Ness County Hospital

All Charges

Charge

Type

Setting

Price

BLOOD COUNT,MICRO EXAM W/O MAN

Facility

$64.00

Service Code	HCPCS 85008
Hospital Charge Code	8500800
Hospital Revenue Code	305
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

BLOOD COUNT; PLATELET, AUTOMAT

Facility

$53.00

Service Code	HCPCS 85049
Hospital Charge Code	8504900
Hospital Revenue Code	305
Min. Negotiated Rate	$15.18
Max. Negotiated Rate	$51.41
Rate for Payer: BCBS Commercial	$15.18
Rate for Payer: Cash Price	$39.75
Rate for Payer: Cash Price	$39.75
Rate for Payer: Celtic Commercial/Exchange	$24.49
Rate for Payer: Health Partners Plans Commercial	$50.35
Rate for Payer: UnitedHealthcare Commercial	$51.41
Rate for Payer: WPPA Commercial	$44.52

BLOOD COUNT; PLATELET, AUTOMAT

Facility

$53.00

Service Code	HCPCS 85049
Hospital Charge Code	8504900
Hospital Revenue Code	305
Min. Negotiated Rate	$43.46
Max. Negotiated Rate	$51.41
Rate for Payer: Cash Price	$39.75
Rate for Payer: Health Partners Plans Commercial	$50.35
Rate for Payer: UnitedHealthcare Commercial	$51.41
Rate for Payer: WPPA Commercial	$43.46

BLOOD COUNT RED BLD CELL,AUTO

Facility

$30.00

Service Code	HCPCS 85041
Hospital Charge Code	8504100
Hospital Revenue Code	305
Min. Negotiated Rate	$10.61
Max. Negotiated Rate	$29.10
Rate for Payer: BCBS Commercial	$10.61
Rate for Payer: Cash Price	$22.50
Rate for Payer: Cash Price	$22.50
Rate for Payer: Celtic Commercial/Exchange	$13.86
Rate for Payer: Health Partners Plans Commercial	$28.50
Rate for Payer: UnitedHealthcare Commercial	$29.10
Rate for Payer: WPPA Commercial	$25.20

BLOOD COUNT RED BLD CELL,AUTO

Facility

$30.00

Service Code	HCPCS 85041
Hospital Charge Code	8504100
Hospital Revenue Code	305
Min. Negotiated Rate	$24.60
Max. Negotiated Rate	$29.10
Rate for Payer: Cash Price	$22.50
Rate for Payer: Health Partners Plans Commercial	$28.50
Rate for Payer: UnitedHealthcare Commercial	$29.10
Rate for Payer: WPPA Commercial	$24.60

BLOOD COUNT RETICULOCYTE,MANL

Facility

$32.00

Service Code	HCPCS 85044
Hospital Charge Code	8504400
Hospital Revenue Code	305
Min. Negotiated Rate	$12.27
Max. Negotiated Rate	$31.04
Rate for Payer: BCBS Commercial	$12.27
Rate for Payer: Cash Price	$24.00
Rate for Payer: Cash Price	$24.00
Rate for Payer: Celtic Commercial/Exchange	$14.78
Rate for Payer: Health Partners Plans Commercial	$30.40
Rate for Payer: UnitedHealthcare Commercial	$31.04
Rate for Payer: WPPA Commercial	$26.88

BLOOD COUNT RETICULOCYTE,MANL

Facility

$32.00

Service Code	HCPCS 85044
Hospital Charge Code	8504400
Hospital Revenue Code	305
Min. Negotiated Rate	$26.24
Max. Negotiated Rate	$31.04
Rate for Payer: Cash Price	$24.00
Rate for Payer: Health Partners Plans Commercial	$30.40
Rate for Payer: UnitedHealthcare Commercial	$31.04
Rate for Payer: WPPA Commercial	$26.24

BLOOD COUNT RETICULOCYTES AUTO

Facility

$130.00

Service Code	HCPCS 85045
Hospital Charge Code	8504500
Hospital Revenue Code	305
Min. Negotiated Rate	$60.06
Max. Negotiated Rate	$126.10
Rate for Payer: BCBS Commercial	$79.36
Rate for Payer: Cash Price	$97.50
Rate for Payer: Cash Price	$97.50
Rate for Payer: Celtic Commercial/Exchange	$60.06
Rate for Payer: Health Partners Plans Commercial	$123.50
Rate for Payer: UnitedHealthcare Commercial	$126.10
Rate for Payer: WPPA Commercial	$109.20

BLOOD COUNT RETICULOCYTES AUTO

Facility

$130.00

Service Code	HCPCS 85045
Hospital Charge Code	8504500
Hospital Revenue Code	305
Min. Negotiated Rate	$106.60
Max. Negotiated Rate	$126.10
Rate for Payer: Cash Price	$97.50
Rate for Payer: Health Partners Plans Commercial	$123.50
Rate for Payer: UnitedHealthcare Commercial	$126.10
Rate for Payer: WPPA Commercial	$106.60

BLOOD TYPING ABO

Facility

$122.00

Service Code	HCPCS 86900
Hospital Charge Code	8690000
Hospital Revenue Code	309
Min. Negotiated Rate	$100.04
Max. Negotiated Rate	$118.34
Rate for Payer: Cash Price	$91.50
Rate for Payer: Health Partners Plans Commercial	$115.90
Rate for Payer: UnitedHealthcare Commercial	$118.34
Rate for Payer: WPPA Commercial	$100.04

BLOOD TYPING ABO

Facility

$122.00

Service Code	HCPCS 86900
Hospital Charge Code	8690000
Hospital Revenue Code	309
Min. Negotiated Rate	$56.36
Max. Negotiated Rate	$210.75
Rate for Payer: BCBS Commercial	$210.75
Rate for Payer: Cash Price	$91.50
Rate for Payer: Cash Price	$91.50
Rate for Payer: Celtic Commercial/Exchange	$56.36
Rate for Payer: Health Partners Plans Commercial	$115.90
Rate for Payer: UnitedHealthcare Commercial	$118.34
Rate for Payer: WPPA Commercial	$102.48

BLOOD TYPING-RBC ANTIGENS

Facility

$325.00

Service Code	HCPCS 86905
Hospital Charge Code	8690500
Hospital Revenue Code	309
Min. Negotiated Rate	$42.57
Max. Negotiated Rate	$315.25
Rate for Payer: BCBS Commercial	$42.57
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

BLOOD TYPING-RBC ANTIGENS

Facility

$325.00

Service Code	HCPCS 86905
Hospital Charge Code	8690500
Hospital Revenue Code	309
Min. Negotiated Rate	$266.50
Max. Negotiated Rate	$315.25
Rate for Payer: Cash Price	$243.75
Rate for Payer: Health Partners Plans Commercial	$308.75
Rate for Payer: UnitedHealthcare Commercial	$315.25
Rate for Payer: WPPA Commercial	$266.50

BLOOD TYPING RH

Facility

$122.00

Service Code	HCPCS 86901
Hospital Charge Code	8690100
Hospital Revenue Code	309
Min. Negotiated Rate	$100.04
Max. Negotiated Rate	$118.34
Rate for Payer: Cash Price	$91.50
Rate for Payer: Health Partners Plans Commercial	$115.90
Rate for Payer: UnitedHealthcare Commercial	$118.34
Rate for Payer: WPPA Commercial	$100.04

BLOOD TYPING RH

Facility

$122.00

Service Code	HCPCS 86901
Hospital Charge Code	8690100
Hospital Revenue Code	309
Min. Negotiated Rate	$56.36
Max. Negotiated Rate	$118.34
Rate for Payer: BCBS Commercial	$61.64
Rate for Payer: Cash Price	$91.50
Rate for Payer: Cash Price	$91.50
Rate for Payer: Celtic Commercial/Exchange	$56.36
Rate for Payer: Health Partners Plans Commercial	$115.90
Rate for Payer: UnitedHealthcare Commercial	$118.34
Rate for Payer: WPPA Commercial	$102.48

BLOOD TYPING; RH PHENOTYPING

Facility

$90.00

Service Code	HCPCS 86906
Hospital Charge Code	8690600
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

BLOOD TYPING; RH PHENOTYPING

Facility

$90.00

Service Code	HCPCS 86906
Hospital Charge Code	8690600
Hospital Revenue Code	302
Min. Negotiated Rate	$41.58
Max. Negotiated Rate	$87.30
Rate for Payer: BCBS Commercial	$47.05
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

BODY & UPPER EXTREM APPL STRAP

Facility

$278.00

Service Code	HCPCS 29240
Hospital Charge Code	2924000
Hospital Revenue Code	761
Min. Negotiated Rate	$128.44
Max. Negotiated Rate	$277.75
Rate for Payer: BCBS Commercial	$277.75
Rate for Payer: Cash Price	$208.50
Rate for Payer: Cash Price	$208.50
Rate for Payer: Celtic Commercial/Exchange	$128.44
Rate for Payer: Health Partners Plans Commercial	$264.10
Rate for Payer: UnitedHealthcare Commercial	$269.66
Rate for Payer: WPPA Commercial	$233.52

BODY & UPPER EXTREM APPL STRAP

Facility

$278.00

Service Code	HCPCS 29240
Hospital Charge Code	2924000
Hospital Revenue Code	761
Min. Negotiated Rate	$227.96
Max. Negotiated Rate	$269.66
Rate for Payer: Cash Price	$208.50
Rate for Payer: Health Partners Plans Commercial	$264.10
Rate for Payer: UnitedHealthcare Commercial	$269.66
Rate for Payer: WPPA Commercial	$227.96

BOLUS FEED EXTENSION SET

Facility

$28.00

Hospital Charge Code	2706847
Hospital Revenue Code	272
Min. Negotiated Rate	$12.94
Max. Negotiated Rate	$27.16
Rate for Payer: Cash Price	$21.00
Rate for Payer: Celtic Commercial/Exchange	$12.94
Rate for Payer: Health Partners Plans Commercial	$26.60
Rate for Payer: UnitedHealthcare Commercial	$27.16
Rate for Payer: WPPA Commercial	$23.52

BOLUS FEED EXTENSION SET

Facility

$28.00

Hospital Charge Code	2706847
Hospital Revenue Code	272
Min. Negotiated Rate	$22.96
Max. Negotiated Rate	$27.16
Rate for Payer: Cash Price	$21.00
Rate for Payer: Health Partners Plans Commercial	$26.60
Rate for Payer: UnitedHealthcare Commercial	$27.16
Rate for Payer: WPPA Commercial	$22.96

BOLUS G TUBE 24 FR

Facility

$109.00

Hospital Charge Code	2706846
Hospital Revenue Code	272
Min. Negotiated Rate	$50.36
Max. Negotiated Rate	$105.73
Rate for Payer: Cash Price	$81.75
Rate for Payer: Celtic Commercial/Exchange	$50.36
Rate for Payer: Health Partners Plans Commercial	$103.55
Rate for Payer: UnitedHealthcare Commercial	$105.73
Rate for Payer: WPPA Commercial	$91.56

BOLUS G TUBE 24 FR

Facility

$109.00

Hospital Charge Code	2706846
Hospital Revenue Code	272
Min. Negotiated Rate	$89.38
Max. Negotiated Rate	$105.73
Rate for Payer: Cash Price	$81.75
Rate for Payer: Health Partners Plans Commercial	$103.55
Rate for Payer: UnitedHealthcare Commercial	$105.73
Rate for Payer: WPPA Commercial	$89.38

BONE AGE STUDY

Facility

$230.00

Service Code	HCPCS 77072
Hospital Charge Code	7707200
Hospital Revenue Code	320
Min. Negotiated Rate	$106.26
Max. Negotiated Rate	$223.10
Rate for Payer: BCBS Commercial	$139.38
Rate for Payer: Cash Price	$172.50
Rate for Payer: Cash Price	$172.50
Rate for Payer: Celtic Commercial/Exchange	$106.26
Rate for Payer: Health Partners Plans Commercial	$218.50
Rate for Payer: UnitedHealthcare Commercial	$223.10
Rate for Payer: WPPA Commercial	$193.20

BONE AGE STUDY

Facility

$230.00

Service Code	HCPCS 77072
Hospital Charge Code	7707200
Hospital Revenue Code	320
Min. Negotiated Rate	$188.60
Max. Negotiated Rate	$223.10
Rate for Payer: Cash Price	$172.50
Rate for Payer: Health Partners Plans Commercial	$218.50
Rate for Payer: UnitedHealthcare Commercial	$223.10
Rate for Payer: WPPA Commercial	$188.60

Know your out-of-pocket cost for care.

All Charges