Ness County Hospital

All Charges

Charge

Type

Setting

Price

CYCLOSPORINE A TROUGH, LC/MS/M

Facility

$92.00

Service Code	HCPCS 80158
Hospital Charge Code	8015800
Hospital Revenue Code	300
Min. Negotiated Rate	$75.44
Max. Negotiated Rate	$89.24
Rate for Payer: Cash Price	$69.00
Rate for Payer: Health Partners Plans Commercial	$87.40
Rate for Payer: UnitedHealthcare Commercial	$89.24
Rate for Payer: WPPA Commercial	$75.44

CYMBALTA 30 MG CAP (DULOXETINE)

Facility

$26.00

Service Code	NDC 60687073411
Hospital Charge Code	2516557
Hospital Revenue Code	250
Min. Negotiated Rate	$12.01
Max. Negotiated Rate	$25.22
Rate for Payer: Cash Price	$19.61
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

CYMBALTA 30 MG CAP (DULOXETINE)

Facility

$26.00

Service Code	NDC 60687073411
Hospital Charge Code	2516557
Hospital Revenue Code	250
Min. Negotiated Rate	$21.32
Max. Negotiated Rate	$25.22
Rate for Payer: Cash Price	$19.61
Rate for Payer: Health Partners Plans Commercial	$24.70
Rate for Payer: UnitedHealthcare Commercial	$25.22
Rate for Payer: WPPA Commercial	$21.32

CYSTATIN C W/GLOMERULAR FILT

Facility

$40.00

Service Code	HCPCS 82610
Hospital Charge Code	8261000
Hospital Revenue Code	301
Min. Negotiated Rate	$32.80
Max. Negotiated Rate	$38.80
Rate for Payer: Cash Price	$30.00
Rate for Payer: Health Partners Plans Commercial	$38.00
Rate for Payer: UnitedHealthcare Commercial	$38.80
Rate for Payer: WPPA Commercial	$32.80

CYSTATIN C W/GLOMERULAR FILT

Facility

$40.00

Service Code	HCPCS 82610
Hospital Charge Code	8261000
Hospital Revenue Code	301
Min. Negotiated Rate	$14.93
Max. Negotiated Rate	$38.80
Rate for Payer: BCBS Commercial	$14.93
Rate for Payer: Cash Price	$30.00
Rate for Payer: Cash Price	$30.00
Rate for Payer: Celtic Commercial/Exchange	$18.48
Rate for Payer: Health Partners Plans Commercial	$38.00
Rate for Payer: UnitedHealthcare Commercial	$38.80
Rate for Payer: WPPA Commercial	$33.60

CYSTIC FIBROSIS SCREEN

Facility

$2,348.00

Service Code	HCPCS 81220
Hospital Charge Code	8122000
Hospital Revenue Code	300
Min. Negotiated Rate	$1,925.36
Max. Negotiated Rate	$2,277.56
Rate for Payer: Cash Price	$1,761.00
Rate for Payer: Health Partners Plans Commercial	$2,230.60
Rate for Payer: UnitedHealthcare Commercial	$2,277.56
Rate for Payer: WPPA Commercial	$1,925.36

CYSTIC FIBROSIS SCREEN

Facility

$2,348.00

Service Code	HCPCS 81220
Hospital Charge Code	8122000
Hospital Revenue Code	300
Min. Negotiated Rate	$1,084.78
Max. Negotiated Rate	$2,371.24
Rate for Payer: BCBS Commercial	$2,371.24
Rate for Payer: Cash Price	$1,761.00
Rate for Payer: Cash Price	$1,761.00
Rate for Payer: Celtic Commercial/Exchange	$1,084.78
Rate for Payer: Health Partners Plans Commercial	$2,230.60
Rate for Payer: UnitedHealthcare Commercial	$2,277.56
Rate for Payer: WPPA Commercial	$1,972.32

CYSTO CATHETER 8 FR.

Facility

$44.00

Hospital Charge Code	2720332
Hospital Revenue Code	272
Min. Negotiated Rate	$20.33
Max. Negotiated Rate	$42.68
Rate for Payer: Cash Price	$33.38
Rate for Payer: Celtic Commercial/Exchange	$20.33
Rate for Payer: Health Partners Plans Commercial	$41.80
Rate for Payer: UnitedHealthcare Commercial	$42.68
Rate for Payer: WPPA Commercial	$36.96

CYSTO CATHETER 8 FR.

Facility

$44.00

Hospital Charge Code	2720332
Hospital Revenue Code	272
Min. Negotiated Rate	$36.08
Max. Negotiated Rate	$42.68
Rate for Payer: Cash Price	$33.38
Rate for Payer: Health Partners Plans Commercial	$41.80
Rate for Payer: UnitedHealthcare Commercial	$42.68
Rate for Payer: WPPA Commercial	$36.08

CYSTOURETHROSCOPY/DILAT BLADER

Facility

$3,200.00

Service Code	HCPCS 52260
Hospital Charge Code	5226000
Hospital Revenue Code	320
Min. Negotiated Rate	$1,478.40
Max. Negotiated Rate	$3,104.00
Rate for Payer: BCBS Commercial	$2,925.97
Rate for Payer: Cash Price	$2,400.00
Rate for Payer: Cash Price	$2,400.00
Rate for Payer: Celtic Commercial/Exchange	$1,478.40
Rate for Payer: Health Partners Plans Commercial	$3,040.00
Rate for Payer: UnitedHealthcare Commercial	$3,104.00
Rate for Payer: WPPA Commercial	$2,688.00

CYSTOURETHROSCOPY/DILAT BLADER

Facility

$3,200.00

Service Code	HCPCS 52260
Hospital Charge Code	5226000
Hospital Revenue Code	320
Min. Negotiated Rate	$2,624.00
Max. Negotiated Rate	$3,104.00
Rate for Payer: Cash Price	$2,400.00
Rate for Payer: Health Partners Plans Commercial	$3,040.00
Rate for Payer: UnitedHealthcare Commercial	$3,104.00
Rate for Payer: WPPA Commercial	$2,624.00

CYTOGENETICS/MOLECULAR CYTOGEN

Facility

$162.00

Service Code	HCPCS 88291
Hospital Charge Code	8829100
Hospital Revenue Code	311
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

CYTOGENETICS/MOLECULAR CYTOGEN

Facility

$162.00

Service Code	HCPCS 88291
Hospital Charge Code	8829100
Hospital Revenue Code	311
Min. Negotiated Rate	$74.84
Max. Negotiated Rate	$157.14
Rate for Payer: BCBS Commercial	$110.29
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

CYTOMEGALOVIRUS(CMV)DNA,QUANT

Facility

$116.00

Service Code	HCPCS 87497
Hospital Charge Code	8749700
Hospital Revenue Code	306
Min. Negotiated Rate	$53.59
Max. Negotiated Rate	$112.52
Rate for Payer: BCBS Commercial	$91.92
Rate for Payer: Cash Price	$87.00
Rate for Payer: Cash Price	$87.00
Rate for Payer: Celtic Commercial/Exchange	$53.59
Rate for Payer: Health Partners Plans Commercial	$110.20
Rate for Payer: UnitedHealthcare Commercial	$112.52
Rate for Payer: WPPA Commercial	$97.44

CYTOMEGALOVIRUS(CMV)DNA,QUANT

Facility

$116.00

Service Code	HCPCS 87497
Hospital Charge Code	8749700
Hospital Revenue Code	306
Min. Negotiated Rate	$95.12
Max. Negotiated Rate	$112.52
Rate for Payer: Cash Price	$87.00
Rate for Payer: Health Partners Plans Commercial	$110.20
Rate for Payer: UnitedHealthcare Commercial	$112.52
Rate for Payer: WPPA Commercial	$95.12

CYTOMEGALOVIRUS (CMV) GENOTYPE

Facility

$430.00

Service Code	HCPCS 87910
Hospital Charge Code	8791000
Hospital Revenue Code	306
Min. Negotiated Rate	$352.60
Max. Negotiated Rate	$417.10
Rate for Payer: Cash Price	$322.50
Rate for Payer: Health Partners Plans Commercial	$408.50
Rate for Payer: UnitedHealthcare Commercial	$417.10
Rate for Payer: WPPA Commercial	$352.60

CYTOMEGALOVIRUS (CMV) GENOTYPE

Facility

$430.00

Service Code	HCPCS 87910
Hospital Charge Code	8791000
Hospital Revenue Code	306
Min. Negotiated Rate	$198.66
Max. Negotiated Rate	$433.37
Rate for Payer: BCBS Commercial	$433.37
Rate for Payer: Cash Price	$322.50
Rate for Payer: Cash Price	$322.50
Rate for Payer: Celtic Commercial/Exchange	$198.66
Rate for Payer: Health Partners Plans Commercial	$408.50
Rate for Payer: UnitedHealthcare Commercial	$417.10
Rate for Payer: WPPA Commercial	$361.20

CYTOPATH CERV/VAG AUTOMAT THIN

Facility

$58.00

Service Code	HCPCS 88175
Hospital Charge Code	8817500
Hospital Revenue Code	311
Min. Negotiated Rate	$26.80
Max. Negotiated Rate	$56.26
Rate for Payer: BCBS Commercial	$33.50
Rate for Payer: Cash Price	$43.50
Rate for Payer: Cash Price	$43.50
Rate for Payer: Celtic Commercial/Exchange	$26.80
Rate for Payer: Health Partners Plans Commercial	$55.10
Rate for Payer: UnitedHealthcare Commercial	$56.26
Rate for Payer: WPPA Commercial	$48.72

CYTOPATH CERV/VAG AUTOMAT THIN

Facility

$58.00

Service Code	HCPCS 88175
Hospital Charge Code	8817500
Hospital Revenue Code	311
Min. Negotiated Rate	$47.56
Max. Negotiated Rate	$56.26
Rate for Payer: Cash Price	$43.50
Rate for Payer: Health Partners Plans Commercial	$55.10
Rate for Payer: UnitedHealthcare Commercial	$56.26
Rate for Payer: WPPA Commercial	$47.56

CYTOPATH,CERV/VAG,PRESERVFLUID

Facility

$89.00

Service Code	HCPCS 88142
Hospital Charge Code	8814200
Hospital Revenue Code	311
Min. Negotiated Rate	$41.12
Max. Negotiated Rate	$86.33
Rate for Payer: BCBS Commercial	$64.77
Rate for Payer: Cash Price	$66.75
Rate for Payer: Cash Price	$66.75
Rate for Payer: Celtic Commercial/Exchange	$41.12
Rate for Payer: Health Partners Plans Commercial	$84.55
Rate for Payer: UnitedHealthcare Commercial	$86.33
Rate for Payer: WPPA Commercial	$74.76

CYTOPATH,CERV/VAG,PRESERVFLUID

Facility

$89.00

Service Code	HCPCS 88142
Hospital Charge Code	8814200
Hospital Revenue Code	311
Min. Negotiated Rate	$72.98
Max. Negotiated Rate	$86.33
Rate for Payer: Cash Price	$66.75
Rate for Payer: Health Partners Plans Commercial	$84.55
Rate for Payer: UnitedHealthcare Commercial	$86.33
Rate for Payer: WPPA Commercial	$72.98

CYTOPATH,CONCEN TECH,SMEARS &

Facility

$123.00

Service Code	HCPCS 88108
Hospital Charge Code	8810800
Hospital Revenue Code	311
Min. Negotiated Rate	$56.83
Max. Negotiated Rate	$119.31
Rate for Payer: BCBS Commercial	$81.92
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

CYTOPATH,CONCEN TECH,SMEARS &

Facility

$123.00

Service Code	HCPCS 88108
Hospital Charge Code	8810800
Hospital Revenue Code	311
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

CYTOPATH,FLUIDS,WASH/BRUSH,

Facility

$124.00

Service Code	HCPCS 88104
Hospital Charge Code	8810400
Hospital Revenue Code	311
Min. Negotiated Rate	$101.68
Max. Negotiated Rate	$120.28
Rate for Payer: Cash Price	$93.00
Rate for Payer: Health Partners Plans Commercial	$117.80
Rate for Payer: UnitedHealthcare Commercial	$120.28
Rate for Payer: WPPA Commercial	$101.68

CYTOPATH,FLUIDS,WASH/BRUSH,

Facility

$124.00

Service Code	HCPCS 88104
Hospital Charge Code	8810400
Hospital Revenue Code	311
Min. Negotiated Rate	$57.29
Max. Negotiated Rate	$120.28
Rate for Payer: BCBS Commercial	$82.57
Rate for Payer: Cash Price	$93.00
Rate for Payer: Cash Price	$93.00
Rate for Payer: Celtic Commercial/Exchange	$57.29
Rate for Payer: Health Partners Plans Commercial	$117.80
Rate for Payer: UnitedHealthcare Commercial	$120.28
Rate for Payer: WPPA Commercial	$104.16

Know your out-of-pocket cost for care.

All Charges