Ness County Hospital

All Charges

Charge

Type

Setting

Price

CYTOPATHOLOGY,EVAL FINE NEEDLE

Facility

$158.00

Service Code	HCPCS 88172
Hospital Charge Code	8817200
Hospital Revenue Code	311
Min. Negotiated Rate	$73.00
Max. Negotiated Rate	$153.26
Rate for Payer: BCBS Commercial	$87.54
Rate for Payer: Cash Price	$118.50
Rate for Payer: Cash Price	$118.50
Rate for Payer: Celtic Commercial/Exchange	$73.00
Rate for Payer: Health Partners Plans Commercial	$150.10
Rate for Payer: UnitedHealthcare Commercial	$153.26
Rate for Payer: WPPA Commercial	$132.72

CYTOPATHOLOGY,EVAL FINE NEEDLE

Facility

$158.00

Service Code	HCPCS 88172
Hospital Charge Code	8817200
Hospital Revenue Code	311
Min. Negotiated Rate	$129.56
Max. Negotiated Rate	$153.26
Rate for Payer: Cash Price	$118.50
Rate for Payer: Health Partners Plans Commercial	$150.10
Rate for Payer: UnitedHealthcare Commercial	$153.26
Rate for Payer: WPPA Commercial	$129.56

CYTOPATHOLOGY,INTERPRE & REPRT

Facility

$248.00

Service Code	HCPCS 88173
Hospital Charge Code	8817300
Hospital Revenue Code	311
Min. Negotiated Rate	$203.36
Max. Negotiated Rate	$240.56
Rate for Payer: Cash Price	$186.00
Rate for Payer: Health Partners Plans Commercial	$235.60
Rate for Payer: UnitedHealthcare Commercial	$240.56
Rate for Payer: WPPA Commercial	$203.36

CYTOPATHOLOGY,INTERPRE & REPRT

Facility

$248.00

Service Code	HCPCS 88173
Hospital Charge Code	8817300
Hospital Revenue Code	311
Min. Negotiated Rate	$114.58
Max. Negotiated Rate	$240.56
Rate for Payer: BCBS Commercial	$225.25
Rate for Payer: Cash Price	$186.00
Rate for Payer: Cash Price	$186.00
Rate for Payer: Celtic Commercial/Exchange	$114.58
Rate for Payer: Health Partners Plans Commercial	$235.60
Rate for Payer: UnitedHealthcare Commercial	$240.56
Rate for Payer: WPPA Commercial	$208.32

CYTOPATH,SEL CELL ENHANCE TECH

Facility

$82.00

Service Code	HCPCS 88112
Hospital Charge Code	8811200
Hospital Revenue Code	311
Min. Negotiated Rate	$67.24
Max. Negotiated Rate	$79.54
Rate for Payer: Cash Price	$61.50
Rate for Payer: Health Partners Plans Commercial	$77.90
Rate for Payer: UnitedHealthcare Commercial	$79.54
Rate for Payer: WPPA Commercial	$67.24

CYTOPATH,SEL CELL ENHANCE TECH

Facility

$82.00

Service Code	HCPCS 88112
Hospital Charge Code	8811200
Hospital Revenue Code	311
Min. Negotiated Rate	$37.88
Max. Negotiated Rate	$81.92
Rate for Payer: BCBS Commercial	$81.92
Rate for Payer: Cash Price	$61.50
Rate for Payer: Cash Price	$61.50
Rate for Payer: Celtic Commercial/Exchange	$37.88
Rate for Payer: Health Partners Plans Commercial	$77.90
Rate for Payer: UnitedHealthcare Commercial	$79.54
Rate for Payer: WPPA Commercial	$68.88

CYTOPATH,SLIDES,CERV/VAG,

Facility

$48.00

Service Code	HCPCS 88164
Hospital Charge Code	8816400
Hospital Revenue Code	311
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

CYTOPATH,SLIDES,CERV/VAG,

Facility

$48.00

Service Code	HCPCS 88164
Hospital Charge Code	8816400
Hospital Revenue Code	311
Min. Negotiated Rate	$18.66
Max. Negotiated Rate	$46.56
Rate for Payer: BCBS Commercial	$18.66
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

CYTOPATH SMEARS ANY SOURCE

Facility

$137.00

Service Code	HCPCS 88161
Hospital Charge Code	8816100
Hospital Revenue Code	311
Min. Negotiated Rate	$63.29
Max. Negotiated Rate	$132.89
Rate for Payer: BCBS Commercial	$93.53
Rate for Payer: Cash Price	$102.75
Rate for Payer: Cash Price	$102.75
Rate for Payer: Celtic Commercial/Exchange	$63.29
Rate for Payer: Health Partners Plans Commercial	$130.15
Rate for Payer: UnitedHealthcare Commercial	$132.89
Rate for Payer: WPPA Commercial	$115.08

CYTOPATH SMEARS ANY SOURCE

Facility

$189.00

Service Code	HCPCS 88162
Hospital Charge Code	8816200
Hospital Revenue Code	311
Min. Negotiated Rate	$87.32
Max. Negotiated Rate	$183.33
Rate for Payer: BCBS Commercial	$123.01
Rate for Payer: Cash Price	$141.75
Rate for Payer: Cash Price	$141.75
Rate for Payer: Celtic Commercial/Exchange	$87.32
Rate for Payer: Health Partners Plans Commercial	$179.55
Rate for Payer: UnitedHealthcare Commercial	$183.33
Rate for Payer: WPPA Commercial	$158.76

CYTOPATH SMEARS ANY SOURCE

Facility

$137.00

Service Code	HCPCS 88161
Hospital Charge Code	8816100
Hospital Revenue Code	311
Min. Negotiated Rate	$112.34
Max. Negotiated Rate	$132.89
Rate for Payer: Cash Price	$102.75
Rate for Payer: Health Partners Plans Commercial	$130.15
Rate for Payer: UnitedHealthcare Commercial	$132.89
Rate for Payer: WPPA Commercial	$112.34

CYTOPATH SMEARS ANY SOURCE

Facility

$189.00

Service Code	HCPCS 88162
Hospital Charge Code	8816200
Hospital Revenue Code	311
Min. Negotiated Rate	$154.98
Max. Negotiated Rate	$183.33
Rate for Payer: Cash Price	$141.75
Rate for Payer: Health Partners Plans Commercial	$179.55
Rate for Payer: UnitedHealthcare Commercial	$183.33
Rate for Payer: WPPA Commercial	$154.98

CYTOPATH SMEARS,OTHER SOURCE

Facility

$128.00

Service Code	HCPCS 88160
Hospital Charge Code	8816000
Hospital Revenue Code	311
Min. Negotiated Rate	$59.14
Max. Negotiated Rate	$124.16
Rate for Payer: BCBS Commercial	$82.14
Rate for Payer: Cash Price	$96.00
Rate for Payer: Cash Price	$96.00
Rate for Payer: Celtic Commercial/Exchange	$59.14
Rate for Payer: Health Partners Plans Commercial	$121.60
Rate for Payer: UnitedHealthcare Commercial	$124.16
Rate for Payer: WPPA Commercial	$107.52

CYTOPATH SMEARS,OTHER SOURCE

Facility

$128.00

Service Code	HCPCS 88160
Hospital Charge Code	8816000
Hospital Revenue Code	311
Min. Negotiated Rate	$104.96
Max. Negotiated Rate	$124.16
Rate for Payer: Cash Price	$96.00
Rate for Payer: Health Partners Plans Commercial	$121.60
Rate for Payer: UnitedHealthcare Commercial	$124.16
Rate for Payer: WPPA Commercial	$104.96

D5 1/2 NSS 1000 ml

Facility

$66.00

Service Code	NDC 00990792609
Hospital Charge Code	2580033
Hospital Revenue Code	258
Min. Negotiated Rate	$54.12
Max. Negotiated Rate	$64.02
Rate for Payer: Cash Price	$49.95
Rate for Payer: Health Partners Plans Commercial	$62.70
Rate for Payer: UnitedHealthcare Commercial	$64.02
Rate for Payer: WPPA Commercial	$54.12

D5 1/2 NSS 1000 ml

Facility

$66.00

Service Code	NDC 00990792609
Hospital Charge Code	2580033
Hospital Revenue Code	258
Min. Negotiated Rate	$30.49
Max. Negotiated Rate	$64.02
Rate for Payer: Cash Price	$49.95
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

D5 1/2 NSS - 500 ml

Facility

$42.00

Service Code	NDC 00409792603
Hospital Charge Code	2517720
Hospital Revenue Code	258
Min. Negotiated Rate	$19.40
Max. Negotiated Rate	$40.74
Rate for Payer: Cash Price	$31.50
Rate for Payer: Celtic Commercial/Exchange	$19.40
Rate for Payer: Health Partners Plans Commercial	$39.90
Rate for Payer: UnitedHealthcare Commercial	$40.74
Rate for Payer: WPPA Commercial	$35.28

D5 1/2 NSS - 500 ml

Facility

$42.00

Service Code	NDC 00409792603
Hospital Charge Code	2517720
Hospital Revenue Code	258
Min. Negotiated Rate	$34.44
Max. Negotiated Rate	$40.74
Rate for Payer: Cash Price	$31.50
Rate for Payer: Health Partners Plans Commercial	$39.90
Rate for Payer: UnitedHealthcare Commercial	$40.74
Rate for Payer: WPPA Commercial	$34.44

D5 1/2 NSS with 20 mEq KCL - 1,000 ml bag

Facility

$76.00

Service Code	NDC 00409790209
Hospital Charge Code	2518157
Hospital Revenue Code	258
Min. Negotiated Rate	$35.11
Max. Negotiated Rate	$73.72
Rate for Payer: Cash Price	$57.45
Rate for Payer: Celtic Commercial/Exchange	$35.11
Rate for Payer: Health Partners Plans Commercial	$72.20
Rate for Payer: UnitedHealthcare Commercial	$73.72
Rate for Payer: WPPA Commercial	$63.84

D5 1/2 NSS with 20 mEq KCL - 1,000 ml bag

Facility

$76.00

Service Code	NDC 00409790209
Hospital Charge Code	2518157
Hospital Revenue Code	258
Min. Negotiated Rate	$62.32
Max. Negotiated Rate	$73.72
Rate for Payer: Cash Price	$57.45
Rate for Payer: Health Partners Plans Commercial	$72.20
Rate for Payer: UnitedHealthcare Commercial	$73.72
Rate for Payer: WPPA Commercial	$62.32

D5 1/2 NSS with 30 mEq KCL - 1,000 ml bag

Facility

$77.00

Service Code	NDC 00990790309
Hospital Charge Code	2518165
Hospital Revenue Code	258
Min. Negotiated Rate	$35.57
Max. Negotiated Rate	$74.69
Rate for Payer: Cash Price	$58.20
Rate for Payer: Celtic Commercial/Exchange	$35.57
Rate for Payer: Health Partners Plans Commercial	$73.15
Rate for Payer: UnitedHealthcare Commercial	$74.69
Rate for Payer: WPPA Commercial	$64.68

D5 1/2 NSS with 30 mEq KCL - 1,000 ml bag

Facility

$77.00

Service Code	NDC 00990790309
Hospital Charge Code	2518165
Hospital Revenue Code	258
Min. Negotiated Rate	$63.14
Max. Negotiated Rate	$74.69
Rate for Payer: Cash Price	$58.20
Rate for Payer: Health Partners Plans Commercial	$73.15
Rate for Payer: UnitedHealthcare Commercial	$74.69
Rate for Payer: WPPA Commercial	$63.14

D5 1/2 NSS with 40 mEq KCL - 1,000 ml bag

Facility

$78.00

Service Code	NDC 00990790409
Hospital Charge Code	2518173
Hospital Revenue Code	258
Min. Negotiated Rate	$63.96
Max. Negotiated Rate	$75.66
Rate for Payer: Cash Price	$58.95
Rate for Payer: Health Partners Plans Commercial	$74.10
Rate for Payer: UnitedHealthcare Commercial	$75.66
Rate for Payer: WPPA Commercial	$63.96

D5 1/2 NSS with 40 mEq KCL - 1,000 ml bag

Facility

$78.00

Service Code	NDC 00990790409
Hospital Charge Code	2518173
Hospital Revenue Code	258
Min. Negotiated Rate	$36.04
Max. Negotiated Rate	$75.66
Rate for Payer: Cash Price	$58.95
Rate for Payer: Celtic Commercial/Exchange	$36.04
Rate for Payer: Health Partners Plans Commercial	$74.10
Rate for Payer: UnitedHealthcare Commercial	$75.66
Rate for Payer: WPPA Commercial	$65.52

D5 1/4 NS 1000ml

Facility

$66.00

Service Code	NDC 00990792409
Hospital Charge Code	2580454
Hospital Revenue Code	258
Min. Negotiated Rate	$54.12
Max. Negotiated Rate	$64.02
Rate for Payer: Cash Price	$49.95
Rate for Payer: Health Partners Plans Commercial	$62.70
Rate for Payer: UnitedHealthcare Commercial	$64.02
Rate for Payer: WPPA Commercial	$54.12

Know your out-of-pocket cost for care.

All Charges