Ness County Hospital

All Charges

Charge

Type

Setting

Price

Gentamicin 80 mg IV Premix

Facility

$14.00

Service Code	NDC 00338050941
Hospital Charge Code	2518371
Hospital Revenue Code	250
Min. Negotiated Rate	$6.47
Max. Negotiated Rate	$13.58
Rate for Payer: Cash Price	$10.99
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 80 mg IV Premix

Facility

$14.00

Service Code	NDC 00338050941
Hospital Charge Code	2518371
Hospital Revenue Code	250
Min. Negotiated Rate	$11.48
Max. Negotiated Rate	$13.58
Rate for Payer: Cash Price	$10.99
Rate for Payer: Health Partners Plans Commercial	$13.30
Rate for Payer: UnitedHealthcare Commercial	$13.58
Rate for Payer: WPPA Commercial	$11.48

GENTIAN VIOLET

Facility

$27.00

Hospital Charge Code	2725063
Hospital Revenue Code	272
Min. Negotiated Rate	$22.14
Max. Negotiated Rate	$26.19
Rate for Payer: Cash Price	$20.25
Rate for Payer: Health Partners Plans Commercial	$25.65
Rate for Payer: UnitedHealthcare Commercial	$26.19
Rate for Payer: WPPA Commercial	$22.14

GENTIAN VIOLET

Facility

$27.00

Hospital Charge Code	2725063
Hospital Revenue Code	272
Min. Negotiated Rate	$12.47
Max. Negotiated Rate	$26.19
Rate for Payer: Cash Price	$20.25
Rate for Payer: Celtic Commercial/Exchange	$12.47
Rate for Payer: Health Partners Plans Commercial	$25.65
Rate for Payer: UnitedHealthcare Commercial	$26.19
Rate for Payer: WPPA Commercial	$22.68

GEODON 20MG/ML INJ. (ZIPRASIDONE MESYLATE) IM USE ONLY

Facility

$178.00

Service Code	NDC 72266016042
Hospital Charge Code	2519494
Hospital Revenue Code	250
Min. Negotiated Rate	$82.24
Max. Negotiated Rate	$172.66
Rate for Payer: Cash Price	$134.14
Rate for Payer: Celtic Commercial/Exchange	$82.24
Rate for Payer: Health Partners Plans Commercial	$169.10
Rate for Payer: UnitedHealthcare Commercial	$172.66
Rate for Payer: WPPA Commercial	$149.52

GEODON 20MG/ML INJ. (ZIPRASIDONE MESYLATE) IM USE ONLY

Facility

$178.00

Service Code	NDC 72266016042
Hospital Charge Code	2519494
Hospital Revenue Code	250
Min. Negotiated Rate	$145.96
Max. Negotiated Rate	$172.66
Rate for Payer: Cash Price	$134.14
Rate for Payer: Health Partners Plans Commercial	$169.10
Rate for Payer: UnitedHealthcare Commercial	$172.66
Rate for Payer: WPPA Commercial	$145.96

GLIADIN AB IGG/IGA

Facility

$73.00

Service Code	HCPCS 86258
Hospital Charge Code	8625800
Hospital Revenue Code	300
Min. Negotiated Rate	$23.37
Max. Negotiated Rate	$70.81
Rate for Payer: BCBS Commercial	$23.37
Rate for Payer: Cash Price	$54.75
Rate for Payer: Cash Price	$54.75
Rate for Payer: Celtic Commercial/Exchange	$33.73
Rate for Payer: Health Partners Plans Commercial	$69.35
Rate for Payer: UnitedHealthcare Commercial	$70.81
Rate for Payer: WPPA Commercial	$61.32

GLIADIN AB IGG/IGA

Facility

$73.00

Service Code	HCPCS 86258
Hospital Charge Code	8625800
Hospital Revenue Code	300
Min. Negotiated Rate	$59.86
Max. Negotiated Rate	$70.81
Rate for Payer: Cash Price	$54.75
Rate for Payer: Health Partners Plans Commercial	$69.35
Rate for Payer: UnitedHealthcare Commercial	$70.81
Rate for Payer: WPPA Commercial	$59.86

GLUCAGON 1 MG EMERGENCY KIT

Facility

$1,018.00

Service Code	NDC 00002803101
Hospital Charge Code	2503019
Hospital Revenue Code	250
Min. Negotiated Rate	$834.76
Max. Negotiated Rate	$987.46
Rate for Payer: Cash Price	$763.84
Rate for Payer: Health Partners Plans Commercial	$967.10
Rate for Payer: UnitedHealthcare Commercial	$987.46
Rate for Payer: WPPA Commercial	$834.76

GLUCAGON 1 MG EMERGENCY KIT

Facility

$1,018.00

Service Code	NDC 00002803101
Hospital Charge Code	2503019
Hospital Revenue Code	250
Min. Negotiated Rate	$470.32
Max. Negotiated Rate	$987.46
Rate for Payer: Cash Price	$763.84
Rate for Payer: Celtic Commercial/Exchange	$470.32
Rate for Payer: Health Partners Plans Commercial	$967.10
Rate for Payer: UnitedHealthcare Commercial	$987.46
Rate for Payer: WPPA Commercial	$855.12

GLUCERNA 1.2 CAL 8 OZ

Facility

$3.00

Hospital Charge Code	2512457
Hospital Revenue Code	250
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.62
Rate for Payer: Health Partners Plans Commercial	$2.85
Rate for Payer: UnitedHealthcare Commercial	$2.91
Rate for Payer: WPPA Commercial	$2.46

GLUCERNA 1.2 CAL 8 OZ

Facility

$3.00

Hospital Charge Code	2512457
Hospital Revenue Code	250
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.62
Rate for Payer: Celtic Commercial/Exchange	$1.39
Rate for Payer: Health Partners Plans Commercial	$2.85
Rate for Payer: UnitedHealthcare Commercial	$2.91
Rate for Payer: WPPA Commercial	$2.52

Glucerna 1.5 Cal (nut.tx.gluc intol,lf,soy-fiber) oral liquid

Facility

$3.00

Service Code	NDC 70074064919
Hospital Charge Code	2512101
Hospital Revenue Code	250
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.78
Rate for Payer: Health Partners Plans Commercial	$2.85
Rate for Payer: UnitedHealthcare Commercial	$2.91
Rate for Payer: WPPA Commercial	$2.46

Glucerna 1.5 Cal (nut.tx.gluc intol,lf,soy-fiber) oral liquid

Facility

$3.00

Service Code	NDC 70074064919
Hospital Charge Code	2512101
Hospital Revenue Code	250
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.78
Rate for Payer: Celtic Commercial/Exchange	$1.39
Rate for Payer: Health Partners Plans Commercial	$2.85
Rate for Payer: UnitedHealthcare Commercial	$2.91
Rate for Payer: WPPA Commercial	$2.52

GLUCOPHAGE 500 MG TAB (METFORMIN HCL)

Facility

$2.00

Service Code	NDC 60687015501
Hospital Charge Code	2514990
Hospital Revenue Code	250
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.76
Rate for Payer: Health Partners Plans Commercial	$1.90
Rate for Payer: UnitedHealthcare Commercial	$1.94
Rate for Payer: WPPA Commercial	$1.64

GLUCOPHAGE 500 MG TAB (METFORMIN HCL)

Facility

$2.00

Service Code	NDC 60687015501
Hospital Charge Code	2514990
Hospital Revenue Code	250
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.76
Rate for Payer: Celtic Commercial/Exchange	$0.92
Rate for Payer: Health Partners Plans Commercial	$1.90
Rate for Payer: UnitedHealthcare Commercial	$1.94
Rate for Payer: WPPA Commercial	$1.68

GLUCOPHAGE XR 500 MG TAB (METFORMIN HCL ER)

Facility

$15.00

Service Code	NDC 50268055011
Hospital Charge Code	2515781
Hospital Revenue Code	250
Min. Negotiated Rate	$12.30
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$11.92
Rate for Payer: Health Partners Plans Commercial	$14.25
Rate for Payer: UnitedHealthcare Commercial	$14.55
Rate for Payer: WPPA Commercial	$12.30

GLUCOPHAGE XR 500 MG TAB (METFORMIN HCL ER)

Facility

$15.00

Service Code	NDC 50268055011
Hospital Charge Code	2515781
Hospital Revenue Code	250
Min. Negotiated Rate	$6.93
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$11.92
Rate for Payer: Celtic Commercial/Exchange	$6.93
Rate for Payer: Health Partners Plans Commercial	$14.25
Rate for Payer: UnitedHealthcare Commercial	$14.55
Rate for Payer: WPPA Commercial	$12.60

GLUCOSE-6-PHOS.DEHYDRO, SCREEN

Facility

$60.00

Service Code	HCPCS 82960
Hospital Charge Code	8296000
Hospital Revenue Code	301
Min. Negotiated Rate	$27.72
Max. Negotiated Rate	$58.20
Rate for Payer: BCBS Commercial	$41.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Celtic Commercial/Exchange	$27.72
Rate for Payer: Health Partners Plans Commercial	$57.00
Rate for Payer: UnitedHealthcare Commercial	$58.20
Rate for Payer: WPPA Commercial	$50.40

GLUCOSE-6-PHOS.DEHYDRO, SCREEN

Facility

$60.00

Service Code	HCPCS 82960
Hospital Charge Code	8296000
Hospital Revenue Code	301
Min. Negotiated Rate	$49.20
Max. Negotiated Rate	$58.20
Rate for Payer: Cash Price	$45.00
Rate for Payer: Health Partners Plans Commercial	$57.00
Rate for Payer: UnitedHealthcare Commercial	$58.20
Rate for Payer: WPPA Commercial	$49.20

GLUCOSE 6 PHOSPHATE DEHYDROG.

Facility

$77.00

Service Code	HCPCS 82955
Hospital Charge Code	8295500
Hospital Revenue Code	301
Min. Negotiated Rate	$63.14
Max. Negotiated Rate	$74.69
Rate for Payer: Cash Price	$57.75
Rate for Payer: Health Partners Plans Commercial	$73.15
Rate for Payer: UnitedHealthcare Commercial	$74.69
Rate for Payer: WPPA Commercial	$63.14

GLUCOSE 6 PHOSPHATE DEHYDROG.

Facility

$77.00

Service Code	HCPCS 82955
Hospital Charge Code	8295500
Hospital Revenue Code	301
Min. Negotiated Rate	$35.57
Max. Negotiated Rate	$77.72
Rate for Payer: BCBS Commercial	$77.72
Rate for Payer: Cash Price	$57.75
Rate for Payer: Cash Price	$57.75
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

GLUCOSE BODY FLUID EXCPT BLOOD

Facility

$25.00

Service Code	HCPCS 82945
Hospital Charge Code	8294500
Hospital Revenue Code	301
Min. Negotiated Rate	$20.50
Max. Negotiated Rate	$24.25
Rate for Payer: Cash Price	$18.75
Rate for Payer: Health Partners Plans Commercial	$23.75
Rate for Payer: UnitedHealthcare Commercial	$24.25
Rate for Payer: WPPA Commercial	$20.50

GLUCOSE BODY FLUID EXCPT BLOOD

Facility

$25.00

Service Code	HCPCS 82945
Hospital Charge Code	8294500
Hospital Revenue Code	301
Min. Negotiated Rate	$11.55
Max. Negotiated Rate	$24.25
Rate for Payer: BCBS Commercial	$14.27
Rate for Payer: Cash Price	$18.75
Rate for Payer: Cash Price	$18.75
Rate for Payer: Celtic Commercial/Exchange	$11.55
Rate for Payer: Health Partners Plans Commercial	$23.75
Rate for Payer: UnitedHealthcare Commercial	$24.25
Rate for Payer: WPPA Commercial	$21.00

GLUCOSE BY MONITOR DEVICE

Facility

$10.00

Service Code	HCPCS 82962
Hospital Charge Code	8296200
Hospital Revenue Code	300
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$9.70
Rate for Payer: BCBS Commercial	$7.99
Rate for Payer: Cash Price	$7.50
Rate for Payer: Cash Price	$7.50
Rate for Payer: Celtic Commercial/Exchange	$4.62
Rate for Payer: Health Partners Plans Commercial	$9.50
Rate for Payer: UnitedHealthcare Commercial	$9.70
Rate for Payer: WPPA Commercial	$8.40

Know your out-of-pocket cost for care.

All Charges