Ness County Hospital

All Charges

Charge

Type

Setting

Price

GLUCOSE BY MONITOR DEVICE

Facility

$10.00

Service Code	HCPCS 82962
Hospital Charge Code	8296200
Hospital Revenue Code	300
Min. Negotiated Rate	$8.20
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$7.50
Rate for Payer: Health Partners Plans Commercial	$9.50
Rate for Payer: UnitedHealthcare Commercial	$9.70
Rate for Payer: WPPA Commercial	$8.20

GLUCOSE GESTATIONAL SCREEN 140

Facility

$58.00

Service Code	HCPCS 82950
Hospital Charge Code	8295001
Hospital Revenue Code	301
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

GLUCOSE GESTATIONAL SCREEN 140

Facility

$58.00

Service Code	HCPCS 82950
Hospital Charge Code	8295001
Hospital Revenue Code	301
Min. Negotiated Rate	$20.08
Max. Negotiated Rate	$56.26
Rate for Payer: BCBS Commercial	$20.08
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

GLUCOSE POST GLUCOSE DOSE

Facility

$38.00

Service Code	HCPCS 82950
Hospital Charge Code	8295000
Hospital Revenue Code	301
Min. Negotiated Rate	$17.56
Max. Negotiated Rate	$36.86
Rate for Payer: BCBS Commercial	$20.08
Rate for Payer: Cash Price	$28.50
Rate for Payer: Cash Price	$28.50
Rate for Payer: Celtic Commercial/Exchange	$17.56
Rate for Payer: Health Partners Plans Commercial	$36.10
Rate for Payer: UnitedHealthcare Commercial	$36.86
Rate for Payer: WPPA Commercial	$31.92

GLUCOSE POST GLUCOSE DOSE

Facility

$38.00

Service Code	HCPCS 82950
Hospital Charge Code	8295000
Hospital Revenue Code	301
Min. Negotiated Rate	$31.16
Max. Negotiated Rate	$36.86
Rate for Payer: Cash Price	$28.50
Rate for Payer: Health Partners Plans Commercial	$36.10
Rate for Payer: UnitedHealthcare Commercial	$36.86
Rate for Payer: WPPA Commercial	$31.16

GLUCOSE QUANT. BLOOD

Facility

$44.00

Service Code	HCPCS 82947
Hospital Charge Code	8294700
Hospital Revenue Code	301
Min. Negotiated Rate	$36.08
Max. Negotiated Rate	$42.68
Rate for Payer: Cash Price	$33.00
Rate for Payer: Health Partners Plans Commercial	$41.80
Rate for Payer: UnitedHealthcare Commercial	$42.68
Rate for Payer: WPPA Commercial	$36.08

GLUCOSE QUANT. BLOOD

Facility

$44.00

Service Code	HCPCS 82947
Hospital Charge Code	8294700
Hospital Revenue Code	301
Min. Negotiated Rate	$8.64
Max. Negotiated Rate	$42.68
Rate for Payer: BCBS Commercial	$8.64
Rate for Payer: Cash Price	$33.00
Rate for Payer: Cash Price	$33.00
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

GLUCOSE TOLERANCE,EA BEYND 3

Facility

$48.00

Service Code	HCPCS 82952
Hospital Charge Code	8295200
Hospital Revenue Code	301
Min. Negotiated Rate	$14.57
Max. Negotiated Rate	$46.56
Rate for Payer: BCBS Commercial	$14.57
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

GLUCOSE TOLERANCE,EA BEYND 3

Facility

$48.00

Service Code	HCPCS 82952
Hospital Charge Code	8295200
Hospital Revenue Code	301
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

GLUCOSE TOLERANCE TEST (GTT)

Facility

$86.00

Service Code	HCPCS 82951
Hospital Charge Code	8295100
Hospital Revenue Code	301
Min. Negotiated Rate	$39.73
Max. Negotiated Rate	$83.42
Rate for Payer: BCBS Commercial	$48.72
Rate for Payer: Cash Price	$64.50
Rate for Payer: Cash Price	$64.50
Rate for Payer: Celtic Commercial/Exchange	$39.73
Rate for Payer: Health Partners Plans Commercial	$81.70
Rate for Payer: UnitedHealthcare Commercial	$83.42
Rate for Payer: WPPA Commercial	$72.24

GLUCOSE TOLERANCE TEST (GTT)

Facility

$86.00

Service Code	HCPCS 82951
Hospital Charge Code	8295100
Hospital Revenue Code	301
Min. Negotiated Rate	$70.52
Max. Negotiated Rate	$83.42
Rate for Payer: Cash Price	$64.50
Rate for Payer: Health Partners Plans Commercial	$81.70
Rate for Payer: UnitedHealthcare Commercial	$83.42
Rate for Payer: WPPA Commercial	$70.52

GLUCOTROL 5MG TAB (GLIPIZIDE)

Facility

$4.00

Service Code	NDC 50268036111
Hospital Charge Code	2511236
Hospital Revenue Code	250
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$3.68
Rate for Payer: Celtic Commercial/Exchange	$1.85
Rate for Payer: Health Partners Plans Commercial	$3.80
Rate for Payer: UnitedHealthcare Commercial	$3.88
Rate for Payer: WPPA Commercial	$3.36

GLUCOTROL 5MG TAB (GLIPIZIDE)

Facility

$4.00

Service Code	NDC 50268036111
Hospital Charge Code	2511236
Hospital Revenue Code	250
Min. Negotiated Rate	$3.28
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$3.68
Rate for Payer: Health Partners Plans Commercial	$3.80
Rate for Payer: UnitedHealthcare Commercial	$3.88
Rate for Payer: WPPA Commercial	$3.28

GLUCOTROL XL 2.5 MG TAB (GLIPIZIDE)

Facility

$4.00

Service Code	NDC 00591090030
Hospital Charge Code	2502920
Hospital Revenue Code	250
Min. Negotiated Rate	$3.28
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$3.08
Rate for Payer: Health Partners Plans Commercial	$3.80
Rate for Payer: UnitedHealthcare Commercial	$3.88
Rate for Payer: WPPA Commercial	$3.28

GLUCOTROL XL 2.5 MG TAB (GLIPIZIDE)

Facility

$4.00

Service Code	NDC 00591090030
Hospital Charge Code	2502920
Hospital Revenue Code	250
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$3.08
Rate for Payer: Celtic Commercial/Exchange	$1.85
Rate for Payer: Health Partners Plans Commercial	$3.80
Rate for Payer: UnitedHealthcare Commercial	$3.88
Rate for Payer: WPPA Commercial	$3.36

GLUTAMYLTRANSFERASE, GAMMA(GGT

Facility

$74.00

Service Code	HCPCS 82977
Hospital Charge Code	8297700
Hospital Revenue Code	301
Min. Negotiated Rate	$60.68
Max. Negotiated Rate	$71.78
Rate for Payer: Cash Price	$55.50
Rate for Payer: Health Partners Plans Commercial	$70.30
Rate for Payer: UnitedHealthcare Commercial	$71.78
Rate for Payer: WPPA Commercial	$60.68

GLUTAMYLTRANSFERASE, GAMMA(GGT

Facility

$74.00

Service Code	HCPCS 82977
Hospital Charge Code	8297700
Hospital Revenue Code	301
Min. Negotiated Rate	$15.45
Max. Negotiated Rate	$71.78
Rate for Payer: BCBS Commercial	$15.45
Rate for Payer: Cash Price	$55.50
Rate for Payer: Cash Price	$55.50
Rate for Payer: Celtic Commercial/Exchange	$34.19
Rate for Payer: Health Partners Plans Commercial	$70.30
Rate for Payer: UnitedHealthcare Commercial	$71.78
Rate for Payer: WPPA Commercial	$62.16

GLUTOSE ORAL JEL 15 GM

Facility

$11.00

Service Code	NDC 05740006930
Hospital Charge Code	2513646
Hospital Revenue Code	250
Min. Negotiated Rate	$5.08
Max. Negotiated Rate	$10.67
Rate for Payer: Cash Price	$8.89
Rate for Payer: Celtic Commercial/Exchange	$5.08
Rate for Payer: Health Partners Plans Commercial	$10.45
Rate for Payer: UnitedHealthcare Commercial	$10.67
Rate for Payer: WPPA Commercial	$9.24

GLUTOSE ORAL JEL 15 GM

Facility

$11.00

Service Code	NDC 05740006930
Hospital Charge Code	2513646
Hospital Revenue Code	250
Min. Negotiated Rate	$9.02
Max. Negotiated Rate	$10.67
Rate for Payer: Cash Price	$8.89
Rate for Payer: Health Partners Plans Commercial	$10.45
Rate for Payer: UnitedHealthcare Commercial	$10.67
Rate for Payer: WPPA Commercial	$9.02

GLYCATED PROTEIN

Facility

$71.00

Service Code	HCPCS 82985
Hospital Charge Code	8298500
Hospital Revenue Code	301
Min. Negotiated Rate	$32.80
Max. Negotiated Rate	$68.87
Rate for Payer: BCBS Commercial	$41.53
Rate for Payer: Cash Price	$53.25
Rate for Payer: Cash Price	$53.25
Rate for Payer: Celtic Commercial/Exchange	$32.80
Rate for Payer: Health Partners Plans Commercial	$67.45
Rate for Payer: UnitedHealthcare Commercial	$68.87
Rate for Payer: WPPA Commercial	$59.64

GLYCATED PROTEIN

Facility

$71.00

Service Code	HCPCS 82985
Hospital Charge Code	8298500
Hospital Revenue Code	301
Min. Negotiated Rate	$58.22
Max. Negotiated Rate	$68.87
Rate for Payer: Cash Price	$53.25
Rate for Payer: Health Partners Plans Commercial	$67.45
Rate for Payer: UnitedHealthcare Commercial	$68.87
Rate for Payer: WPPA Commercial	$58.22

Glycerin Supp-Adult

Facility

$4.00

Service Code	NDC 46122022163
Hospital Charge Code	2509081
Hospital Revenue Code	250
Min. Negotiated Rate	$3.28
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$3.68
Rate for Payer: Health Partners Plans Commercial	$3.80
Rate for Payer: UnitedHealthcare Commercial	$3.88
Rate for Payer: WPPA Commercial	$3.28

Glycerin Supp-Adult

Facility

$4.00

Service Code	NDC 46122022163
Hospital Charge Code	2509081
Hospital Revenue Code	250
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$3.68
Rate for Payer: Celtic Commercial/Exchange	$1.85
Rate for Payer: Health Partners Plans Commercial	$3.80
Rate for Payer: UnitedHealthcare Commercial	$3.88
Rate for Payer: WPPA Commercial	$3.36

GLYDO (LIDOCAINE HCL JELLY) IN APPLICATOR

Facility

$35.00

Service Code	NDC 25021067376
Hospital Charge Code	2508042
Hospital Revenue Code	250
Min. Negotiated Rate	$16.17
Max. Negotiated Rate	$33.95
Rate for Payer: Cash Price	$26.40
Rate for Payer: Celtic Commercial/Exchange	$16.17
Rate for Payer: Health Partners Plans Commercial	$33.25
Rate for Payer: UnitedHealthcare Commercial	$33.95
Rate for Payer: WPPA Commercial	$29.40

GLYDO (LIDOCAINE HCL JELLY) IN APPLICATOR

Facility

$35.00

Service Code	NDC 25021067376
Hospital Charge Code	2508042
Hospital Revenue Code	250
Min. Negotiated Rate	$28.70
Max. Negotiated Rate	$33.95
Rate for Payer: Cash Price	$26.40
Rate for Payer: Health Partners Plans Commercial	$33.25
Rate for Payer: UnitedHealthcare Commercial	$33.95
Rate for Payer: WPPA Commercial	$28.70

Know your out-of-pocket cost for care.

All Charges