Ness County Hospital

All Charges

Charge

Type

Setting

Price

CT WRIST RT WO

Facility

$1,518.00

Service Code	HCPCS 73200 RT
Hospital Charge Code	7111136
Hospital Revenue Code	350
Min. Negotiated Rate	$1,244.76
Max. Negotiated Rate	$1,472.46
Rate for Payer: Cash Price	$1,138.50
Rate for Payer: Health Partners Plans Commercial	$1,442.10
Rate for Payer: UnitedHealthcare Commercial	$1,472.46
Rate for Payer: WPPA Commercial	$1,244.76

CT WRIST RT WO

Facility

$1,518.00

Service Code	HCPCS 73200 RT
Hospital Charge Code	7111136
Hospital Revenue Code	350
Min. Negotiated Rate	$480.41
Max. Negotiated Rate	$1,472.46
Rate for Payer: BCBS Commercial	$480.41
Rate for Payer: Cash Price	$1,138.50
Rate for Payer: Cash Price	$1,138.50
Rate for Payer: Celtic Commercial/Exchange	$701.32
Rate for Payer: Health Partners Plans Commercial	$1,442.10
Rate for Payer: UnitedHealthcare Commercial	$1,472.46
Rate for Payer: WPPA Commercial	$1,275.12

Cubicin 500 mg IV (daptomycin)

Facility

$1,603.00

Service Code	NDC 67457081350
Hospital Charge Code	2518504
Hospital Revenue Code	250
Min. Negotiated Rate	$1,314.46
Max. Negotiated Rate	$1,554.91
Rate for Payer: Cash Price	$1,202.70
Rate for Payer: Health Partners Plans Commercial	$1,522.85
Rate for Payer: UnitedHealthcare Commercial	$1,554.91
Rate for Payer: WPPA Commercial	$1,314.46

Cubicin 500 mg IV (daptomycin)

Facility

$1,603.00

Service Code	NDC 67457081350
Hospital Charge Code	2518504
Hospital Revenue Code	250
Min. Negotiated Rate	$740.59
Max. Negotiated Rate	$1,554.91
Rate for Payer: Cash Price	$1,202.70
Rate for Payer: Celtic Commercial/Exchange	$740.59
Rate for Payer: Health Partners Plans Commercial	$1,522.85
Rate for Payer: UnitedHealthcare Commercial	$1,554.91
Rate for Payer: WPPA Commercial	$1,346.52

CUL,BACT QUANT COLONY CNT,URIN

Facility

$97.00

Service Code	HCPCS 87086
Hospital Charge Code	8708600
Hospital Revenue Code	306
Min. Negotiated Rate	$79.54
Max. Negotiated Rate	$94.09
Rate for Payer: Cash Price	$72.75
Rate for Payer: Health Partners Plans Commercial	$92.15
Rate for Payer: UnitedHealthcare Commercial	$94.09
Rate for Payer: WPPA Commercial	$79.54

CUL,BACT QUANT COLONY CNT,URIN

Facility

$97.00

Service Code	HCPCS 87086
Hospital Charge Code	8708600
Hospital Revenue Code	306
Min. Negotiated Rate	$30.38
Max. Negotiated Rate	$94.09
Rate for Payer: BCBS Commercial	$30.38
Rate for Payer: Cash Price	$72.75
Rate for Payer: Cash Price	$72.75
Rate for Payer: Celtic Commercial/Exchange	$44.81
Rate for Payer: Health Partners Plans Commercial	$92.15
Rate for Payer: UnitedHealthcare Commercial	$94.09
Rate for Payer: WPPA Commercial	$81.48

CUL,FUNGI,ISOLTN W/PRSUMPT ID

Facility

$54.00

Service Code	HCPCS 87102
Hospital Charge Code	8710200
Hospital Revenue Code	306
Min. Negotiated Rate	$24.95
Max. Negotiated Rate	$52.38
Rate for Payer: BCBS Commercial	$35.59
Rate for Payer: Cash Price	$40.50
Rate for Payer: Cash Price	$40.50
Rate for Payer: Celtic Commercial/Exchange	$24.95
Rate for Payer: Health Partners Plans Commercial	$51.30
Rate for Payer: UnitedHealthcare Commercial	$52.38
Rate for Payer: WPPA Commercial	$45.36

CUL,FUNGI,ISOLTN W/PRSUMPT ID

Facility

$54.00

Service Code	HCPCS 87102
Hospital Charge Code	8710200
Hospital Revenue Code	306
Min. Negotiated Rate	$44.28
Max. Negotiated Rate	$52.38
Rate for Payer: Cash Price	$40.50
Rate for Payer: Health Partners Plans Commercial	$51.30
Rate for Payer: UnitedHealthcare Commercial	$52.38
Rate for Payer: WPPA Commercial	$44.28

CULT BACT AEROBIC ISOLATE,ADTL

Facility

$127.00

Service Code	HCPCS 87077
Hospital Charge Code	8707700
Hospital Revenue Code	306
Min. Negotiated Rate	$30.65
Max. Negotiated Rate	$123.19
Rate for Payer: BCBS Commercial	$30.65
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

CULT BACT AEROBIC ISOLATE,ADTL

Facility

$127.00

Service Code	HCPCS 87077
Hospital Charge Code	8707700
Hospital Revenue Code	306
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

CULT BACT ANAEROBIC ISOLATE,

Facility

$70.00

Service Code	HCPCS 87076
Hospital Charge Code	8707600
Hospital Revenue Code	306
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

CULT BACT ANAEROBIC ISOLATE,

Facility

$70.00

Service Code	HCPCS 87076
Hospital Charge Code	8707600
Hospital Revenue Code	306
Min. Negotiated Rate	$30.65
Max. Negotiated Rate	$67.90
Rate for Payer: BCBS Commercial	$30.65
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

CULT,BACT NOT BLD,ANAEROBIC

Facility

$100.00

Service Code	HCPCS 87075
Hospital Charge Code	8707500
Hospital Revenue Code	306
Min. Negotiated Rate	$82.00
Max. Negotiated Rate	$97.00
Rate for Payer: Cash Price	$75.00
Rate for Payer: Health Partners Plans Commercial	$95.00
Rate for Payer: UnitedHealthcare Commercial	$97.00
Rate for Payer: WPPA Commercial	$82.00

CULT,BACT NOT BLD,ANAEROBIC

Facility

$100.00

Service Code	HCPCS 87075
Hospital Charge Code	8707500
Hospital Revenue Code	306
Min. Negotiated Rate	$31.21
Max. Negotiated Rate	$97.00
Rate for Payer: BCBS Commercial	$31.21
Rate for Payer: Cash Price	$75.00
Rate for Payer: Cash Price	$75.00
Rate for Payer: Celtic Commercial/Exchange	$46.20
Rate for Payer: Health Partners Plans Commercial	$95.00
Rate for Payer: UnitedHealthcare Commercial	$97.00
Rate for Payer: WPPA Commercial	$84.00

CULT,BACT QUANT,AEROB W/ISOLTN

Facility

$55.00

Service Code	HCPCS 87071
Hospital Charge Code	8707100
Hospital Revenue Code	306
Min. Negotiated Rate	$25.41
Max. Negotiated Rate	$53.35
Rate for Payer: BCBS Commercial	$31.63
Rate for Payer: Cash Price	$41.25
Rate for Payer: Cash Price	$41.25
Rate for Payer: Celtic Commercial/Exchange	$25.41
Rate for Payer: Health Partners Plans Commercial	$52.25
Rate for Payer: UnitedHealthcare Commercial	$53.35
Rate for Payer: WPPA Commercial	$46.20

CULT,BACT QUANT,AEROB W/ISOLTN

Facility

$55.00

Service Code	HCPCS 87071
Hospital Charge Code	8707100
Hospital Revenue Code	306
Min. Negotiated Rate	$45.10
Max. Negotiated Rate	$53.35
Rate for Payer: Cash Price	$41.25
Rate for Payer: Health Partners Plans Commercial	$52.25
Rate for Payer: UnitedHealthcare Commercial	$53.35
Rate for Payer: WPPA Commercial	$45.10

CULT,BACT QUANT,ANAEROBIC

Facility

$52.00

Service Code	HCPCS 87073
Hospital Charge Code	8707300
Hospital Revenue Code	306
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

CULT,BACT QUANT,ANAEROBIC

Facility

$52.00

Service Code	HCPCS 87073
Hospital Charge Code	8707300
Hospital Revenue Code	306
Min. Negotiated Rate	$24.02
Max. Negotiated Rate	$50.44
Rate for Payer: BCBS Commercial	$33.30
Rate for Payer: Cash Price	$39.00
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

CULT,BACT W/ISOLAT PRESUMPT ID

Facility

$107.00

Service Code	HCPCS 87088
Hospital Charge Code	8708800
Hospital Revenue Code	306
Min. Negotiated Rate	$26.20
Max. Negotiated Rate	$103.79
Rate for Payer: BCBS Commercial	$26.20
Rate for Payer: Cash Price	$80.25
Rate for Payer: Cash Price	$80.25
Rate for Payer: Celtic Commercial/Exchange	$49.43
Rate for Payer: Health Partners Plans Commercial	$101.65
Rate for Payer: UnitedHealthcare Commercial	$103.79
Rate for Payer: WPPA Commercial	$89.88

CULT,BACT W/ISOLAT PRESUMPT ID

Facility

$107.00

Service Code	HCPCS 87088
Hospital Charge Code	8708800
Hospital Revenue Code	306
Min. Negotiated Rate	$87.74
Max. Negotiated Rate	$103.79
Rate for Payer: Cash Price	$80.25
Rate for Payer: Health Partners Plans Commercial	$101.65
Rate for Payer: UnitedHealthcare Commercial	$103.79
Rate for Payer: WPPA Commercial	$87.74

CULT,FUNGI,DEFIN ID, MOLD

Facility

$63.00

Service Code	HCPCS 87107
Hospital Charge Code	8710700
Hospital Revenue Code	306
Min. Negotiated Rate	$29.11
Max. Negotiated Rate	$61.11
Rate for Payer: BCBS Commercial	$38.54
Rate for Payer: Cash Price	$47.25
Rate for Payer: Cash Price	$47.25
Rate for Payer: Celtic Commercial/Exchange	$29.11
Rate for Payer: Health Partners Plans Commercial	$59.85
Rate for Payer: UnitedHealthcare Commercial	$61.11
Rate for Payer: WPPA Commercial	$52.92

CULT,FUNGI,DEFIN ID, MOLD

Facility

$63.00

Service Code	HCPCS 87107
Hospital Charge Code	8710700
Hospital Revenue Code	306
Min. Negotiated Rate	$51.66
Max. Negotiated Rate	$61.11
Rate for Payer: Cash Price	$47.25
Rate for Payer: Health Partners Plans Commercial	$59.85
Rate for Payer: UnitedHealthcare Commercial	$61.11
Rate for Payer: WPPA Commercial	$51.66

CULT,FUNGI DEFIN ID, YEAST

Facility

$66.00

Service Code	HCPCS 87106
Hospital Charge Code	8710600
Hospital Revenue Code	306
Min. Negotiated Rate	$54.12
Max. Negotiated Rate	$64.02
Rate for Payer: Cash Price	$49.50
Rate for Payer: Health Partners Plans Commercial	$62.70
Rate for Payer: UnitedHealthcare Commercial	$64.02
Rate for Payer: WPPA Commercial	$54.12

CULT,FUNGI DEFIN ID, YEAST

Facility

$66.00

Service Code	HCPCS 87106
Hospital Charge Code	8710600
Hospital Revenue Code	306
Min. Negotiated Rate	$30.49
Max. Negotiated Rate	$64.02
Rate for Payer: BCBS Commercial	$38.54
Rate for Payer: Cash Price	$49.50
Rate for Payer: Cash Price	$49.50
Rate for Payer: Celtic Commercial/Exchange	$30.49
Rate for Payer: Health Partners Plans Commercial	$62.70
Rate for Payer: UnitedHealthcare Commercial	$64.02
Rate for Payer: WPPA Commercial	$55.44

CULT,FUNGI,ISOLATN W/PRSUMP ID

Facility

$54.00

Service Code	HCPCS 87101
Hospital Charge Code	8710100
Hospital Revenue Code	306
Min. Negotiated Rate	$24.15
Max. Negotiated Rate	$52.38
Rate for Payer: BCBS Commercial	$24.15
Rate for Payer: Cash Price	$40.50
Rate for Payer: Cash Price	$40.50
Rate for Payer: Celtic Commercial/Exchange	$24.95
Rate for Payer: Health Partners Plans Commercial	$51.30
Rate for Payer: UnitedHealthcare Commercial	$52.38
Rate for Payer: WPPA Commercial	$45.36

Know your out-of-pocket cost for care.

All Charges