Ness County Hospital

All Charges

Charge

Type

Setting

Price

GAUZE VASELINE 1/2X72" FOIL PK

Facility

$9.00

Hospital Charge Code	2720898
Hospital Revenue Code	270
Min. Negotiated Rate	$7.38
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$6.75
Rate for Payer: Health Partners Plans Commercial	$8.55
Rate for Payer: UnitedHealthcare Commercial	$8.73
Rate for Payer: WPPA Commercial	$7.38

GAUZE VASELINE 1X8" STR

Facility

$9.00

Hospital Charge Code	2720895
Hospital Revenue Code	270
Min. Negotiated Rate	$7.38
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$6.75
Rate for Payer: Health Partners Plans Commercial	$8.55
Rate for Payer: UnitedHealthcare Commercial	$8.73
Rate for Payer: WPPA Commercial	$7.38

GAUZE VASELINE 1X8" STR

Facility

$9.00

Hospital Charge Code	2720895
Hospital Revenue Code	270
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$6.75
Rate for Payer: Celtic Commercial/Exchange	$4.16
Rate for Payer: Health Partners Plans Commercial	$8.55
Rate for Payer: UnitedHealthcare Commercial	$8.73
Rate for Payer: WPPA Commercial	$7.56

GAUZE VASELINE 3X18" FOIL PK

Facility

$9.00

Hospital Charge Code	2720896
Hospital Revenue Code	270
Min. Negotiated Rate	$7.38
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$6.75
Rate for Payer: Health Partners Plans Commercial	$8.55
Rate for Payer: UnitedHealthcare Commercial	$8.73
Rate for Payer: WPPA Commercial	$7.38

GAUZE VASELINE 3X18" FOIL PK

Facility

$9.00

Hospital Charge Code	2720896
Hospital Revenue Code	270
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$6.75
Rate for Payer: Celtic Commercial/Exchange	$4.16
Rate for Payer: Health Partners Plans Commercial	$8.55
Rate for Payer: UnitedHealthcare Commercial	$8.73
Rate for Payer: WPPA Commercial	$7.56

GAUZE VASELINE 3X9"

Facility

$9.00

Hospital Charge Code	2720897
Hospital Revenue Code	270
Min. Negotiated Rate	$7.38
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$6.75
Rate for Payer: Health Partners Plans Commercial	$8.55
Rate for Payer: UnitedHealthcare Commercial	$8.73
Rate for Payer: WPPA Commercial	$7.38

GAUZE VASELINE 3X9"

Facility

$9.00

Hospital Charge Code	2720897
Hospital Revenue Code	270
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$6.75
Rate for Payer: Celtic Commercial/Exchange	$4.16
Rate for Payer: Health Partners Plans Commercial	$8.55
Rate for Payer: UnitedHealthcare Commercial	$8.73
Rate for Payer: WPPA Commercial	$7.56

GAVISCON 30 ML (ALUMINUM HYDROX-MAGNESIUM CARB) (ACID GONE)

Facility

$1.00

Service Code	NDC 00904772714
Hospital Charge Code	2508760
Hospital Revenue Code	250
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$1.42
Rate for Payer: Celtic Commercial/Exchange	$0.46
Rate for Payer: Health Partners Plans Commercial	$0.95
Rate for Payer: UnitedHealthcare Commercial	$0.97
Rate for Payer: WPPA Commercial	$0.84

GAVISCON 30 ML (ALUMINUM HYDROX-MAGNESIUM CARB) (ACID GONE)

Facility

$1.00

Service Code	NDC 00904772714
Hospital Charge Code	2508760
Hospital Revenue Code	250
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$1.42
Rate for Payer: Health Partners Plans Commercial	$0.95
Rate for Payer: UnitedHealthcare Commercial	$0.97
Rate for Payer: WPPA Commercial	$0.82

GELFOAM

Facility

$40.00

Hospital Charge Code	2725052
Hospital Revenue Code	270
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

GELFOAM

Facility

$40.00

Hospital Charge Code	2725052
Hospital Revenue Code	270
Min. Negotiated Rate	$18.48
Max. Negotiated Rate	$38.80
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

GENERAL HLTH PANEL W/AUTO DIFF

Facility

$165.00

Service Code	HCPCS 80050
Hospital Charge Code	8005000
Hospital Revenue Code	301
Min. Negotiated Rate	$135.30
Max. Negotiated Rate	$160.05
Rate for Payer: Cash Price	$123.75
Rate for Payer: Health Partners Plans Commercial	$156.75
Rate for Payer: UnitedHealthcare Commercial	$160.05
Rate for Payer: WPPA Commercial	$135.30

GENERAL HLTH PANEL W/AUTO DIFF

Facility

$165.00

Service Code	HCPCS 80050
Hospital Charge Code	8005000
Hospital Revenue Code	301
Min. Negotiated Rate	$72.69
Max. Negotiated Rate	$160.05
Rate for Payer: BCBS Commercial	$72.69
Rate for Payer: Cash Price	$123.75
Rate for Payer: Cash Price	$123.75
Rate for Payer: Celtic Commercial/Exchange	$76.23
Rate for Payer: Health Partners Plans Commercial	$156.75
Rate for Payer: UnitedHealthcare Commercial	$160.05
Rate for Payer: WPPA Commercial	$138.60

GENERAL HLTH PANEL W/MANL DIFF

Facility

$165.00

Service Code	HCPCS 80050
Hospital Charge Code	8005001
Hospital Revenue Code	301
Min. Negotiated Rate	$72.69
Max. Negotiated Rate	$160.05
Rate for Payer: BCBS Commercial	$72.69
Rate for Payer: Cash Price	$123.75
Rate for Payer: Cash Price	$123.75
Rate for Payer: Celtic Commercial/Exchange	$76.23
Rate for Payer: Health Partners Plans Commercial	$156.75
Rate for Payer: UnitedHealthcare Commercial	$160.05
Rate for Payer: WPPA Commercial	$138.60

GENERAL HLTH PANEL W/MANL DIFF

Facility

$165.00

Service Code	HCPCS 80050
Hospital Charge Code	8005001
Hospital Revenue Code	301
Min. Negotiated Rate	$135.30
Max. Negotiated Rate	$160.05
Rate for Payer: Cash Price	$123.75
Rate for Payer: Health Partners Plans Commercial	$156.75
Rate for Payer: UnitedHealthcare Commercial	$160.05
Rate for Payer: WPPA Commercial	$135.30

GENTAMICIN

Facility

$146.00

Service Code	HCPCS 80170
Hospital Charge Code	8017000
Hospital Revenue Code	301
Min. Negotiated Rate	$57.41
Max. Negotiated Rate	$141.62
Rate for Payer: BCBS Commercial	$57.41
Rate for Payer: Cash Price	$109.50
Rate for Payer: Cash Price	$109.50
Rate for Payer: Celtic Commercial/Exchange	$67.45
Rate for Payer: Health Partners Plans Commercial	$138.70
Rate for Payer: UnitedHealthcare Commercial	$141.62
Rate for Payer: WPPA Commercial	$122.64

GENTAMICIN

Facility

$12.00

Hospital Charge Code	2700747
Hospital Revenue Code	272
Min. Negotiated Rate	$9.84
Max. Negotiated Rate	$11.64
Rate for Payer: Cash Price	$9.00
Rate for Payer: Health Partners Plans Commercial	$11.40
Rate for Payer: UnitedHealthcare Commercial	$11.64
Rate for Payer: WPPA Commercial	$9.84

GENTAMICIN

Facility

$146.00

Service Code	HCPCS 80170
Hospital Charge Code	8017000
Hospital Revenue Code	301
Min. Negotiated Rate	$119.72
Max. Negotiated Rate	$141.62
Rate for Payer: Cash Price	$109.50
Rate for Payer: Health Partners Plans Commercial	$138.70
Rate for Payer: UnitedHealthcare Commercial	$141.62
Rate for Payer: WPPA Commercial	$119.72

GENTAMICIN

Facility

$12.00

Hospital Charge Code	2700747
Hospital Revenue Code	272
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$11.64
Rate for Payer: Cash Price	$9.00
Rate for Payer: Celtic Commercial/Exchange	$5.54
Rate for Payer: Health Partners Plans Commercial	$11.40
Rate for Payer: UnitedHealthcare Commercial	$11.64
Rate for Payer: WPPA Commercial	$10.08

Gentamicin 100 mg IV Premix

Facility

$14.00

Service Code	NDC 00338050548
Hospital Charge Code	2518389
Hospital Revenue Code	250
Min. Negotiated Rate	$11.48
Max. Negotiated Rate	$13.58
Rate for Payer: Cash Price	$11.02
Rate for Payer: Health Partners Plans Commercial	$13.30
Rate for Payer: UnitedHealthcare Commercial	$13.58
Rate for Payer: WPPA Commercial	$11.48

Gentamicin 100 mg IV Premix

Facility

$14.00

Service Code	NDC 00338050548
Hospital Charge Code	2518389
Hospital Revenue Code	250
Min. Negotiated Rate	$6.47
Max. Negotiated Rate	$13.58
Rate for Payer: Cash Price	$11.02
Rate for Payer: Celtic Commercial/Exchange	$6.47
Rate for Payer: Health Partners Plans Commercial	$13.30
Rate for Payer: UnitedHealthcare Commercial	$13.58
Rate for Payer: WPPA Commercial	$11.76

Gentamicin 60 mg IV Premix

Facility

$13.00

Service Code	NDC 00338050741
Hospital Charge Code	2518363
Hospital Revenue Code	250
Min. Negotiated Rate	$6.01
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$10.35
Rate for Payer: Celtic Commercial/Exchange	$6.01
Rate for Payer: Health Partners Plans Commercial	$12.35
Rate for Payer: UnitedHealthcare Commercial	$12.61
Rate for Payer: WPPA Commercial	$10.92

Gentamicin 60 mg IV Premix

Facility

$13.00

Service Code	NDC 00338050741
Hospital Charge Code	2518363
Hospital Revenue Code	250
Min. Negotiated Rate	$10.66
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$10.35
Rate for Payer: Health Partners Plans Commercial	$12.35
Rate for Payer: UnitedHealthcare Commercial	$12.61
Rate for Payer: WPPA Commercial	$10.66

Gentamicin 80mg/2ml inj.

Facility

$21.00

Service Code	NDC 00409120725
Hospital Charge Code	2502979
Hospital Revenue Code	250
Min. Negotiated Rate	$9.70
Max. Negotiated Rate	$20.37
Rate for Payer: Cash Price	$16.35
Rate for Payer: Celtic Commercial/Exchange	$9.70
Rate for Payer: Health Partners Plans Commercial	$19.95
Rate for Payer: UnitedHealthcare Commercial	$20.37
Rate for Payer: WPPA Commercial	$17.64

Gentamicin 80mg/2ml inj.

Facility

$21.00

Service Code	NDC 00409120725
Hospital Charge Code	2502979
Hospital Revenue Code	250
Min. Negotiated Rate	$17.22
Max. Negotiated Rate	$20.37
Rate for Payer: Cash Price	$16.35
Rate for Payer: Health Partners Plans Commercial	$19.95
Rate for Payer: UnitedHealthcare Commercial	$20.37
Rate for Payer: WPPA Commercial	$17.22

Know your out-of-pocket cost for care.

All Charges