Ness County Hospital

All Charges

Charge

Type

Setting

Price

ANTIBODY; TETANUS

Facility

$95.00

Service Code	HCPCS 86774
Hospital Charge Code	8677400
Hospital Revenue Code	302
Min. Negotiated Rate	$43.89
Max. Negotiated Rate	$92.15
Rate for Payer: BCBS Commercial	$71.02
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; TETANUS

Facility

$95.00

Service Code	HCPCS 86774
Hospital Charge Code	8677400
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 TOXOPLASMA

Facility

$127.00

Service Code	HCPCS 86777
Hospital Charge Code	8677700
Hospital Revenue Code	302
Min. Negotiated Rate	$58.67
Max. Negotiated Rate	$123.19
Rate for Payer: BCBS Commercial	$67.81
Rate for Payer: Cash Price	$95.25
Rate for Payer: Cash Price	$95.25
Rate for Payer: Celtic Commercial/Exchange	$58.67
Rate for Payer: Health Partners Plans Commercial	$120.65
Rate for Payer: UnitedHealthcare Commercial	$123.19
Rate for Payer: WPPA Commercial	$106.68

ANTIBODY TOXOPLASMA

Facility

$127.00

Service Code	HCPCS 86777
Hospital Charge Code	8677700
Hospital Revenue Code	302
Min. Negotiated Rate	$104.14
Max. Negotiated Rate	$123.19
Rate for Payer: Cash Price	$95.25
Rate for Payer: Health Partners Plans Commercial	$120.65
Rate for Payer: UnitedHealthcare Commercial	$123.19
Rate for Payer: WPPA Commercial	$104.14

ANTIBODY; TOXOPLASMA, IGM

Facility

$75.00

Service Code	HCPCS 86778
Hospital Charge Code	8677800
Hospital Revenue Code	302
Min. Negotiated Rate	$34.65
Max. Negotiated Rate	$72.75
Rate for Payer: BCBS Commercial	$54.29
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

ANTIBODY; TOXOPLASMA, IGM

Facility

$75.00

Service Code	HCPCS 86778
Hospital Charge Code	8677800
Hospital Revenue Code	302
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

ANTIBODY TRICHINELLA

Facility

$88.00

Service Code	HCPCS 86784
Hospital Charge Code	8678400
Hospital Revenue Code	302
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

ANTIBODY TRICHINELLA

Facility

$88.00

Service Code	HCPCS 86784
Hospital Charge Code	8678400
Hospital Revenue Code	302
Min. Negotiated Rate	$40.66
Max. Negotiated Rate	$85.36
Rate for Payer: BCBS Commercial	$79.10
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

ANTIBODY VARICELLA-ZOSTER

Facility

$123.00

Service Code	HCPCS 86787
Hospital Charge Code	8678700
Hospital Revenue Code	302
Min. Negotiated Rate	$56.83
Max. Negotiated Rate	$119.31
Rate for Payer: BCBS Commercial	$66.20
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 VARICELLA-ZOSTER

Facility

$123.00

Service Code	HCPCS 86787
Hospital Charge Code	8678700
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 VIRUS (NES)

Facility

$162.00

Service Code	HCPCS 86790
Hospital Charge Code	8679000
Hospital Revenue Code	302
Min. Negotiated Rate	$33.65
Max. Negotiated Rate	$157.14
Rate for Payer: BCBS Commercial	$33.65
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cash Price	$121.50
Rate for Payer: Celtic Commercial/Exchange	$74.84
Rate for Payer: Health Partners Plans Commercial	$153.90
Rate for Payer: UnitedHealthcare Commercial	$157.14
Rate for Payer: WPPA Commercial	$136.08

ANTIBODY VIRUS (NES)

Facility

$162.00

Service Code	HCPCS 86790
Hospital Charge Code	8679000
Hospital Revenue Code	302
Min. Negotiated Rate	$132.84
Max. Negotiated Rate	$157.14
Rate for Payer: Cash Price	$121.50
Rate for Payer: Health Partners Plans Commercial	$153.90
Rate for Payer: UnitedHealthcare Commercial	$157.14
Rate for Payer: WPPA Commercial	$132.84

ANTIBODY WEST NILE VIRUS

Facility

$151.00

Service Code	HCPCS 86789
Hospital Charge Code	8678900
Hospital Revenue Code	302
Min. Negotiated Rate	$30.89
Max. Negotiated Rate	$146.47
Rate for Payer: BCBS Commercial	$30.89
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

ANTIBODY WEST NILE VIRUS

Facility

$151.00

Service Code	HCPCS 86789
Hospital Charge Code	8678900
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

ANTIBODY WEST NILE VIRUS,IGM

Facility

$152.00

Service Code	HCPCS 86788
Hospital Charge Code	8678800
Hospital Revenue Code	302
Min. Negotiated Rate	$124.64
Max. Negotiated Rate	$147.44
Rate for Payer: Cash Price	$114.00
Rate for Payer: Health Partners Plans Commercial	$144.40
Rate for Payer: UnitedHealthcare Commercial	$147.44
Rate for Payer: WPPA Commercial	$124.64

ANTIBODY WEST NILE VIRUS,IGM

Facility

$152.00

Service Code	HCPCS 86788
Hospital Charge Code	8678800
Hospital Revenue Code	302
Min. Negotiated Rate	$36.15
Max. Negotiated Rate	$147.44
Rate for Payer: BCBS Commercial	$36.15
Rate for Payer: Cash Price	$114.00
Rate for Payer: Cash Price	$114.00
Rate for Payer: Celtic Commercial/Exchange	$70.22
Rate for Payer: Health Partners Plans Commercial	$144.40
Rate for Payer: UnitedHealthcare Commercial	$147.44
Rate for Payer: WPPA Commercial	$127.68

ANTIC SIPHON ANESTHESIA SET

Facility

$22.00

Hospital Charge Code	2709956
Hospital Revenue Code	270
Min. Negotiated Rate	$18.04
Max. Negotiated Rate	$21.34
Rate for Payer: Cash Price	$17.06
Rate for Payer: Health Partners Plans Commercial	$20.90
Rate for Payer: UnitedHealthcare Commercial	$21.34
Rate for Payer: WPPA Commercial	$18.04

ANTIC SIPHON ANESTHESIA SET

Facility

$22.00

Hospital Charge Code	2709956
Hospital Revenue Code	270
Min. Negotiated Rate	$10.16
Max. Negotiated Rate	$21.34
Rate for Payer: Cash Price	$17.06
Rate for Payer: Celtic Commercial/Exchange	$10.16
Rate for Payer: Health Partners Plans Commercial	$20.90
Rate for Payer: UnitedHealthcare Commercial	$21.34
Rate for Payer: WPPA Commercial	$18.48

ANTIDEPRESSANT LVL CLASS 3-5

Facility

$271.00

Service Code	HCPCS 80333
Hospital Charge Code	8033300
Hospital Revenue Code	300
Min. Negotiated Rate	$222.22
Max. Negotiated Rate	$262.87
Rate for Payer: Cash Price	$203.25
Rate for Payer: Health Partners Plans Commercial	$257.45
Rate for Payer: UnitedHealthcare Commercial	$262.87
Rate for Payer: WPPA Commercial	$222.22

ANTIDEPRESSANT LVL CLASS 3-5

Facility

$271.00

Service Code	HCPCS 80333
Hospital Charge Code	8033300
Hospital Revenue Code	300
Min. Negotiated Rate	$125.20
Max. Negotiated Rate	$262.87
Rate for Payer: BCBS Commercial	$154.59
Rate for Payer: Cash Price	$203.25
Rate for Payer: Cash Price	$203.25
Rate for Payer: Celtic Commercial/Exchange	$125.20
Rate for Payer: Health Partners Plans Commercial	$257.45
Rate for Payer: UnitedHealthcare Commercial	$262.87
Rate for Payer: WPPA Commercial	$227.64

ANTIDEPRESSANTS,TRICYCLIC&OTHR

Facility

$190.00

Service Code	HCPCS 80337
Hospital Charge Code	8033700
Hospital Revenue Code	300
Min. Negotiated Rate	$155.80
Max. Negotiated Rate	$184.30
Rate for Payer: Cash Price	$142.50
Rate for Payer: Health Partners Plans Commercial	$180.50
Rate for Payer: UnitedHealthcare Commercial	$184.30
Rate for Payer: WPPA Commercial	$155.80

ANTIDEPRESSANTS,TRICYCLIC&OTHR

Facility

$190.00

Service Code	HCPCS 80337
Hospital Charge Code	8033700
Hospital Revenue Code	300
Min. Negotiated Rate	$87.78
Max. Negotiated Rate	$184.30
Rate for Payer: BCBS Commercial	$93.71
Rate for Payer: Cash Price	$142.50
Rate for Payer: Cash Price	$142.50
Rate for Payer: Celtic Commercial/Exchange	$87.78
Rate for Payer: Health Partners Plans Commercial	$180.50
Rate for Payer: UnitedHealthcare Commercial	$184.30
Rate for Payer: WPPA Commercial	$159.60

ANTI-EMBOLISM HOSE

Facility

$22.00

Hospital Charge Code	2700060
Hospital Revenue Code	270
Min. Negotiated Rate	$10.16
Max. Negotiated Rate	$21.34
Rate for Payer: Cash Price	$16.69
Rate for Payer: Celtic Commercial/Exchange	$10.16
Rate for Payer: Health Partners Plans Commercial	$20.90
Rate for Payer: UnitedHealthcare Commercial	$21.34
Rate for Payer: WPPA Commercial	$18.48

ANTI-EMBOLISM HOSE

Facility

$22.00

Hospital Charge Code	2700060
Hospital Revenue Code	270
Min. Negotiated Rate	$18.04
Max. Negotiated Rate	$21.34
Rate for Payer: Cash Price	$16.69
Rate for Payer: Health Partners Plans Commercial	$20.90
Rate for Payer: UnitedHealthcare Commercial	$21.34
Rate for Payer: WPPA Commercial	$18.04

ANTIEPILEPTICS LVL NOS 4-6

Facility

$271.00

Service Code	HCPCS 80340
Hospital Charge Code	8034000
Hospital Revenue Code	300
Min. Negotiated Rate	$74.24
Max. Negotiated Rate	$262.87
Rate for Payer: BCBS Commercial	$74.24
Rate for Payer: Cash Price	$203.25
Rate for Payer: Cash Price	$203.25
Rate for Payer: Celtic Commercial/Exchange	$125.20
Rate for Payer: Health Partners Plans Commercial	$257.45
Rate for Payer: UnitedHealthcare Commercial	$262.87
Rate for Payer: WPPA Commercial	$227.64

Know your out-of-pocket cost for care.

All Charges