Ness County Hospital

All Charges

Charge

Type

Setting

Price

THYROXINE FREE (FREE T4)

Facility

$102.00

Service Code	HCPCS 84439
Hospital Charge Code	8443900
Hospital Revenue Code	301
Min. Negotiated Rate	$30.77
Max. Negotiated Rate	$98.94
Rate for Payer: BCBS Commercial	$30.77
Rate for Payer: Cash Price	$76.50
Rate for Payer: Cash Price	$76.50
Rate for Payer: Celtic Commercial/Exchange	$47.12
Rate for Payer: Health Partners Plans Commercial	$96.90
Rate for Payer: UnitedHealthcare Commercial	$98.94
Rate for Payer: WPPA Commercial	$85.68

TIBIA-FIBULA LT

Facility

$272.00

Service Code	HCPCS 73590 LT
Hospital Charge Code	3290015
Hospital Revenue Code	320
Min. Negotiated Rate	$125.66
Max. Negotiated Rate	$263.84
Rate for Payer: BCBS Commercial	$142.17
Rate for Payer: Cash Price	$204.00
Rate for Payer: Cash Price	$204.00
Rate for Payer: Celtic Commercial/Exchange	$125.66
Rate for Payer: Health Partners Plans Commercial	$258.40
Rate for Payer: UnitedHealthcare Commercial	$263.84
Rate for Payer: WPPA Commercial	$228.48

TIBIA-FIBULA LT

Facility

$272.00

Service Code	HCPCS 73590 LT
Hospital Charge Code	3290015
Hospital Revenue Code	320
Min. Negotiated Rate	$223.04
Max. Negotiated Rate	$263.84
Rate for Payer: Cash Price	$204.00
Rate for Payer: Health Partners Plans Commercial	$258.40
Rate for Payer: UnitedHealthcare Commercial	$263.84
Rate for Payer: WPPA Commercial	$223.04

TIBIA-FIBULA RT

Facility

$272.00

Service Code	HCPCS 73590 RT
Hospital Charge Code	3290014
Hospital Revenue Code	320
Min. Negotiated Rate	$223.04
Max. Negotiated Rate	$263.84
Rate for Payer: Cash Price	$204.00
Rate for Payer: Health Partners Plans Commercial	$258.40
Rate for Payer: UnitedHealthcare Commercial	$263.84
Rate for Payer: WPPA Commercial	$223.04

TIBIA-FIBULA RT

Facility

$272.00

Service Code	HCPCS 73590 RT
Hospital Charge Code	3290014
Hospital Revenue Code	320
Min. Negotiated Rate	$125.66
Max. Negotiated Rate	$263.84
Rate for Payer: BCBS Commercial	$142.17
Rate for Payer: Cash Price	$204.00
Rate for Payer: Cash Price	$204.00
Rate for Payer: Celtic Commercial/Exchange	$125.66
Rate for Payer: Health Partners Plans Commercial	$258.40
Rate for Payer: UnitedHealthcare Commercial	$263.84
Rate for Payer: WPPA Commercial	$228.48

Tier 2 Molecular Path Proc., Level 8

Facility

$250.00

Service Code	HCPCS 81407
Hospital Charge Code	8140700
Hospital Revenue Code	300
Min. Negotiated Rate	$205.00
Max. Negotiated Rate	$242.50
Rate for Payer: Cash Price	$187.50
Rate for Payer: Health Partners Plans Commercial	$237.50
Rate for Payer: UnitedHealthcare Commercial	$242.50
Rate for Payer: WPPA Commercial	$205.00

Tier 2 Molecular Path Proc., Level 8

Facility

$250.00

Service Code	HCPCS 81407
Hospital Charge Code	8140700
Hospital Revenue Code	300
Min. Negotiated Rate	$115.50
Max. Negotiated Rate	$242.50
Rate for Payer: Cash Price	$187.50
Rate for Payer: Celtic Commercial/Exchange	$115.50
Rate for Payer: Health Partners Plans Commercial	$237.50
Rate for Payer: UnitedHealthcare Commercial	$242.50
Rate for Payer: WPPA Commercial	$210.00

Tigan 200 mg/2 ml Inj (trimethobenzamide)

Facility

$160.00

Service Code	NDC 42023011925
Hospital Charge Code	2507226
Hospital Revenue Code	250
Min. Negotiated Rate	$73.92
Max. Negotiated Rate	$155.20
Rate for Payer: Cash Price	$120.11
Rate for Payer: Celtic Commercial/Exchange	$73.92
Rate for Payer: Health Partners Plans Commercial	$152.00
Rate for Payer: UnitedHealthcare Commercial	$155.20
Rate for Payer: WPPA Commercial	$134.40

Tigan 200 mg/2 ml Inj (trimethobenzamide)

Facility

$160.00

Service Code	NDC 42023011925
Hospital Charge Code	2507226
Hospital Revenue Code	250
Min. Negotiated Rate	$131.20
Max. Negotiated Rate	$155.20
Rate for Payer: Cash Price	$120.11
Rate for Payer: Health Partners Plans Commercial	$152.00
Rate for Payer: UnitedHealthcare Commercial	$155.20
Rate for Payer: WPPA Commercial	$131.20

Tinactin 1% Powder - 1.5oz.(tolnaftate)

Facility

$10.00

Service Code	NDC 00536515026
Hospital Charge Code	2519015
Hospital Revenue Code	250
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$7.57
Rate for Payer: Celtic Commercial/Exchange	$4.62
Rate for Payer: Health Partners Plans Commercial	$9.50
Rate for Payer: UnitedHealthcare Commercial	$9.70
Rate for Payer: WPPA Commercial	$8.40

Tinactin 1% Powder - 1.5oz.(tolnaftate)

Facility

$10.00

Service Code	NDC 00536515026
Hospital Charge Code	2519015
Hospital Revenue Code	250
Min. Negotiated Rate	$8.20
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$7.57
Rate for Payer: Health Partners Plans Commercial	$9.50
Rate for Payer: UnitedHealthcare Commercial	$9.70
Rate for Payer: WPPA Commercial	$8.20

TINACTIN CREAM 1% - 1 OZ. (TOLNAFTATE)

Facility

$26.00

Service Code	NDC 24385003203
Hospital Charge Code	2513364
Hospital Revenue Code	250
Min. Negotiated Rate	$21.32
Max. Negotiated Rate	$25.22
Rate for Payer: Cash Price	$19.58
Rate for Payer: Health Partners Plans Commercial	$24.70
Rate for Payer: UnitedHealthcare Commercial	$25.22
Rate for Payer: WPPA Commercial	$21.32

TINACTIN CREAM 1% - 1 OZ. (TOLNAFTATE)

Facility

$26.00

Service Code	NDC 24385003203
Hospital Charge Code	2513364
Hospital Revenue Code	250
Min. Negotiated Rate	$12.01
Max. Negotiated Rate	$25.22
Rate for Payer: Cash Price	$19.58
Rate for Payer: Celtic Commercial/Exchange	$12.01
Rate for Payer: Health Partners Plans Commercial	$24.70
Rate for Payer: UnitedHealthcare Commercial	$25.22
Rate for Payer: WPPA Commercial	$21.84

TISSUE CULT,NON-NEOPLAS DISORD

Facility

$865.00

Service Code	HCPCS 88235
Hospital Charge Code	8823500
Hospital Revenue Code	311
Min. Negotiated Rate	$399.63
Max. Negotiated Rate	$839.05
Rate for Payer: BCBS Commercial	$786.01
Rate for Payer: Cash Price	$648.75
Rate for Payer: Cash Price	$648.75
Rate for Payer: Celtic Commercial/Exchange	$399.63
Rate for Payer: Health Partners Plans Commercial	$821.75
Rate for Payer: UnitedHealthcare Commercial	$839.05
Rate for Payer: WPPA Commercial	$726.60

TISSUE CULT,NON-NEOPLAS DISORD

Facility

$865.00

Service Code	HCPCS 88235
Hospital Charge Code	8823500
Hospital Revenue Code	311
Min. Negotiated Rate	$709.30
Max. Negotiated Rate	$839.05
Rate for Payer: Cash Price	$648.75
Rate for Payer: Health Partners Plans Commercial	$821.75
Rate for Payer: UnitedHealthcare Commercial	$839.05
Rate for Payer: WPPA Commercial	$709.30

TISSUE CULT NON-NEOPLAST DISOR

Facility

$598.00

Service Code	HCPCS 88233
Hospital Charge Code	8823300
Hospital Revenue Code	311
Min. Negotiated Rate	$490.36
Max. Negotiated Rate	$580.06
Rate for Payer: Cash Price	$448.50
Rate for Payer: Health Partners Plans Commercial	$568.10
Rate for Payer: UnitedHealthcare Commercial	$580.06
Rate for Payer: WPPA Commercial	$490.36

TISSUE CULT NON-NEOPLAST DISOR

Facility

$598.00

Service Code	HCPCS 88233
Hospital Charge Code	8823300
Hospital Revenue Code	311
Min. Negotiated Rate	$276.28
Max. Negotiated Rate	$580.06
Rate for Payer: BCBS Commercial	$407.46
Rate for Payer: Cash Price	$448.50
Rate for Payer: Cash Price	$448.50
Rate for Payer: Celtic Commercial/Exchange	$276.28
Rate for Payer: Health Partners Plans Commercial	$568.10
Rate for Payer: UnitedHealthcare Commercial	$580.06
Rate for Payer: WPPA Commercial	$502.32

TISSUE CULTURE NON-NEOPLASTIC

Facility

$600.00

Service Code	HCPCS 88230
Hospital Charge Code	8823000
Hospital Revenue Code	300
Min. Negotiated Rate	$492.00
Max. Negotiated Rate	$582.00
Rate for Payer: Cash Price	$450.00
Rate for Payer: Health Partners Plans Commercial	$570.00
Rate for Payer: UnitedHealthcare Commercial	$582.00
Rate for Payer: WPPA Commercial	$492.00

TISSUE CULTURE NON-NEOPLASTIC

Facility

$600.00

Service Code	HCPCS 88230
Hospital Charge Code	8823000
Hospital Revenue Code	300
Min. Negotiated Rate	$277.20
Max. Negotiated Rate	$588.63
Rate for Payer: BCBS Commercial	$588.63
Rate for Payer: Cash Price	$450.00
Rate for Payer: Cash Price	$450.00
Rate for Payer: Celtic Commercial/Exchange	$277.20
Rate for Payer: Health Partners Plans Commercial	$570.00
Rate for Payer: UnitedHealthcare Commercial	$582.00
Rate for Payer: WPPA Commercial	$504.00

TISSUE,EXAM,KOH SLIDE SAMPLES

Facility

$34.00

Service Code	HCPCS 87220
Hospital Charge Code	8722000
Hospital Revenue Code	306
Min. Negotiated Rate	$15.71
Max. Negotiated Rate	$32.98
Rate for Payer: BCBS Commercial	$18.06
Rate for Payer: Cash Price	$25.50
Rate for Payer: Cash Price	$25.50
Rate for Payer: Celtic Commercial/Exchange	$15.71
Rate for Payer: Health Partners Plans Commercial	$32.30
Rate for Payer: UnitedHealthcare Commercial	$32.98
Rate for Payer: WPPA Commercial	$28.56

TISSUE,EXAM,KOH SLIDE SAMPLES

Facility

$34.00

Service Code	HCPCS 87220
Hospital Charge Code	8722000
Hospital Revenue Code	306
Min. Negotiated Rate	$27.88
Max. Negotiated Rate	$32.98
Rate for Payer: Cash Price	$25.50
Rate for Payer: Health Partners Plans Commercial	$32.30
Rate for Payer: UnitedHealthcare Commercial	$32.98
Rate for Payer: WPPA Commercial	$27.88

TISSUE TRANSGLUTAMINASE(TTG)

Facility

$151.00

Service Code	HCPCS 83516
Hospital Charge Code	8351602
Hospital Revenue Code	301
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

TISSUE TRANSGLUTAMINASE(TTG)

Facility

$151.00

Service Code	HCPCS 83516
Hospital Charge Code	8351602
Hospital Revenue Code	301
Min. Negotiated Rate	$45.34
Max. Negotiated Rate	$146.47
Rate for Payer: BCBS Commercial	$45.34
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

TMAO (Trimethylamine N-Oxide)

Facility

$346.00

Service Code	HCPCS 82542
Hospital Charge Code	8254200
Hospital Revenue Code	301
Min. Negotiated Rate	$159.85
Max. Negotiated Rate	$335.62
Rate for Payer: BCBS Commercial	$194.29
Rate for Payer: Cash Price	$259.50
Rate for Payer: Cash Price	$259.50
Rate for Payer: Celtic Commercial/Exchange	$159.85
Rate for Payer: Health Partners Plans Commercial	$328.70
Rate for Payer: UnitedHealthcare Commercial	$335.62
Rate for Payer: WPPA Commercial	$290.64

TMAO (Trimethylamine N-Oxide)

Facility

$346.00

Service Code	HCPCS 82542
Hospital Charge Code	8254200
Hospital Revenue Code	301
Min. Negotiated Rate	$283.72
Max. Negotiated Rate	$335.62
Rate for Payer: Cash Price	$259.50
Rate for Payer: Health Partners Plans Commercial	$328.70
Rate for Payer: UnitedHealthcare Commercial	$335.62
Rate for Payer: WPPA Commercial	$283.72

Know your out-of-pocket cost for care.

All Charges