Ness County Hospital

All Charges

Charge

Type

Setting

Price

KNEE SUPPORT ELASTIC

Facility

$45.00

Hospital Charge Code	2701076
Hospital Revenue Code	270
Min. Negotiated Rate	$20.79
Max. Negotiated Rate	$43.65
Rate for Payer: Cash Price	$33.94
Rate for Payer: Celtic Commercial/Exchange	$20.79
Rate for Payer: Health Partners Plans Commercial	$42.75
Rate for Payer: UnitedHealthcare Commercial	$43.65
Rate for Payer: WPPA Commercial	$37.80

KNEE SUPPORT ELASTIC

Facility

$45.00

Hospital Charge Code	2701076
Hospital Revenue Code	270
Min. Negotiated Rate	$36.90
Max. Negotiated Rate	$43.65
Rate for Payer: Cash Price	$33.94
Rate for Payer: Health Partners Plans Commercial	$42.75
Rate for Payer: UnitedHealthcare Commercial	$43.65
Rate for Payer: WPPA Commercial	$36.90

KNEE SUPPORT OPEN PATELLA MD

Facility

$45.00

Hospital Charge Code	2701077
Hospital Revenue Code	270
Min. Negotiated Rate	$36.90
Max. Negotiated Rate	$43.65
Rate for Payer: Cash Price	$33.94
Rate for Payer: Health Partners Plans Commercial	$42.75
Rate for Payer: UnitedHealthcare Commercial	$43.65
Rate for Payer: WPPA Commercial	$36.90

KNEE SUPPORT OPEN PATELLA MD

Facility

$45.00

Hospital Charge Code	2701077
Hospital Revenue Code	270
Min. Negotiated Rate	$20.79
Max. Negotiated Rate	$43.65
Rate for Payer: Cash Price	$33.94
Rate for Payer: Celtic Commercial/Exchange	$20.79
Rate for Payer: Health Partners Plans Commercial	$42.75
Rate for Payer: UnitedHealthcare Commercial	$43.65
Rate for Payer: WPPA Commercial	$37.80

KNEE SUPPORT OPEN PATELLA XL

Facility

$45.00

Hospital Charge Code	2701078
Hospital Revenue Code	270
Min. Negotiated Rate	$36.90
Max. Negotiated Rate	$43.65
Rate for Payer: Cash Price	$33.94
Rate for Payer: Health Partners Plans Commercial	$42.75
Rate for Payer: UnitedHealthcare Commercial	$43.65
Rate for Payer: WPPA Commercial	$36.90

KNEE SUPPORT OPEN PATELLA XL

Facility

$45.00

Hospital Charge Code	2701078
Hospital Revenue Code	270
Min. Negotiated Rate	$20.79
Max. Negotiated Rate	$43.65
Rate for Payer: Cash Price	$33.94
Rate for Payer: Celtic Commercial/Exchange	$20.79
Rate for Payer: Health Partners Plans Commercial	$42.75
Rate for Payer: UnitedHealthcare Commercial	$43.65
Rate for Payer: WPPA Commercial	$37.80

KNEE SUPPORT W/REIN PAREL MD

Facility

$25.00

Hospital Charge Code	2701079
Hospital Revenue Code	270
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

KNEE SUPPORT W/REIN PAREL MD

Facility

$25.00

Hospital Charge Code	2701079
Hospital Revenue Code	270
Min. Negotiated Rate	$11.55
Max. Negotiated Rate	$24.25
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

KNEE SUPPORT W/REIN PATEL LG

Facility

$25.00

Hospital Charge Code	2701080
Hospital Revenue Code	270
Min. Negotiated Rate	$11.55
Max. Negotiated Rate	$24.25
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

KNEE SUPPORT W/REIN PATEL LG

Facility

$25.00

Hospital Charge Code	2701080
Hospital Revenue Code	270
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

KNIT PULL UP MD/L

Facility

$13.00

Hospital Charge Code	2706725
Hospital Revenue Code	272
Min. Negotiated Rate	$6.01
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$9.75
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

KNIT PULL UP MD/L

Facility

$13.00

Hospital Charge Code	2706725
Hospital Revenue Code	272
Min. Negotiated Rate	$10.66
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$9.75
Rate for Payer: Health Partners Plans Commercial	$12.35
Rate for Payer: UnitedHealthcare Commercial	$12.61
Rate for Payer: WPPA Commercial	$10.66

K-TAB 10 MEQ TAB (POTASSIUM CHLORIDE ER)

Facility

$1.00

Service Code	NDC 00245531689
Hospital Charge Code	2509131
Hospital Revenue Code	250
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$1.46
Rate for Payer: Health Partners Plans Commercial	$0.95
Rate for Payer: UnitedHealthcare Commercial	$0.97
Rate for Payer: WPPA Commercial	$0.82

K-TAB 10 MEQ TAB (POTASSIUM CHLORIDE ER)

Facility

$1.00

Service Code	NDC 00245531689
Hospital Charge Code	2509131
Hospital Revenue Code	250
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$1.46
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

KVL BLADE

Facility

$110.00

Hospital Charge Code	2726102
Hospital Revenue Code	270
Min. Negotiated Rate	$90.20
Max. Negotiated Rate	$106.70
Rate for Payer: Cash Price	$82.50
Rate for Payer: Health Partners Plans Commercial	$104.50
Rate for Payer: UnitedHealthcare Commercial	$106.70
Rate for Payer: WPPA Commercial	$90.20

KVL BLADE

Facility

$110.00

Hospital Charge Code	2726102
Hospital Revenue Code	270
Min. Negotiated Rate	$50.82
Max. Negotiated Rate	$106.70
Rate for Payer: Cash Price	$82.50
Rate for Payer: Celtic Commercial/Exchange	$50.82
Rate for Payer: Health Partners Plans Commercial	$104.50
Rate for Payer: UnitedHealthcare Commercial	$106.70
Rate for Payer: WPPA Commercial	$92.40

K-Y GEL 4 OZ. TUBE (SURGILUBE)

Facility

$17.00

Service Code	NDC 00281020537
Hospital Charge Code	2503647
Hospital Revenue Code	270
Min. Negotiated Rate	$7.85
Max. Negotiated Rate	$16.49
Rate for Payer: Cash Price	$13.39
Rate for Payer: Celtic Commercial/Exchange	$7.85
Rate for Payer: Health Partners Plans Commercial	$16.15
Rate for Payer: UnitedHealthcare Commercial	$16.49
Rate for Payer: WPPA Commercial	$14.28

K-Y GEL 4 OZ. TUBE (SURGILUBE)

Facility

$17.00

Service Code	NDC 00281020537
Hospital Charge Code	2503647
Hospital Revenue Code	270
Min. Negotiated Rate	$13.94
Max. Negotiated Rate	$16.49
Rate for Payer: Cash Price	$13.39
Rate for Payer: Health Partners Plans Commercial	$16.15
Rate for Payer: UnitedHealthcare Commercial	$16.49
Rate for Payer: WPPA Commercial	$13.94

K-Y GEL FOIL PACK (SURGICAL LUBRICANT )

Facility

$1.00

Service Code	NDC 00281020543
Hospital Charge Code	2513489
Hospital Revenue Code	270
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.75
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

K-Y GEL FOIL PACK (SURGICAL LUBRICANT )

Facility

$1.00

Service Code	NDC 00281020543
Hospital Charge Code	2513489
Hospital Revenue Code	270
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.75
Rate for Payer: Health Partners Plans Commercial	$0.95
Rate for Payer: UnitedHealthcare Commercial	$0.97
Rate for Payer: WPPA Commercial	$0.82

LABETALOL 200 MG/40 ML INJ. (FOR DRIP USE ORDER UNDER COMPOUND DRUGS) VIAL

Facility

$82.00

Service Code	NDC 36000032402
Hospital Charge Code	2515013
Hospital Revenue Code	250
Min. Negotiated Rate	$37.88
Max. Negotiated Rate	$79.54
Rate for Payer: Cash Price	$61.88
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

LABETALOL 200 MG/40 ML INJ. (FOR DRIP USE ORDER UNDER COMPOUND DRUGS) VIAL

Facility

$82.00

Service Code	NDC 36000032402
Hospital Charge Code	2515013
Hospital Revenue Code	250
Min. Negotiated Rate	$67.24
Max. Negotiated Rate	$79.54
Rate for Payer: Cash Price	$61.88
Rate for Payer: Health Partners Plans Commercial	$77.90
Rate for Payer: UnitedHealthcare Commercial	$79.54
Rate for Payer: WPPA Commercial	$67.24

LABETALOL 20 MG/4 ML INJ. CPJ. IV

Facility

$117.00

Service Code	NDC 00409233934
Hospital Charge Code	2518769
Hospital Revenue Code	250
Min. Negotiated Rate	$95.94
Max. Negotiated Rate	$113.49
Rate for Payer: Cash Price	$87.75
Rate for Payer: Health Partners Plans Commercial	$111.15
Rate for Payer: UnitedHealthcare Commercial	$113.49
Rate for Payer: WPPA Commercial	$95.94

LABETALOL 20 MG/4 ML INJ. CPJ. IV

Facility

$117.00

Service Code	NDC 00409233934
Hospital Charge Code	2518769
Hospital Revenue Code	250
Min. Negotiated Rate	$54.05
Max. Negotiated Rate	$113.49
Rate for Payer: Cash Price	$87.75
Rate for Payer: Celtic Commercial/Exchange	$54.05
Rate for Payer: Health Partners Plans Commercial	$111.15
Rate for Payer: UnitedHealthcare Commercial	$113.49
Rate for Payer: WPPA Commercial	$98.28

LAB- HIV

Facility

$80.00

Service Code	HCPCS 87390
Hospital Charge Code	8739000
Hospital Revenue Code	302
Min. Negotiated Rate	$36.96
Max. Negotiated Rate	$77.60
Rate for Payer: BCBS Commercial	$60.02
Rate for Payer: Cash Price	$60.00
Rate for Payer: Cash Price	$60.00
Rate for Payer: Celtic Commercial/Exchange	$36.96
Rate for Payer: Health Partners Plans Commercial	$76.00
Rate for Payer: UnitedHealthcare Commercial	$77.60
Rate for Payer: WPPA Commercial	$67.20

Know your out-of-pocket cost for care.

All Charges