Ness County Hospital

All Charges

Charge

Type

Setting

Price

NORMAL SALINE INJ 50 ML IV

Facility

$48.00

Service Code	NDC 00990798436
Hospital Charge Code	2580140
Hospital Revenue Code	258
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

NORMAL SALINE INJ 50 ML IV

Facility

$48.00

Service Code	NDC 00990798436
Hospital Charge Code	2580140
Hospital Revenue Code	258
Min. Negotiated Rate	$22.18
Max. Negotiated Rate	$46.56
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

NORMAL SALINE IRRIGATION 1000 ML

Facility

$21.00

Service Code	NDC 00990713809
Hospital Charge Code	2518124
Hospital Revenue Code	250
Min. Negotiated Rate	$9.70
Max. Negotiated Rate	$20.37
Rate for Payer: Cash Price	$15.79
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

NORMAL SALINE IRRIGATION 1000 ML

Facility

$21.00

Service Code	NDC 00990713809
Hospital Charge Code	2518124
Hospital Revenue Code	250
Min. Negotiated Rate	$17.22
Max. Negotiated Rate	$20.37
Rate for Payer: Cash Price	$15.79
Rate for Payer: Health Partners Plans Commercial	$19.95
Rate for Payer: UnitedHealthcare Commercial	$20.37
Rate for Payer: WPPA Commercial	$17.22

NORMAL SALINE IRRIGATION 500 ML

Facility

$13.00

Service Code	NDC 00338004803
Hospital Charge Code	2512515
Hospital Revenue Code	250
Min. Negotiated Rate	$6.01
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$10.42
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

NORMAL SALINE IRRIGATION 500 ML

Facility

$13.00

Service Code	NDC 00338004803
Hospital Charge Code	2512515
Hospital Revenue Code	250
Min. Negotiated Rate	$10.66
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$10.42
Rate for Payer: Health Partners Plans Commercial	$12.35
Rate for Payer: UnitedHealthcare Commercial	$12.61
Rate for Payer: WPPA Commercial	$10.66

Normal saline with 20mEq KCL - 1,000 ml bag

Facility

$80.00

Service Code	NDC 00990711509
Hospital Charge Code	2518140
Hospital Revenue Code	250
Min. Negotiated Rate	$36.96
Max. Negotiated Rate	$77.60
Rate for Payer: Cash Price	$60.56
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

Normal saline with 20mEq KCL - 1,000 ml bag

Facility

$80.00

Service Code	NDC 00990711509
Hospital Charge Code	2518140
Hospital Revenue Code	250
Min. Negotiated Rate	$65.60
Max. Negotiated Rate	$77.60
Rate for Payer: Cash Price	$60.56
Rate for Payer: Health Partners Plans Commercial	$76.00
Rate for Payer: UnitedHealthcare Commercial	$77.60
Rate for Payer: WPPA Commercial	$65.60

Normal Saline with 40mEq KCL - 1,000 ml bag

Facility

$80.00

Service Code	NDC 00990711609
Hospital Charge Code	2518777
Hospital Revenue Code	250
Min. Negotiated Rate	$65.60
Max. Negotiated Rate	$77.60
Rate for Payer: Cash Price	$60.56
Rate for Payer: Health Partners Plans Commercial	$76.00
Rate for Payer: UnitedHealthcare Commercial	$77.60
Rate for Payer: WPPA Commercial	$65.60

Normal Saline with 40mEq KCL - 1,000 ml bag

Facility

$80.00

Service Code	NDC 00990711609
Hospital Charge Code	2518777
Hospital Revenue Code	250
Min. Negotiated Rate	$36.96
Max. Negotiated Rate	$77.60
Rate for Payer: Cash Price	$60.56
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

NORMAL STERILE SALINE 250 ML IRRIGATION

Facility

$19.00

Service Code	NDC 00990613822
Hospital Charge Code	2515518
Hospital Revenue Code	250
Min. Negotiated Rate	$8.78
Max. Negotiated Rate	$18.43
Rate for Payer: Cash Price	$14.77
Rate for Payer: Celtic Commercial/Exchange	$8.78
Rate for Payer: Health Partners Plans Commercial	$18.05
Rate for Payer: UnitedHealthcare Commercial	$18.43
Rate for Payer: WPPA Commercial	$15.96

NORMAL STERILE SALINE 250 ML IRRIGATION

Facility

$19.00

Service Code	NDC 00990613822
Hospital Charge Code	2515518
Hospital Revenue Code	250
Min. Negotiated Rate	$15.58
Max. Negotiated Rate	$18.43
Rate for Payer: Cash Price	$14.77
Rate for Payer: Health Partners Plans Commercial	$18.05
Rate for Payer: UnitedHealthcare Commercial	$18.43
Rate for Payer: WPPA Commercial	$15.58

NORMODYNE 100 MG TAB (LABETALOL HCL)

Facility

$6.00

Service Code	NDC 60687043911
Hospital Charge Code	2512010
Hospital Revenue Code	250
Min. Negotiated Rate	$2.77
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$5.14
Rate for Payer: Celtic Commercial/Exchange	$2.77
Rate for Payer: Health Partners Plans Commercial	$5.70
Rate for Payer: UnitedHealthcare Commercial	$5.82
Rate for Payer: WPPA Commercial	$5.04

NORMODYNE 100 MG TAB (LABETALOL HCL)

Facility

$6.00

Service Code	NDC 60687043911
Hospital Charge Code	2512010
Hospital Revenue Code	250
Min. Negotiated Rate	$4.92
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$5.14
Rate for Payer: Health Partners Plans Commercial	$5.70
Rate for Payer: UnitedHealthcare Commercial	$5.82
Rate for Payer: WPPA Commercial	$4.92

NORVASC 5 MG TAB (AMLODIPINE BESYLATE)

Facility

$10.00

Service Code	NDC 60687048811
Hospital Charge Code	2511954
Hospital Revenue Code	250
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$7.84
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

NORVASC 5 MG TAB (AMLODIPINE BESYLATE)

Facility

$10.00

Service Code	NDC 60687048811
Hospital Charge Code	2511954
Hospital Revenue Code	250
Min. Negotiated Rate	$8.20
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$7.84
Rate for Payer: Health Partners Plans Commercial	$9.50
Rate for Payer: UnitedHealthcare Commercial	$9.70
Rate for Payer: WPPA Commercial	$8.20

NOSE SPLINTS

Facility

$13.00

Hospital Charge Code	2701407
Hospital Revenue Code	270
Min. Negotiated Rate	$10.66
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$10.31
Rate for Payer: Health Partners Plans Commercial	$12.35
Rate for Payer: UnitedHealthcare Commercial	$12.61
Rate for Payer: WPPA Commercial	$10.66

NOSE SPLINTS

Facility

$13.00

Hospital Charge Code	2701407
Hospital Revenue Code	270
Min. Negotiated Rate	$6.01
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$10.31
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

NOVASOURCE, PER CAN

Facility

$1.00

Hospital Charge Code	9998878
Hospital Revenue Code	990
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$1.05
Rate for Payer: Health Partners Plans Commercial	$0.95
Rate for Payer: UnitedHealthcare Commercial	$0.97
Rate for Payer: WPPA Commercial	$0.82

NOVASOURCE, PER CAN

Facility

$1.00

Hospital Charge Code	9998878
Hospital Revenue Code	990
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$1.05
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

NOVOLIN 70/30 INSULIN PEN

Facility

$66.00

Hospital Charge Code	2513075
Hospital Revenue Code	250
Min. Negotiated Rate	$30.49
Max. Negotiated Rate	$64.02
Rate for Payer: Cash Price	$49.50
Rate for Payer: Celtic Commercial/Exchange	$30.49
Rate for Payer: Health Partners Plans Commercial	$62.70
Rate for Payer: UnitedHealthcare Commercial	$64.02
Rate for Payer: WPPA Commercial	$55.44

NOVOLIN 70/30 INSULIN PEN

Facility

$66.00

Hospital Charge Code	2513075
Hospital Revenue Code	250
Min. Negotiated Rate	$54.12
Max. Negotiated Rate	$64.02
Rate for Payer: Cash Price	$49.50
Rate for Payer: Health Partners Plans Commercial	$62.70
Rate for Payer: UnitedHealthcare Commercial	$64.02
Rate for Payer: WPPA Commercial	$54.12

NSS-IRRIG 1500ML STERILE

Facility

$27.00

Hospital Charge Code	2507929
Hospital Revenue Code	250
Min. Negotiated Rate	$12.47
Max. Negotiated Rate	$26.19
Rate for Payer: Cash Price	$20.29
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

NSS-IRRIG 1500ML STERILE

Facility

$27.00

Hospital Charge Code	2507929
Hospital Revenue Code	250
Min. Negotiated Rate	$22.14
Max. Negotiated Rate	$26.19
Rate for Payer: Cash Price	$20.29
Rate for Payer: Health Partners Plans Commercial	$25.65
Rate for Payer: UnitedHealthcare Commercial	$26.19
Rate for Payer: WPPA Commercial	$22.14

NUBAIN 10 MG/ML

Facility

$13.00

Hospital Charge Code	2519809
Hospital Revenue Code	250
Min. Negotiated Rate	$6.01
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$10.28
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

Know your out-of-pocket cost for care.

All Charges