Ness County Hospital

All Charges

Charge

Type

Setting

Price

INCIS/REMOVE FOREIGN BODY-SMPL

Facility

$703.00

Service Code	HCPCS 10120
Hospital Charge Code	1012023
Hospital Revenue Code	761
Min. Negotiated Rate	$324.79
Max. Negotiated Rate	$1,075.65
Rate for Payer: BCBS Commercial	$1,075.65
Rate for Payer: Cash Price	$527.25
Rate for Payer: Cash Price	$527.25
Rate for Payer: Celtic Commercial/Exchange	$324.79
Rate for Payer: Health Partners Plans Commercial	$667.85
Rate for Payer: UnitedHealthcare Commercial	$681.91
Rate for Payer: WPPA Commercial	$590.52

INCIS/REMOVE FOREIGN BODY-SMPL

Facility

$703.00

Service Code	HCPCS 10120
Hospital Charge Code	1012023
Hospital Revenue Code	761
Min. Negotiated Rate	$576.46
Max. Negotiated Rate	$681.91
Rate for Payer: Cash Price	$527.25
Rate for Payer: Health Partners Plans Commercial	$667.85
Rate for Payer: UnitedHealthcare Commercial	$681.91
Rate for Payer: WPPA Commercial	$576.46

INC&REM FBSUBQTISS SMPL

Facility

$1,076.00

Service Code	HCPCS 10120
Hospital Charge Code	1012000
Hospital Revenue Code	761
Min. Negotiated Rate	$497.11
Max. Negotiated Rate	$1,075.65
Rate for Payer: BCBS Commercial	$1,075.65
Rate for Payer: Cash Price	$807.00
Rate for Payer: Cash Price	$807.00
Rate for Payer: Celtic Commercial/Exchange	$497.11
Rate for Payer: Health Partners Plans Commercial	$1,022.20
Rate for Payer: UnitedHealthcare Commercial	$1,043.72
Rate for Payer: WPPA Commercial	$903.84

INC&REM FBSUBQTISS SMPL

Facility

$1,076.00

Service Code	HCPCS 10120
Hospital Charge Code	1012000
Hospital Revenue Code	761
Min. Negotiated Rate	$882.32
Max. Negotiated Rate	$1,043.72
Rate for Payer: Cash Price	$807.00
Rate for Payer: Health Partners Plans Commercial	$1,022.20
Rate for Payer: UnitedHealthcare Commercial	$1,043.72
Rate for Payer: WPPA Commercial	$882.32

INDERAL 10 MG TAB (PROPRANOLOL HCL)

Facility

$1.00

Service Code	NDC 69238207701
Hospital Charge Code	2503365
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

INDERAL 10 MG TAB (PROPRANOLOL HCL)

Facility

$1.00

Service Code	NDC 69238207701
Hospital Charge Code	2503365
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

INF AGENT ANTIGEN DETEC,FLU A

Facility

$75.00

Service Code	HCPCS 87276
Hospital Charge Code	8727600
Hospital Revenue Code	306
Min. Negotiated Rate	$61.50
Max. Negotiated Rate	$72.75
Rate for Payer: Cash Price	$56.25
Rate for Payer: Health Partners Plans Commercial	$71.25
Rate for Payer: UnitedHealthcare Commercial	$72.75
Rate for Payer: WPPA Commercial	$61.50

INF AGENT ANTIGEN DETEC,FLU A

Facility

$75.00

Service Code	HCPCS 87276
Hospital Charge Code	8727600
Hospital Revenue Code	306
Min. Negotiated Rate	$34.65
Max. Negotiated Rate	$72.75
Rate for Payer: BCBS Commercial	$54.84
Rate for Payer: Cash Price	$56.25
Rate for Payer: Cash Price	$56.25
Rate for Payer: Celtic Commercial/Exchange	$34.65
Rate for Payer: Health Partners Plans Commercial	$71.25
Rate for Payer: UnitedHealthcare Commercial	$72.75
Rate for Payer: WPPA Commercial	$63.00

INF AGENT ANTIGEN DETEC,IMMONO

Facility

$75.00

Service Code	HCPCS 87300
Hospital Charge Code	8730000
Hospital Revenue Code	306
Min. Negotiated Rate	$61.50
Max. Negotiated Rate	$72.75
Rate for Payer: Cash Price	$56.25
Rate for Payer: Health Partners Plans Commercial	$71.25
Rate for Payer: UnitedHealthcare Commercial	$72.75
Rate for Payer: WPPA Commercial	$61.50

INF AGENT ANTIGEN DETEC,IMMONO

Facility

$75.00

Service Code	HCPCS 87300
Hospital Charge Code	8730000
Hospital Revenue Code	306
Min. Negotiated Rate	$34.65
Max. Negotiated Rate	$72.75
Rate for Payer: BCBS Commercial	$54.84
Rate for Payer: Cash Price	$56.25
Rate for Payer: Cash Price	$56.25
Rate for Payer: Celtic Commercial/Exchange	$34.65
Rate for Payer: Health Partners Plans Commercial	$71.25
Rate for Payer: UnitedHealthcare Commercial	$72.75
Rate for Payer: WPPA Commercial	$63.00

INF AGENT ANTIGEN DETECTION

Facility

$147.00

Service Code	HCPCS 87329
Hospital Charge Code	8732900
Hospital Revenue Code	306
Min. Negotiated Rate	$60.35
Max. Negotiated Rate	$142.59
Rate for Payer: BCBS Commercial	$60.35
Rate for Payer: Cash Price	$110.25
Rate for Payer: Cash Price	$110.25
Rate for Payer: Celtic Commercial/Exchange	$67.91
Rate for Payer: Health Partners Plans Commercial	$139.65
Rate for Payer: UnitedHealthcare Commercial	$142.59
Rate for Payer: WPPA Commercial	$123.48

INF AGENT ANTIGEN DETECTION

Facility

$147.00

Service Code	HCPCS 87329
Hospital Charge Code	8732900
Hospital Revenue Code	306
Min. Negotiated Rate	$120.54
Max. Negotiated Rate	$142.59
Rate for Payer: Cash Price	$110.25
Rate for Payer: Health Partners Plans Commercial	$139.65
Rate for Payer: UnitedHealthcare Commercial	$142.59
Rate for Payer: WPPA Commercial	$120.54

INF AGENT ANTIGEN DETECT,SHIGA

Facility

$100.00

Service Code	HCPCS 87427
Hospital Charge Code	8742700
Hospital Revenue Code	306
Min. Negotiated Rate	$46.20
Max. Negotiated Rate	$97.00
Rate for Payer: BCBS Commercial	$54.84
Rate for Payer: Cash Price	$75.00
Rate for Payer: Cash Price	$75.00
Rate for Payer: Celtic Commercial/Exchange	$46.20
Rate for Payer: Health Partners Plans Commercial	$95.00
Rate for Payer: UnitedHealthcare Commercial	$97.00
Rate for Payer: WPPA Commercial	$84.00

INF AGENT ANTIGEN DETECT,SHIGA

Facility

$100.00

Service Code	HCPCS 87427
Hospital Charge Code	8742700
Hospital Revenue Code	306
Min. Negotiated Rate	$82.00
Max. Negotiated Rate	$97.00
Rate for Payer: Cash Price	$75.00
Rate for Payer: Health Partners Plans Commercial	$95.00
Rate for Payer: UnitedHealthcare Commercial	$97.00
Rate for Payer: WPPA Commercial	$82.00

INF AGENT ANTIGEN-SARS-COV

Facility

$122.00

Service Code	HCPCS 87426
Hospital Charge Code	8742600
Hospital Revenue Code	306
Min. Negotiated Rate	$54.84
Max. Negotiated Rate	$118.34
Rate for Payer: BCBS Commercial	$54.84
Rate for Payer: Cash Price	$91.50
Rate for Payer: Cash Price	$91.50
Rate for Payer: Celtic Commercial/Exchange	$56.36
Rate for Payer: Health Partners Plans Commercial	$115.90
Rate for Payer: UnitedHealthcare Commercial	$118.34
Rate for Payer: WPPA Commercial	$102.48

INF AGENT ANTIGEN-SARS-COV

Facility

$122.00

Service Code	HCPCS 87426
Hospital Charge Code	8742600
Hospital Revenue Code	306
Min. Negotiated Rate	$100.04
Max. Negotiated Rate	$118.34
Rate for Payer: Cash Price	$91.50
Rate for Payer: Health Partners Plans Commercial	$115.90
Rate for Payer: UnitedHealthcare Commercial	$118.34
Rate for Payer: WPPA Commercial	$100.04

INF AGNT ANTG DETEC IMMUNOFLUO

Facility

$89.00

Service Code	HCPCS 87269
Hospital Charge Code	8726900
Hospital Revenue Code	306
Min. Negotiated Rate	$41.12
Max. Negotiated Rate	$86.33
Rate for Payer: BCBS Commercial	$60.95
Rate for Payer: Cash Price	$66.75
Rate for Payer: Cash Price	$66.75
Rate for Payer: Celtic Commercial/Exchange	$41.12
Rate for Payer: Health Partners Plans Commercial	$84.55
Rate for Payer: UnitedHealthcare Commercial	$86.33
Rate for Payer: WPPA Commercial	$74.76

INF AGNT ANTG DETEC IMMUNOFLUO

Facility

$103.00

Service Code	HCPCS 87265
Hospital Charge Code	8726500
Hospital Revenue Code	306
Min. Negotiated Rate	$47.59
Max. Negotiated Rate	$99.91
Rate for Payer: BCBS Commercial	$54.84
Rate for Payer: Cash Price	$77.25
Rate for Payer: Cash Price	$77.25
Rate for Payer: Celtic Commercial/Exchange	$47.59
Rate for Payer: Health Partners Plans Commercial	$97.85
Rate for Payer: UnitedHealthcare Commercial	$99.91
Rate for Payer: WPPA Commercial	$86.52

INF AGNT ANTG DETEC IMMUNOFLUO

Facility

$89.00

Service Code	HCPCS 87269
Hospital Charge Code	8726900
Hospital Revenue Code	306
Min. Negotiated Rate	$72.98
Max. Negotiated Rate	$86.33
Rate for Payer: Cash Price	$66.75
Rate for Payer: Health Partners Plans Commercial	$84.55
Rate for Payer: UnitedHealthcare Commercial	$86.33
Rate for Payer: WPPA Commercial	$72.98

INF AGNT ANTG DETEC IMMUNOFLUO

Facility

$103.00

Service Code	HCPCS 87265
Hospital Charge Code	8726500
Hospital Revenue Code	306
Min. Negotiated Rate	$84.46
Max. Negotiated Rate	$99.91
Rate for Payer: Cash Price	$77.25
Rate for Payer: Health Partners Plans Commercial	$97.85
Rate for Payer: UnitedHealthcare Commercial	$99.91
Rate for Payer: WPPA Commercial	$84.46

INFAGNT ANTGN DECTC,ASPERGILUS

Facility

$235.00

Service Code	HCPCS 87305
Hospital Charge Code	8730500
Hospital Revenue Code	306
Min. Negotiated Rate	$25.74
Max. Negotiated Rate	$227.95
Rate for Payer: BCBS Commercial	$25.74
Rate for Payer: Cash Price	$176.25
Rate for Payer: Cash Price	$176.25
Rate for Payer: Celtic Commercial/Exchange	$108.57
Rate for Payer: Health Partners Plans Commercial	$223.25
Rate for Payer: UnitedHealthcare Commercial	$227.95
Rate for Payer: WPPA Commercial	$197.40

INFAGNT ANTGN DECTC,ASPERGILUS

Facility

$235.00

Service Code	HCPCS 87305
Hospital Charge Code	8730500
Hospital Revenue Code	306
Min. Negotiated Rate	$192.70
Max. Negotiated Rate	$227.95
Rate for Payer: Cash Price	$176.25
Rate for Payer: Health Partners Plans Commercial	$223.25
Rate for Payer: UnitedHealthcare Commercial	$227.95
Rate for Payer: WPPA Commercial	$192.70

INF AGNT ANTGN DETEC BY ENZYME

Facility

$97.00

Service Code	HCPCS 87420
Hospital Charge Code	8742000
Hospital Revenue Code	306
Min. Negotiated Rate	$44.81
Max. Negotiated Rate	$94.09
Rate for Payer: BCBS Commercial	$54.84
Rate for Payer: Cash Price	$72.75
Rate for Payer: Cash Price	$72.75
Rate for Payer: Celtic Commercial/Exchange	$44.81
Rate for Payer: Health Partners Plans Commercial	$92.15
Rate for Payer: UnitedHealthcare Commercial	$94.09
Rate for Payer: WPPA Commercial	$81.48

INF AGNT ANTGN DETEC BY ENZYME

Facility

$149.00

Service Code	HCPCS 87338
Hospital Charge Code	8733800
Hospital Revenue Code	306
Min. Negotiated Rate	$122.18
Max. Negotiated Rate	$144.53
Rate for Payer: Cash Price	$111.75
Rate for Payer: Health Partners Plans Commercial	$141.55
Rate for Payer: UnitedHealthcare Commercial	$144.53
Rate for Payer: WPPA Commercial	$122.18

INF AGNT ANTGN DETEC BY ENZYME

Facility

$97.00

Service Code	HCPCS 87420
Hospital Charge Code	8742000
Hospital Revenue Code	306
Min. Negotiated Rate	$79.54
Max. Negotiated Rate	$94.09
Rate for Payer: Cash Price	$72.75
Rate for Payer: Health Partners Plans Commercial	$92.15
Rate for Payer: UnitedHealthcare Commercial	$94.09
Rate for Payer: WPPA Commercial	$79.54

Know your out-of-pocket cost for care.

All Charges