Ness County Hospital

All Charges

Charge

Type

Setting

Price

ANTIBODY ENTEROVIRUS (COXSACK

Facility

$85.00

Service Code	HCPCS 86658
Hospital Charge Code	8665800
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 ENTEROVIRUS (COXSACK

Facility

$85.00

Service Code	HCPCS 86658
Hospital Charge Code	8665800
Hospital Revenue Code	302
Min. Negotiated Rate	$39.27
Max. Negotiated Rate	$82.45
Rate for Payer: BCBS Commercial	$74.45
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 FUNGUS, NES

Facility

$125.00

Service Code	HCPCS 86671
Hospital Charge Code	8667100
Hospital Revenue Code	302
Min. Negotiated Rate	$30.27
Max. Negotiated Rate	$121.25
Rate for Payer: BCBS Commercial	$30.27
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 FUNGUS, NES

Facility

$125.00

Service Code	HCPCS 86671
Hospital Charge Code	8667100
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; HEPATITIS,DELTA AGNT

Facility

$90.00

Service Code	HCPCS 86692
Hospital Charge Code	8669200
Hospital Revenue Code	302
Min. Negotiated Rate	$73.80
Max. Negotiated Rate	$87.30
Rate for Payer: Cash Price	$67.50
Rate for Payer: Health Partners Plans Commercial	$85.50
Rate for Payer: UnitedHealthcare Commercial	$87.30
Rate for Payer: WPPA Commercial	$73.80

ANTIBODY; HEPATITIS,DELTA AGNT

Facility

$90.00

Service Code	HCPCS 86692
Hospital Charge Code	8669200
Hospital Revenue Code	302
Min. Negotiated Rate	$41.58
Max. Negotiated Rate	$87.30
Rate for Payer: BCBS Commercial	$65.51
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cash Price	$67.50
Rate for Payer: Celtic Commercial/Exchange	$41.58
Rate for Payer: Health Partners Plans Commercial	$85.50
Rate for Payer: UnitedHealthcare Commercial	$87.30
Rate for Payer: WPPA Commercial	$75.60

ANTIBODY:HERPES SIMPLEX,NONSPE

Facility

$101.00

Service Code	HCPCS 86694
Hospital Charge Code	8669400
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

ANTIBODY:HERPES SIMPLEX,NONSPE

Facility

$101.00

Service Code	HCPCS 86694
Hospital Charge Code	8669400
Hospital Revenue Code	302
Min. Negotiated Rate	$46.66
Max. Negotiated Rate	$97.97
Rate for Payer: BCBS Commercial	$76.81
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

ANTIBODY HERPES SIMPLEX TYPE1

Facility

$65.00

Service Code	HCPCS 86695
Hospital Charge Code	8669500
Hospital Revenue Code	302
Min. Negotiated Rate	$30.03
Max. Negotiated Rate	$63.53
Rate for Payer: BCBS Commercial	$63.53
Rate for Payer: Cash Price	$48.75
Rate for Payer: Cash Price	$48.75
Rate for Payer: Celtic Commercial/Exchange	$30.03
Rate for Payer: Health Partners Plans Commercial	$61.75
Rate for Payer: UnitedHealthcare Commercial	$63.05
Rate for Payer: WPPA Commercial	$54.60

ANTIBODY HERPES SIMPLEX TYPE1

Facility

$65.00

Service Code	HCPCS 86695
Hospital Charge Code	8669500
Hospital Revenue Code	302
Min. Negotiated Rate	$53.30
Max. Negotiated Rate	$63.05
Rate for Payer: Cash Price	$48.75
Rate for Payer: Health Partners Plans Commercial	$61.75
Rate for Payer: UnitedHealthcare Commercial	$63.05
Rate for Payer: WPPA Commercial	$53.30

ANTIBODY HERPES SIMPLEX TYPE2

Facility

$70.00

Service Code	HCPCS 86696
Hospital Charge Code	8669600
Hospital Revenue Code	302
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

ANTIBODY HERPES SIMPLEX TYPE2

Facility

$70.00

Service Code	HCPCS 86696
Hospital Charge Code	8669600
Hospital Revenue Code	302
Min. Negotiated Rate	$32.34
Max. Negotiated Rate	$67.90
Rate for Payer: BCBS Commercial	$67.05
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

ANTIBODY HISTOPLASMA

Facility

$146.00

Service Code	HCPCS 86698
Hospital Charge Code	8669800
Hospital Revenue Code	302
Min. Negotiated Rate	$58.80
Max. Negotiated Rate	$141.62
Rate for Payer: BCBS Commercial	$58.80
Rate for Payer: Cash Price	$109.50
Rate for Payer: Cash Price	$109.50
Rate for Payer: Celtic Commercial/Exchange	$67.45
Rate for Payer: Health Partners Plans Commercial	$138.70
Rate for Payer: UnitedHealthcare Commercial	$141.62
Rate for Payer: WPPA Commercial	$122.64

ANTIBODY HISTOPLASMA

Facility

$146.00

Service Code	HCPCS 86698
Hospital Charge Code	8669800
Hospital Revenue Code	302
Min. Negotiated Rate	$119.72
Max. Negotiated Rate	$141.62
Rate for Payer: Cash Price	$109.50
Rate for Payer: Health Partners Plans Commercial	$138.70
Rate for Payer: UnitedHealthcare Commercial	$141.62
Rate for Payer: WPPA Commercial	$119.72

ANTIBODY HIV-1

Facility

$123.00

Service Code	HCPCS 86701
Hospital Charge Code	8670100
Hospital Revenue Code	302
Min. Negotiated Rate	$56.83
Max. Negotiated Rate	$119.31
Rate for Payer: BCBS Commercial	$66.29
Rate for Payer: Cash Price	$92.25
Rate for Payer: Cash Price	$92.25
Rate for Payer: Celtic Commercial/Exchange	$56.83
Rate for Payer: Health Partners Plans Commercial	$116.85
Rate for Payer: UnitedHealthcare Commercial	$119.31
Rate for Payer: WPPA Commercial	$103.32

ANTIBODY HIV-1

Facility

$123.00

Service Code	HCPCS 86701
Hospital Charge Code	8670100
Hospital Revenue Code	302
Min. Negotiated Rate	$100.86
Max. Negotiated Rate	$119.31
Rate for Payer: Cash Price	$92.25
Rate for Payer: Health Partners Plans Commercial	$116.85
Rate for Payer: UnitedHealthcare Commercial	$119.31
Rate for Payer: WPPA Commercial	$100.86

ANTIBODY HIV 2

Facility

$123.00

Service Code	HCPCS 86702
Hospital Charge Code	8670200
Hospital Revenue Code	302
Min. Negotiated Rate	$100.86
Max. Negotiated Rate	$119.31
Rate for Payer: Cash Price	$92.25
Rate for Payer: Health Partners Plans Commercial	$116.85
Rate for Payer: UnitedHealthcare Commercial	$119.31
Rate for Payer: WPPA Commercial	$100.86

ANTIBODY HIV 2

Facility

$123.00

Service Code	HCPCS 86702
Hospital Charge Code	8670200
Hospital Revenue Code	302
Min. Negotiated Rate	$56.83
Max. Negotiated Rate	$119.31
Rate for Payer: BCBS Commercial	$61.04
Rate for Payer: Cash Price	$92.25
Rate for Payer: Cash Price	$92.25
Rate for Payer: Celtic Commercial/Exchange	$56.83
Rate for Payer: Health Partners Plans Commercial	$116.85
Rate for Payer: UnitedHealthcare Commercial	$119.31
Rate for Payer: WPPA Commercial	$103.32

ANTIBODY HTLV-L

Facility

$74.00

Service Code	HCPCS 86687
Hospital Charge Code	8668700
Hospital Revenue Code	302
Min. Negotiated Rate	$34.19
Max. Negotiated Rate	$71.78
Rate for Payer: BCBS Commercial	$43.90
Rate for Payer: Cash Price	$55.50
Rate for Payer: Cash Price	$55.50
Rate for Payer: Celtic Commercial/Exchange	$34.19
Rate for Payer: Health Partners Plans Commercial	$70.30
Rate for Payer: UnitedHealthcare Commercial	$71.78
Rate for Payer: WPPA Commercial	$62.16

ANTIBODY HTLV-L

Facility

$74.00

Service Code	HCPCS 86687
Hospital Charge Code	8668700
Hospital Revenue Code	302
Min. Negotiated Rate	$60.68
Max. Negotiated Rate	$71.78
Rate for Payer: Cash Price	$55.50
Rate for Payer: Health Partners Plans Commercial	$70.30
Rate for Payer: UnitedHealthcare Commercial	$71.78
Rate for Payer: WPPA Commercial	$60.68

ANTIBODY ID LEUKOCYTE ANTIBOD

Facility

$167.00

Service Code	HCPCS 86021
Hospital Charge Code	8602100
Hospital Revenue Code	302
Min. Negotiated Rate	$136.94
Max. Negotiated Rate	$161.99
Rate for Payer: Cash Price	$125.25
Rate for Payer: Health Partners Plans Commercial	$158.65
Rate for Payer: UnitedHealthcare Commercial	$161.99
Rate for Payer: WPPA Commercial	$136.94

ANTIBODY ID LEUKOCYTE ANTIBOD

Facility

$167.00

Service Code	HCPCS 86021
Hospital Charge Code	8602100
Hospital Revenue Code	302
Min. Negotiated Rate	$27.03
Max. Negotiated Rate	$161.99
Rate for Payer: BCBS Commercial	$27.03
Rate for Payer: Cash Price	$125.25
Rate for Payer: Cash Price	$125.25
Rate for Payer: Celtic Commercial/Exchange	$77.15
Rate for Payer: Health Partners Plans Commercial	$158.65
Rate for Payer: UnitedHealthcare Commercial	$161.99
Rate for Payer: WPPA Commercial	$140.28

ANTIBODY ID PLATELET ASSOCIATD

Facility

$210.00

Service Code	HCPCS 86023
Hospital Charge Code	8602300
Hospital Revenue Code	302
Min. Negotiated Rate	$172.20
Max. Negotiated Rate	$203.70
Rate for Payer: Cash Price	$157.50
Rate for Payer: Health Partners Plans Commercial	$199.50
Rate for Payer: UnitedHealthcare Commercial	$203.70
Rate for Payer: WPPA Commercial	$172.20

ANTIBODY ID PLATELET ASSOCIATD

Facility

$210.00

Service Code	HCPCS 86023
Hospital Charge Code	8602300
Hospital Revenue Code	302
Min. Negotiated Rate	$97.02
Max. Negotiated Rate	$203.70
Rate for Payer: BCBS Commercial	$101.11
Rate for Payer: Cash Price	$157.50
Rate for Payer: Cash Price	$157.50
Rate for Payer: Celtic Commercial/Exchange	$97.02
Rate for Payer: Health Partners Plans Commercial	$199.50
Rate for Payer: UnitedHealthcare Commercial	$203.70
Rate for Payer: WPPA Commercial	$176.40

ANTIBODY ID, RBC ANTIB,EA PANL

Facility

$325.00

Service Code	HCPCS 86870
Hospital Charge Code	8687000
Hospital Revenue Code	309
Min. Negotiated Rate	$97.50
Max. Negotiated Rate	$315.25
Rate for Payer: BCBS Commercial	$97.50
Rate for Payer: Cash Price	$243.75
Rate for Payer: Cash Price	$243.75
Rate for Payer: Celtic Commercial/Exchange	$150.15
Rate for Payer: Health Partners Plans Commercial	$308.75
Rate for Payer: UnitedHealthcare Commercial	$315.25
Rate for Payer: WPPA Commercial	$273.00

Know your out-of-pocket cost for care.

All Charges