Ness County Hospital

All Charges

Charge

Type

Setting

Price

ANTIBODY BRUCELLA

Facility

$62.00

Service Code	HCPCS 86622
Hospital Charge Code	8662200
Hospital Revenue Code	302
Min. Negotiated Rate	$50.84
Max. Negotiated Rate	$60.14
Rate for Payer: Cash Price	$46.50
Rate for Payer: Health Partners Plans Commercial	$58.90
Rate for Payer: UnitedHealthcare Commercial	$60.14
Rate for Payer: WPPA Commercial	$50.84

ANTIBODY; CANDIDA

Facility

$85.00

Service Code	HCPCS 86628
Hospital Charge Code	8662800
Hospital Revenue Code	302
Min. Negotiated Rate	$69.70
Max. Negotiated Rate	$82.45
Rate for Payer: Cash Price	$63.75
Rate for Payer: Health Partners Plans Commercial	$80.75
Rate for Payer: UnitedHealthcare Commercial	$82.45
Rate for Payer: WPPA Commercial	$69.70

ANTIBODY; CANDIDA

Facility

$85.00

Service Code	HCPCS 86628
Hospital Charge Code	8662800
Hospital Revenue Code	302
Min. Negotiated Rate	$39.27
Max. Negotiated Rate	$82.45
Rate for Payer: BCBS Commercial	$61.59
Rate for Payer: Cash Price	$63.75
Rate for Payer: Cash Price	$63.75
Rate for Payer: Celtic Commercial/Exchange	$39.27
Rate for Payer: Health Partners Plans Commercial	$80.75
Rate for Payer: UnitedHealthcare Commercial	$82.45
Rate for Payer: WPPA Commercial	$71.40

ANTIBODY, CHLAMYDIA

Facility

$128.00

Service Code	HCPCS 86631
Hospital Charge Code	8663100
Hospital Revenue Code	302
Min. Negotiated Rate	$104.96
Max. Negotiated Rate	$124.16
Rate for Payer: Cash Price	$96.00
Rate for Payer: Health Partners Plans Commercial	$121.60
Rate for Payer: UnitedHealthcare Commercial	$124.16
Rate for Payer: WPPA Commercial	$104.96

ANTIBODY, CHLAMYDIA

Facility

$128.00

Service Code	HCPCS 86631
Hospital Charge Code	8663100
Hospital Revenue Code	302
Min. Negotiated Rate	$59.14
Max. Negotiated Rate	$124.16
Rate for Payer: BCBS Commercial	$68.53
Rate for Payer: Cash Price	$96.00
Rate for Payer: Cash Price	$96.00
Rate for Payer: Celtic Commercial/Exchange	$59.14
Rate for Payer: Health Partners Plans Commercial	$121.60
Rate for Payer: UnitedHealthcare Commercial	$124.16
Rate for Payer: WPPA Commercial	$107.52

ANTIBODY CHLAMYDIA, IGM

Facility

$85.00

Service Code	HCPCS 86632
Hospital Charge Code	8663200
Hospital Revenue Code	302
Min. Negotiated Rate	$39.27
Max. Negotiated Rate	$82.45
Rate for Payer: BCBS Commercial	$64.78
Rate for Payer: Cash Price	$63.75
Rate for Payer: Cash Price	$63.75
Rate for Payer: Celtic Commercial/Exchange	$39.27
Rate for Payer: Health Partners Plans Commercial	$80.75
Rate for Payer: UnitedHealthcare Commercial	$82.45
Rate for Payer: WPPA Commercial	$71.40

ANTIBODY CHLAMYDIA, IGM

Facility

$85.00

Service Code	HCPCS 86632
Hospital Charge Code	8663200
Hospital Revenue Code	302
Min. Negotiated Rate	$69.70
Max. Negotiated Rate	$82.45
Rate for Payer: Cash Price	$63.75
Rate for Payer: Health Partners Plans Commercial	$80.75
Rate for Payer: UnitedHealthcare Commercial	$82.45
Rate for Payer: WPPA Commercial	$69.70

ANTIBODY COCCIDIOIDES

Facility

$125.00

Service Code	HCPCS 86635
Hospital Charge Code	8663500
Hospital Revenue Code	302
Min. Negotiated Rate	$102.50
Max. Negotiated Rate	$121.25
Rate for Payer: Cash Price	$93.75
Rate for Payer: Health Partners Plans Commercial	$118.75
Rate for Payer: UnitedHealthcare Commercial	$121.25
Rate for Payer: WPPA Commercial	$102.50

ANTIBODY COCCIDIOIDES

Facility

$125.00

Service Code	HCPCS 86635
Hospital Charge Code	8663500
Hospital Revenue Code	302
Min. Negotiated Rate	$51.81
Max. Negotiated Rate	$121.25
Rate for Payer: BCBS Commercial	$51.81
Rate for Payer: Cash Price	$93.75
Rate for Payer: Cash Price	$93.75
Rate for Payer: Celtic Commercial/Exchange	$57.75
Rate for Payer: Health Partners Plans Commercial	$118.75
Rate for Payer: UnitedHealthcare Commercial	$121.25
Rate for Payer: WPPA Commercial	$105.00

ANTIBODY CRYPTOCOCCUS

Facility

$149.00

Service Code	HCPCS 86641
Hospital Charge Code	8664100
Hospital Revenue Code	302
Min. Negotiated Rate	$46.65
Max. Negotiated Rate	$144.53
Rate for Payer: BCBS Commercial	$46.65
Rate for Payer: Cash Price	$111.75
Rate for Payer: Cash Price	$111.75
Rate for Payer: Celtic Commercial/Exchange	$68.84
Rate for Payer: Health Partners Plans Commercial	$141.55
Rate for Payer: UnitedHealthcare Commercial	$144.53
Rate for Payer: WPPA Commercial	$125.16

ANTIBODY CRYPTOCOCCUS

Facility

$149.00

Service Code	HCPCS 86641
Hospital Charge Code	8664100
Hospital Revenue Code	302
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

ANTIBODY CYTOMEGALOVIRUS (CMV

Facility

$149.00

Service Code	HCPCS 86644
Hospital Charge Code	8664400
Hospital Revenue Code	302
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

ANTIBODY CYTOMEGALOVIRUS (CMV

Facility

$149.00

Service Code	HCPCS 86644
Hospital Charge Code	8664400
Hospital Revenue Code	302
Min. Negotiated Rate	$68.84
Max. Negotiated Rate	$144.53
Rate for Payer: BCBS Commercial	$72.11
Rate for Payer: Cash Price	$111.75
Rate for Payer: Cash Price	$111.75
Rate for Payer: Celtic Commercial/Exchange	$68.84
Rate for Payer: Health Partners Plans Commercial	$141.55
Rate for Payer: UnitedHealthcare Commercial	$144.53
Rate for Payer: WPPA Commercial	$125.16

ANTIBODY, CYTOMEGALOVIRUS(CMV)

Facility

$133.00

Service Code	HCPCS 86645
Hospital Charge Code	8664500
Hospital Revenue Code	302
Min. Negotiated Rate	$109.06
Max. Negotiated Rate	$129.01
Rate for Payer: Cash Price	$99.75
Rate for Payer: Health Partners Plans Commercial	$126.35
Rate for Payer: UnitedHealthcare Commercial	$129.01
Rate for Payer: WPPA Commercial	$109.06

ANTIBODY, CYTOMEGALOVIRUS(CMV)

Facility

$133.00

Service Code	HCPCS 86645
Hospital Charge Code	8664500
Hospital Revenue Code	302
Min. Negotiated Rate	$61.45
Max. Negotiated Rate	$129.01
Rate for Payer: BCBS Commercial	$72.11
Rate for Payer: Cash Price	$99.75
Rate for Payer: Cash Price	$99.75
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

ANTIBODY; DIPHTHERIA

Facility

$95.00

Service Code	HCPCS 86648
Hospital Charge Code	8664800
Hospital Revenue Code	302
Min. Negotiated Rate	$39.56
Max. Negotiated Rate	$92.15
Rate for Payer: BCBS Commercial	$39.56
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

ANTIBODY; DIPHTHERIA

Facility

$95.00

Service Code	HCPCS 86648
Hospital Charge Code	8664800
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

ANTIBODY ELUTION RBC,EA ELUTN

Facility

$158.00

Service Code	HCPCS 86860
Hospital Charge Code	8686000
Hospital Revenue Code	309
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

ANTIBODY ELUTION RBC,EA ELUTN

Facility

$158.00

Service Code	HCPCS 86860
Hospital Charge Code	8686000
Hospital Revenue Code	309
Min. Negotiated Rate	$19.23
Max. Negotiated Rate	$153.26
Rate for Payer: BCBS Commercial	$19.23
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

ANTIBODY:ENCEPALITIS,WESTEQUIN

Facility

$82.00

Service Code	HCPCS 86654
Hospital Charge Code	8665400
Hospital Revenue Code	302
Min. Negotiated Rate	$67.24
Max. Negotiated Rate	$79.54
Rate for Payer: Cash Price	$61.50
Rate for Payer: Health Partners Plans Commercial	$77.90
Rate for Payer: UnitedHealthcare Commercial	$79.54
Rate for Payer: WPPA Commercial	$67.24

ANTIBODY:ENCEPALITIS,WESTEQUIN

Facility

$82.00

Service Code	HCPCS 86654
Hospital Charge Code	8665400
Hospital Revenue Code	302
Min. Negotiated Rate	$37.88
Max. Negotiated Rate	$79.54
Rate for Payer: BCBS Commercial	$56.99
Rate for Payer: Cash Price	$61.50
Rate for Payer: Cash Price	$61.50
Rate for Payer: Celtic Commercial/Exchange	$37.88
Rate for Payer: Health Partners Plans Commercial	$77.90
Rate for Payer: UnitedHealthcare Commercial	$79.54
Rate for Payer: WPPA Commercial	$68.88

ANTIBODY:ENCEPHALITIS,CALIFORN

Facility

$82.00

Service Code	HCPCS 86651
Hospital Charge Code	8665100
Hospital Revenue Code	302
Min. Negotiated Rate	$37.88
Max. Negotiated Rate	$79.54
Rate for Payer: BCBS Commercial	$56.99
Rate for Payer: Cash Price	$61.50
Rate for Payer: Cash Price	$61.50
Rate for Payer: Celtic Commercial/Exchange	$37.88
Rate for Payer: Health Partners Plans Commercial	$77.90
Rate for Payer: UnitedHealthcare Commercial	$79.54
Rate for Payer: WPPA Commercial	$68.88

ANTIBODY:ENCEPHALITIS,CALIFORN

Facility

$82.00

Service Code	HCPCS 86651
Hospital Charge Code	8665100
Hospital Revenue Code	302
Min. Negotiated Rate	$67.24
Max. Negotiated Rate	$79.54
Rate for Payer: Cash Price	$61.50
Rate for Payer: Health Partners Plans Commercial	$77.90
Rate for Payer: UnitedHealthcare Commercial	$79.54
Rate for Payer: WPPA Commercial	$67.24

ANTIBODY:ENCEPHALITIS,EASTEQUI

Facility

$82.00

Service Code	HCPCS 86652
Hospital Charge Code	8665200
Hospital Revenue Code	302
Min. Negotiated Rate	$67.24
Max. Negotiated Rate	$79.54
Rate for Payer: Cash Price	$61.50
Rate for Payer: Health Partners Plans Commercial	$77.90
Rate for Payer: UnitedHealthcare Commercial	$79.54
Rate for Payer: WPPA Commercial	$67.24

ANTIBODY:ENCEPHALITIS,EASTEQUI

Facility

$82.00

Service Code	HCPCS 86652
Hospital Charge Code	8665200
Hospital Revenue Code	302
Min. Negotiated Rate	$37.88
Max. Negotiated Rate	$79.54
Rate for Payer: BCBS Commercial	$56.99
Rate for Payer: Cash Price	$61.50
Rate for Payer: Cash Price	$61.50
Rate for Payer: Celtic Commercial/Exchange	$37.88
Rate for Payer: Health Partners Plans Commercial	$77.90
Rate for Payer: UnitedHealthcare Commercial	$79.54
Rate for Payer: WPPA Commercial	$68.88

Know your out-of-pocket cost for care.

All Charges