Ness County Hospital

All Charges

Charge

Type

Setting

Price

GAMMAGLOB IMMUNOGLOB SUBCLASS

Facility

$93.00

Service Code	HCPCS 82787
Hospital Charge Code	8278700
Hospital Revenue Code	301
Min. Negotiated Rate	$76.26
Max. Negotiated Rate	$90.21
Rate for Payer: Cash Price	$69.75
Rate for Payer: Health Partners Plans Commercial	$88.35
Rate for Payer: UnitedHealthcare Commercial	$90.21
Rate for Payer: WPPA Commercial	$76.26

GAMMAGLOBULIN IGE

Facility

$267.00

Service Code	HCPCS 82785
Hospital Charge Code	8278500
Hospital Revenue Code	301
Min. Negotiated Rate	$218.94
Max. Negotiated Rate	$258.99
Rate for Payer: Cash Price	$200.25
Rate for Payer: Health Partners Plans Commercial	$253.65
Rate for Payer: UnitedHealthcare Commercial	$258.99
Rate for Payer: WPPA Commercial	$218.94

GAMMAGLOBULIN IGE

Facility

$267.00

Service Code	HCPCS 82785
Hospital Charge Code	8278500
Hospital Revenue Code	301
Min. Negotiated Rate	$63.27
Max. Negotiated Rate	$258.99
Rate for Payer: BCBS Commercial	$63.27
Rate for Payer: Cash Price	$200.25
Rate for Payer: Cash Price	$200.25
Rate for Payer: Celtic Commercial/Exchange	$123.35
Rate for Payer: Health Partners Plans Commercial	$253.65
Rate for Payer: UnitedHealthcare Commercial	$258.99
Rate for Payer: WPPA Commercial	$224.28

Gamunex-C 10 GM

Facility

$5,103.00

Service Code	NDC 13533080071
Hospital Charge Code	2511053
Hospital Revenue Code	250
Min. Negotiated Rate	$4,184.46
Max. Negotiated Rate	$4,949.91
Rate for Payer: Cash Price	$3,827.27
Rate for Payer: Health Partners Plans Commercial	$4,847.85
Rate for Payer: UnitedHealthcare Commercial	$4,949.91
Rate for Payer: WPPA Commercial	$4,184.46

Gamunex-C 10 GM

Facility

$5,103.00

Service Code	NDC 13533080071
Hospital Charge Code	2511053
Hospital Revenue Code	250
Min. Negotiated Rate	$2,357.59
Max. Negotiated Rate	$4,949.91
Rate for Payer: Cash Price	$3,827.27
Rate for Payer: Celtic Commercial/Exchange	$2,357.59
Rate for Payer: Health Partners Plans Commercial	$4,847.85
Rate for Payer: UnitedHealthcare Commercial	$4,949.91
Rate for Payer: WPPA Commercial	$4,286.52

Gamunex-C 20 GM

Facility

$10,200.00

Service Code	NDC 13533080024
Hospital Charge Code	2519130
Hospital Revenue Code	250
Min. Negotiated Rate	$4,712.40
Max. Negotiated Rate	$9,894.00
Rate for Payer: Cash Price	$7,650.00
Rate for Payer: Celtic Commercial/Exchange	$4,712.40
Rate for Payer: Health Partners Plans Commercial	$9,690.00
Rate for Payer: UnitedHealthcare Commercial	$9,894.00
Rate for Payer: WPPA Commercial	$8,568.00

Gamunex-C 20 GM

Facility

$10,200.00

Service Code	NDC 13533080024
Hospital Charge Code	2519130
Hospital Revenue Code	250
Min. Negotiated Rate	$8,364.00
Max. Negotiated Rate	$9,894.00
Rate for Payer: Cash Price	$7,650.00
Rate for Payer: Health Partners Plans Commercial	$9,690.00
Rate for Payer: UnitedHealthcare Commercial	$9,894.00
Rate for Payer: WPPA Commercial	$8,364.00

Gamunex-C 40 GM 10% inj solution

Facility

$19,716.00

Service Code	NDC 13533080040
Hospital Charge Code	2519148
Hospital Revenue Code	250
Min. Negotiated Rate	$9,108.79
Max. Negotiated Rate	$19,124.52
Rate for Payer: Cash Price	$14,787.43
Rate for Payer: Celtic Commercial/Exchange	$9,108.79
Rate for Payer: Health Partners Plans Commercial	$18,730.20
Rate for Payer: UnitedHealthcare Commercial	$19,124.52
Rate for Payer: WPPA Commercial	$16,561.44

Gamunex-C 40 GM 10% inj solution

Facility

$19,716.00

Service Code	NDC 13533080040
Hospital Charge Code	2519148
Hospital Revenue Code	250
Min. Negotiated Rate	$16,167.12
Max. Negotiated Rate	$19,124.52
Rate for Payer: Cash Price	$14,787.43
Rate for Payer: Health Partners Plans Commercial	$18,730.20
Rate for Payer: UnitedHealthcare Commercial	$19,124.52
Rate for Payer: WPPA Commercial	$16,167.12

GANGLIOSIDE ASIALO-GM-1(IGM)

Facility

$159.00

Service Code	HCPCS 83520
Hospital Charge Code	8352001
Hospital Revenue Code	301
Min. Negotiated Rate	$36.48
Max. Negotiated Rate	$154.23
Rate for Payer: BCBS Commercial	$36.48
Rate for Payer: Cash Price	$119.25
Rate for Payer: Cash Price	$119.25
Rate for Payer: Celtic Commercial/Exchange	$73.46
Rate for Payer: Health Partners Plans Commercial	$151.05
Rate for Payer: UnitedHealthcare Commercial	$154.23
Rate for Payer: WPPA Commercial	$133.56

GANGLIOSIDE ASIALO-GM-1(IGM)

Facility

$159.00

Service Code	HCPCS 83520
Hospital Charge Code	8352001
Hospital Revenue Code	301
Min. Negotiated Rate	$130.38
Max. Negotiated Rate	$154.23
Rate for Payer: Cash Price	$119.25
Rate for Payer: Health Partners Plans Commercial	$151.05
Rate for Payer: UnitedHealthcare Commercial	$154.23
Rate for Payer: WPPA Commercial	$130.38

GANLIOSIDE ASIALO-GM-1 (IGG)

Facility

$159.00

Service Code	HCPCS 83520
Hospital Charge Code	8352002
Hospital Revenue Code	301
Min. Negotiated Rate	$36.48
Max. Negotiated Rate	$154.23
Rate for Payer: BCBS Commercial	$36.48
Rate for Payer: Cash Price	$119.25
Rate for Payer: Cash Price	$119.25
Rate for Payer: Celtic Commercial/Exchange	$73.46
Rate for Payer: Health Partners Plans Commercial	$151.05
Rate for Payer: UnitedHealthcare Commercial	$154.23
Rate for Payer: WPPA Commercial	$133.56

GANLIOSIDE ASIALO-GM-1 (IGG)

Facility

$159.00

Service Code	HCPCS 83520
Hospital Charge Code	8352002
Hospital Revenue Code	301
Min. Negotiated Rate	$130.38
Max. Negotiated Rate	$154.23
Rate for Payer: Cash Price	$119.25
Rate for Payer: Health Partners Plans Commercial	$151.05
Rate for Payer: UnitedHealthcare Commercial	$154.23
Rate for Payer: WPPA Commercial	$130.38

Garamycin ointment 30 GM

Facility

$296.00

Service Code	NDC 00713068231
Hospital Charge Code	2519171
Hospital Revenue Code	250
Min. Negotiated Rate	$136.75
Max. Negotiated Rate	$287.12
Rate for Payer: Cash Price	$222.19
Rate for Payer: Celtic Commercial/Exchange	$136.75
Rate for Payer: Health Partners Plans Commercial	$281.20
Rate for Payer: UnitedHealthcare Commercial	$287.12
Rate for Payer: WPPA Commercial	$248.64

Garamycin ointment 30 GM

Facility

$296.00

Service Code	NDC 00713068231
Hospital Charge Code	2519171
Hospital Revenue Code	250
Min. Negotiated Rate	$242.72
Max. Negotiated Rate	$287.12
Rate for Payer: Cash Price	$222.19
Rate for Payer: Health Partners Plans Commercial	$281.20
Rate for Payer: UnitedHealthcare Commercial	$287.12
Rate for Payer: WPPA Commercial	$242.72

GARAMYCIN OPTH. OINT (GENTAK)

Facility

$113.00

Service Code	NDC 17478028435
Hospital Charge Code	2502904
Hospital Revenue Code	250
Min. Negotiated Rate	$52.21
Max. Negotiated Rate	$109.61
Rate for Payer: Cash Price	$85.09
Rate for Payer: Celtic Commercial/Exchange	$52.21
Rate for Payer: Health Partners Plans Commercial	$107.35
Rate for Payer: UnitedHealthcare Commercial	$109.61
Rate for Payer: WPPA Commercial	$94.92

GARAMYCIN OPTH. OINT (GENTAK)

Facility

$113.00

Service Code	NDC 17478028435
Hospital Charge Code	2502904
Hospital Revenue Code	250
Min. Negotiated Rate	$92.66
Max. Negotiated Rate	$109.61
Rate for Payer: Cash Price	$85.09
Rate for Payer: Health Partners Plans Commercial	$107.35
Rate for Payer: UnitedHealthcare Commercial	$109.61
Rate for Payer: WPPA Commercial	$92.66

GARAMYCIN OPTH SOLUTION 5 ml vial (GENTAMICIN)

Facility

$128.00

Service Code	NDC 60758018805
Hospital Charge Code	2502912
Hospital Revenue Code	250
Min. Negotiated Rate	$104.96
Max. Negotiated Rate	$124.16
Rate for Payer: Cash Price	$96.41
Rate for Payer: Health Partners Plans Commercial	$121.60
Rate for Payer: UnitedHealthcare Commercial	$124.16
Rate for Payer: WPPA Commercial	$104.96

GARAMYCIN OPTH SOLUTION 5 ml vial (GENTAMICIN)

Facility

$128.00

Service Code	NDC 60758018805
Hospital Charge Code	2502912
Hospital Revenue Code	250
Min. Negotiated Rate	$59.14
Max. Negotiated Rate	$124.16
Rate for Payer: Cash Price	$96.41
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

GARDNERELLA VAGINALIS, QUANT

Facility

$89.00

Service Code	HCPCS 87512
Hospital Charge Code	8751200
Hospital Revenue Code	306
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

GARDNERELLA VAGINALIS, QUANT

Facility

$89.00

Service Code	HCPCS 87512
Hospital Charge Code	8751200
Hospital Revenue Code	306
Min. Negotiated Rate	$41.12
Max. Negotiated Rate	$89.57
Rate for Payer: BCBS Commercial	$89.57
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

GASTRIC

Facility

$120.00

Service Code	HCPCS 82941
Hospital Charge Code	8294100
Hospital Revenue Code	301
Min. Negotiated Rate	$55.44
Max. Negotiated Rate	$116.40
Rate for Payer: BCBS Commercial	$68.24
Rate for Payer: Cash Price	$90.00
Rate for Payer: Cash Price	$90.00
Rate for Payer: Celtic Commercial/Exchange	$55.44
Rate for Payer: Health Partners Plans Commercial	$114.00
Rate for Payer: UnitedHealthcare Commercial	$116.40
Rate for Payer: WPPA Commercial	$100.80

GASTRIC

Facility

$120.00

Service Code	HCPCS 82941
Hospital Charge Code	8294100
Hospital Revenue Code	301
Min. Negotiated Rate	$98.40
Max. Negotiated Rate	$116.40
Rate for Payer: Cash Price	$90.00
Rate for Payer: Health Partners Plans Commercial	$114.00
Rate for Payer: UnitedHealthcare Commercial	$116.40
Rate for Payer: WPPA Commercial	$98.40

GASTRIC INTUBATION/ASPIRATION

Facility

$377.00

Service Code	HCPCS 43753
Hospital Charge Code	4375300
Hospital Revenue Code	450
Min. Negotiated Rate	$174.17
Max. Negotiated Rate	$389.25
Rate for Payer: BCBS Commercial	$389.25
Rate for Payer: Cash Price	$282.75
Rate for Payer: Cash Price	$282.75
Rate for Payer: Celtic Commercial/Exchange	$174.17
Rate for Payer: Health Partners Plans Commercial	$358.15
Rate for Payer: UnitedHealthcare Commercial	$365.69
Rate for Payer: WPPA Commercial	$316.68

GASTRIC INTUBATION/ASPIRATION

Facility

$377.00

Service Code	HCPCS 43753
Hospital Charge Code	4375300
Hospital Revenue Code	450
Min. Negotiated Rate	$309.14
Max. Negotiated Rate	$365.69
Rate for Payer: Cash Price	$282.75
Rate for Payer: Health Partners Plans Commercial	$358.15
Rate for Payer: UnitedHealthcare Commercial	$365.69
Rate for Payer: WPPA Commercial	$309.14

Know your out-of-pocket cost for care.

All Charges