WPPA Commercial	$115.08

IMMUNO TUMOR ANTIG,QUAN CA125

Facility

$95.00

Service Code	HCPCS 86304
Hospital Charge Code	8630400
Hospital Revenue Code	302
Min. Negotiated Rate	$77.90
Max. Negotiated Rate	$92.15
Rate for Payer: Cash Price	$71.25
Rate for Payer: Health Partners Plans Commercial	$90.25
Rate for Payer: UnitedHealthcare Commercial	$92.15
Rate for Payer: WPPA Commercial	$77.90

IMMUNO TUMOR ANTIG,QUAN CA125

Facility

$95.00

Service Code	HCPCS 86304
Hospital Charge Code	8630400
Hospital Revenue Code	302
Min. Negotiated Rate	$43.89
Max. Negotiated Rate	$92.15
Rate for Payer: BCBS Commercial	$54.77
Rate for Payer: Cash Price	$71.25
Rate for Payer: Cash Price	$71.25
Rate for Payer: Celtic Commercial/Exchange	$43.89
Rate for Payer: Health Partners Plans Commercial	$90.25
Rate for Payer: UnitedHealthcare Commercial	$92.15
Rate for Payer: WPPA Commercial	$79.80

IMMUNO TUMOR ANTIG,QUAN CA15-3

Facility

$151.00

Service Code	HCPCS 86300
Hospital Charge Code	8630000
Hospital Revenue Code	302
Min. Negotiated Rate	$54.84
Max. Negotiated Rate	$146.47
Rate for Payer: BCBS Commercial	$54.84
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 TUMOR ANTIG,QUAN CA15-3

Facility

$151.00

Service Code	HCPCS 86300
Hospital Charge Code	8630000
Hospital Revenue Code	302
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 TUMOR ANTIG,QUAN CA19-9

Facility

$151.00

Service Code	HCPCS 86301
Hospital Charge Code	8630100
Hospital Revenue Code	302
Min. Negotiated Rate	$54.51
Max. Negotiated Rate	$146.47
Rate for Payer: BCBS Commercial	$54.51
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 TUMOR ANTIG,QUAN CA19-9

Facility

$151.00

Service Code	HCPCS 86301
Hospital Charge Code	8630100
Hospital Revenue Code	302
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

IMODIUM 1 MG/7.5 ML OS (LOPERAMIDE HCL)

Facility

$1.00

Service Code	NDC 46122054426
Hospital Charge Code	2512218
Hospital Revenue Code	250
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$1.46
Rate for Payer: Health Partners Plans Commercial	$0.95
Rate for Payer: UnitedHealthcare Commercial	$0.97
Rate for Payer: WPPA Commercial	$0.82

IMODIUM 1 MG/7.5 ML OS (LOPERAMIDE HCL)

Facility

$1.00

Service Code	NDC 46122054426
Hospital Charge Code	2512218
Hospital Revenue Code	250
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$1.46
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

IMODIUM 2 MG CAP (LOPERAMIDE HCL)

Facility

$2.00

Service Code	NDC 60687022911
Hospital Charge Code	2503340
Hospital Revenue Code	250
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.95
Rate for Payer: Celtic Commercial/Exchange	$0.92
Rate for Payer: Health Partners Plans Commercial	$1.90
Rate for Payer: UnitedHealthcare Commercial	$1.94
Rate for Payer: WPPA Commercial	$1.68

IMODIUM 2 MG CAP (LOPERAMIDE HCL)

Facility

$2.00

Service Code	NDC 60687022911
Hospital Charge Code	2503340
Hospital Revenue Code	250
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.95
Rate for Payer: Health Partners Plans Commercial	$1.90
Rate for Payer: UnitedHealthcare Commercial	$1.94
Rate for Payer: WPPA Commercial	$1.64

INBORN AND OTHER DISORDERS OF METABOLISM

Facility

$9,156.02

Service Code	MSDRG 642
Min. Negotiated Rate	$9,156.02
Max. Negotiated Rate	$9,156.02
Rate for Payer: BCBS Commercial	$9,156.02

INCIS BIOP SKIN,EA ADD LESION

Facility

$520.00

Service Code	HCPCS 11107
Hospital Charge Code	1110723
Hospital Revenue Code	761
Min. Negotiated Rate	$240.24
Max. Negotiated Rate	$639.33
Rate for Payer: BCBS Commercial	$639.33
Rate for Payer: Cash Price	$390.00
Rate for Payer: Cash Price	$390.00
Rate for Payer: Celtic Commercial/Exchange	$240.24
Rate for Payer: Health Partners Plans Commercial	$494.00
Rate for Payer: UnitedHealthcare Commercial	$504.40
Rate for Payer: WPPA Commercial	$436.80

INCIS BIOP SKIN,EA ADD LESION

Facility

$520.00

Service Code	HCPCS 11107
Hospital Charge Code	1110723
Hospital Revenue Code	761
Min. Negotiated Rate	$426.40
Max. Negotiated Rate	$504.40
Rate for Payer: Cash Price	$390.00
Rate for Payer: Health Partners Plans Commercial	$494.00
Rate for Payer: UnitedHealthcare Commercial	$504.40
Rate for Payer: WPPA Commercial	$426.40

INCIS/DRAINAGE PILONIDAL CYST

Facility

$649.00

Service Code	HCPCS 10080
Hospital Charge Code	1008000
Hospital Revenue Code	761
Min. Negotiated Rate	$299.84
Max. Negotiated Rate	$982.73
Rate for Payer: BCBS Commercial	$982.73
Rate for Payer: Cash Price	$486.75
Rate for Payer: Cash Price	$486.75
Rate for Payer: Celtic Commercial/Exchange	$299.84
Rate for Payer: Health Partners Plans Commercial	$616.55
Rate for Payer: UnitedHealthcare Commercial	$629.53
Rate for Payer: WPPA Commercial	$545.16

Know your out-of-pocket cost for care.

All Charges