Ness County Hospital

All Charges

Charge

Type

Setting

Price

THROMBOPLASTIN TIME, PARTIAL

Facility

$95.00

Service Code	HCPCS 85730
Hospital Charge Code	8573000
Hospital Revenue Code	305
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

THROMBOPLASTIN TIME,SUBSTITUTE

Facility

$35.00

Service Code	HCPCS 85732
Hospital Charge Code	8573200
Hospital Revenue Code	305
Min. Negotiated Rate	$16.17
Max. Negotiated Rate	$33.95
Rate for Payer: BCBS Commercial	$23.11
Rate for Payer: Cash Price	$26.25
Rate for Payer: Cash Price	$26.25
Rate for Payer: Celtic Commercial/Exchange	$16.17
Rate for Payer: Health Partners Plans Commercial	$33.25
Rate for Payer: UnitedHealthcare Commercial	$33.95
Rate for Payer: WPPA Commercial	$29.40

THROMBOPLASTIN TIME,SUBSTITUTE

Facility

$35.00

Service Code	HCPCS 85732
Hospital Charge Code	8573200
Hospital Revenue Code	305
Min. Negotiated Rate	$28.70
Max. Negotiated Rate	$33.95
Rate for Payer: Cash Price	$26.25
Rate for Payer: Health Partners Plans Commercial	$33.25
Rate for Payer: UnitedHealthcare Commercial	$33.95
Rate for Payer: WPPA Commercial	$28.70

THROXINE, TOTAL (T4)

Facility

$64.00

Service Code	HCPCS 84436
Hospital Charge Code	8443600
Hospital Revenue Code	301
Min. Negotiated Rate	$17.96
Max. Negotiated Rate	$62.08
Rate for Payer: BCBS Commercial	$17.96
Rate for Payer: Cash Price	$48.00
Rate for Payer: Cash Price	$48.00
Rate for Payer: Celtic Commercial/Exchange	$29.57
Rate for Payer: Health Partners Plans Commercial	$60.80
Rate for Payer: UnitedHealthcare Commercial	$62.08
Rate for Payer: WPPA Commercial	$53.76

THROXINE, TOTAL (T4)

Facility

$64.00

Service Code	HCPCS 84436
Hospital Charge Code	8443600
Hospital Revenue Code	301
Min. Negotiated Rate	$52.48
Max. Negotiated Rate	$62.08
Rate for Payer: Cash Price	$48.00
Rate for Payer: Health Partners Plans Commercial	$60.80
Rate for Payer: UnitedHealthcare Commercial	$62.08
Rate for Payer: WPPA Commercial	$52.48

THUMB SPICA MD/LG LEFT

Facility

$52.00

Hospital Charge Code	2702627
Hospital Revenue Code	270
Min. Negotiated Rate	$42.64
Max. Negotiated Rate	$50.44
Rate for Payer: Cash Price	$39.00
Rate for Payer: Health Partners Plans Commercial	$49.40
Rate for Payer: UnitedHealthcare Commercial	$50.44
Rate for Payer: WPPA Commercial	$42.64

THUMB SPICA MD/LG LEFT

Facility

$52.00

Hospital Charge Code	2702627
Hospital Revenue Code	270
Min. Negotiated Rate	$24.02
Max. Negotiated Rate	$50.44
Rate for Payer: Cash Price	$39.00
Rate for Payer: Celtic Commercial/Exchange	$24.02
Rate for Payer: Health Partners Plans Commercial	$49.40
Rate for Payer: UnitedHealthcare Commercial	$50.44
Rate for Payer: WPPA Commercial	$43.68

THUMB SPICA MD/LG RIGHT

Facility

$52.00

Hospital Charge Code	2702628
Hospital Revenue Code	270
Min. Negotiated Rate	$24.02
Max. Negotiated Rate	$50.44
Rate for Payer: Cash Price	$39.00
Rate for Payer: Celtic Commercial/Exchange	$24.02
Rate for Payer: Health Partners Plans Commercial	$49.40
Rate for Payer: UnitedHealthcare Commercial	$50.44
Rate for Payer: WPPA Commercial	$43.68

THUMB SPICA MD/LG RIGHT

Facility

$52.00

Hospital Charge Code	2702628
Hospital Revenue Code	270
Min. Negotiated Rate	$42.64
Max. Negotiated Rate	$50.44
Rate for Payer: Cash Price	$39.00
Rate for Payer: Health Partners Plans Commercial	$49.40
Rate for Payer: UnitedHealthcare Commercial	$50.44
Rate for Payer: WPPA Commercial	$42.64

THUMB SPICA SPLINT

Facility

$60.00

Hospital Charge Code	2707331
Hospital Revenue Code	270
Min. Negotiated Rate	$49.20
Max. Negotiated Rate	$58.20
Rate for Payer: Cash Price	$45.00
Rate for Payer: Health Partners Plans Commercial	$57.00
Rate for Payer: UnitedHealthcare Commercial	$58.20
Rate for Payer: WPPA Commercial	$49.20

THUMB SPICA SPLINT

Facility

$60.00

Hospital Charge Code	2707331
Hospital Revenue Code	270
Min. Negotiated Rate	$27.72
Max. Negotiated Rate	$58.20
Rate for Payer: Cash Price	$45.00
Rate for Payer: Celtic Commercial/Exchange	$27.72
Rate for Payer: Health Partners Plans Commercial	$57.00
Rate for Payer: UnitedHealthcare Commercial	$58.20
Rate for Payer: WPPA Commercial	$50.40

THYROGLOBULIN

Facility

$170.00

Service Code	HCPCS 84432
Hospital Charge Code	8443200
Hospital Revenue Code	301
Min. Negotiated Rate	$139.40
Max. Negotiated Rate	$164.90
Rate for Payer: Cash Price	$127.50
Rate for Payer: Health Partners Plans Commercial	$161.50
Rate for Payer: UnitedHealthcare Commercial	$164.90
Rate for Payer: WPPA Commercial	$139.40

THYROGLOBULIN

Facility

$170.00

Service Code	HCPCS 84432
Hospital Charge Code	8443200
Hospital Revenue Code	301
Min. Negotiated Rate	$78.54
Max. Negotiated Rate	$164.90
Rate for Payer: BCBS Commercial	$88.89
Rate for Payer: Cash Price	$127.50
Rate for Payer: Cash Price	$127.50
Rate for Payer: Celtic Commercial/Exchange	$78.54
Rate for Payer: Health Partners Plans Commercial	$161.50
Rate for Payer: UnitedHealthcare Commercial	$164.90
Rate for Payer: WPPA Commercial	$142.80

THYROGLOBULIN ANTIBODY

Facility

$131.00

Service Code	HCPCS 86800
Hospital Charge Code	8680000
Hospital Revenue Code	302
Min. Negotiated Rate	$107.42
Max. Negotiated Rate	$127.07
Rate for Payer: Cash Price	$98.25
Rate for Payer: Health Partners Plans Commercial	$124.45
Rate for Payer: UnitedHealthcare Commercial	$127.07
Rate for Payer: WPPA Commercial	$107.42

THYROGLOBULIN ANTIBODY

Facility

$131.00

Service Code	HCPCS 86800
Hospital Charge Code	8680000
Hospital Revenue Code	302
Min. Negotiated Rate	$60.52
Max. Negotiated Rate	$127.07
Rate for Payer: BCBS Commercial	$69.07
Rate for Payer: Cash Price	$98.25
Rate for Payer: Cash Price	$98.25
Rate for Payer: Celtic Commercial/Exchange	$60.52
Rate for Payer: Health Partners Plans Commercial	$124.45
Rate for Payer: UnitedHealthcare Commercial	$127.07
Rate for Payer: WPPA Commercial	$110.04

THYROID HORMONE(T3)UPTAKE

Facility

$48.00

Service Code	HCPCS 84479
Hospital Charge Code	8447900
Hospital Revenue Code	301
Min. Negotiated Rate	$18.84
Max. Negotiated Rate	$46.56
Rate for Payer: BCBS Commercial	$18.84
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cash Price	$36.00
Rate for Payer: Celtic Commercial/Exchange	$22.18
Rate for Payer: Health Partners Plans Commercial	$45.60
Rate for Payer: UnitedHealthcare Commercial	$46.56
Rate for Payer: WPPA Commercial	$40.32

THYROID HORMONE(T3)UPTAKE

Facility

$48.00

Service Code	HCPCS 84479
Hospital Charge Code	8447900
Hospital Revenue Code	301
Min. Negotiated Rate	$39.36
Max. Negotiated Rate	$46.56
Rate for Payer: Cash Price	$36.00
Rate for Payer: Health Partners Plans Commercial	$45.60
Rate for Payer: UnitedHealthcare Commercial	$46.56
Rate for Payer: WPPA Commercial	$39.36

THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC

Facility

$14,670.31

Service Code	MSDRG 626
Min. Negotiated Rate	$14,670.31
Max. Negotiated Rate	$14,670.31
Rate for Payer: BCBS Commercial	$14,670.31

THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC

Facility

$20,136.55

Service Code	MSDRG 625
Min. Negotiated Rate	$20,136.55
Max. Negotiated Rate	$20,136.55
Rate for Payer: BCBS Commercial	$20,136.55

THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC

Facility

$10,605.26

Service Code	MSDRG 627
Min. Negotiated Rate	$10,605.26
Max. Negotiated Rate	$10,605.26
Rate for Payer: BCBS Commercial	$10,605.26

THYROID STIM. IMMUNE GLOBULINS

Facility

$605.00

Service Code	HCPCS 84445
Hospital Charge Code	8444500
Hospital Revenue Code	301
Min. Negotiated Rate	$496.10
Max. Negotiated Rate	$586.85
Rate for Payer: Cash Price	$453.75
Rate for Payer: Health Partners Plans Commercial	$574.75
Rate for Payer: UnitedHealthcare Commercial	$586.85
Rate for Payer: WPPA Commercial	$496.10

THYROID STIM. IMMUNE GLOBULINS

Facility

$605.00

Service Code	HCPCS 84445
Hospital Charge Code	8444500
Hospital Revenue Code	301
Min. Negotiated Rate	$279.51
Max. Negotiated Rate	$586.85
Rate for Payer: BCBS Commercial	$469.86
Rate for Payer: Cash Price	$453.75
Rate for Payer: Cash Price	$453.75
Rate for Payer: Celtic Commercial/Exchange	$279.51
Rate for Payer: Health Partners Plans Commercial	$574.75
Rate for Payer: UnitedHealthcare Commercial	$586.85
Rate for Payer: WPPA Commercial	$508.20

THYROID STIMULAT.HORMONE (TSH)

Facility

$127.00

Service Code	HCPCS 84443
Hospital Charge Code	8444300
Hospital Revenue Code	301
Min. Negotiated Rate	$43.97
Max. Negotiated Rate	$123.19
Rate for Payer: BCBS Commercial	$43.97
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

THYROID STIMULAT.HORMONE (TSH)

Facility

$127.00

Service Code	HCPCS 84443
Hospital Charge Code	8444300
Hospital Revenue Code	301
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

THYROXINE FREE (FREE T4)

Facility

$102.00

Service Code	HCPCS 84439
Hospital Charge Code	8443900
Hospital Revenue Code	301
Min. Negotiated Rate	$83.64
Max. Negotiated Rate	$98.94
Rate for Payer: Cash Price	$76.50
Rate for Payer: Health Partners Plans Commercial	$96.90
Rate for Payer: UnitedHealthcare Commercial	$98.94
Rate for Payer: WPPA Commercial	$83.64

Know your out-of-pocket cost for care.

All Charges