Ness County Hospital

All Charges

Charge

Type

Setting

Price

APRESOLINE 10MG TAB(HYDRALAZINE)

Facility

$1.00

Service Code	NDC 00904644061
Hospital Charge Code	2510063
Hospital Revenue Code	250
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$1.27
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

APRESOLINE 10MG TAB(HYDRALAZINE)

Facility

$1.00

Service Code	NDC 00904644061
Hospital Charge Code	2510063
Hospital Revenue Code	250
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$1.27
Rate for Payer: Health Partners Plans Commercial	$0.95
Rate for Payer: UnitedHealthcare Commercial	$0.97
Rate for Payer: WPPA Commercial	$0.82

APRESOLINE 20 MG/ML INJ. (HYDRALAZINE)

Facility

$383.00

Service Code	NDC 67457029101
Hospital Charge Code	2505212
Hospital Revenue Code	250
Min. Negotiated Rate	$314.06
Max. Negotiated Rate	$371.51
Rate for Payer: Cash Price	$287.40
Rate for Payer: Health Partners Plans Commercial	$363.85
Rate for Payer: UnitedHealthcare Commercial	$371.51
Rate for Payer: WPPA Commercial	$314.06

APRESOLINE 20 MG/ML INJ. (HYDRALAZINE)

Facility

$383.00

Service Code	NDC 67457029101
Hospital Charge Code	2505212
Hospital Revenue Code	250
Min. Negotiated Rate	$176.95
Max. Negotiated Rate	$371.51
Rate for Payer: Cash Price	$287.40
Rate for Payer: Celtic Commercial/Exchange	$176.95
Rate for Payer: Health Partners Plans Commercial	$363.85
Rate for Payer: UnitedHealthcare Commercial	$371.51
Rate for Payer: WPPA Commercial	$321.72

APRESOLINE 25 MG TAB (HYDRALAZINE)

Facility

$1.00

Service Code	NDC 62584073311
Hospital Charge Code	2500585
Hospital Revenue Code	250
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.82
Rate for Payer: Health Partners Plans Commercial	$0.95
Rate for Payer: UnitedHealthcare Commercial	$0.97
Rate for Payer: WPPA Commercial	$0.82

APRESOLINE 25 MG TAB (HYDRALAZINE)

Facility

$1.00

Service Code	NDC 62584073311
Hospital Charge Code	2500585
Hospital Revenue Code	250
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.82
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

AQUACEL AG

Facility

$45.00

Hospital Charge Code	2726479
Hospital Revenue Code	272
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

AQUACEL AG

Facility

$45.00

Hospital Charge Code	2726479
Hospital Revenue Code	272
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

AQUACEL AG 3.5X10

Facility

$113.00

Hospital Charge Code	2726477
Hospital Revenue Code	272
Min. Negotiated Rate	$52.21
Max. Negotiated Rate	$109.61
Rate for Payer: Cash Price	$84.75
Rate for Payer: Celtic Commercial/Exchange	$52.21
Rate for Payer: Health Partners Plans Commercial	$107.35
Rate for Payer: UnitedHealthcare Commercial	$109.61
Rate for Payer: WPPA Commercial	$94.92

AQUACEL AG 3.5X10

Facility

$113.00

Hospital Charge Code	2726477
Hospital Revenue Code	272
Min. Negotiated Rate	$92.66
Max. Negotiated Rate	$109.61
Rate for Payer: Cash Price	$84.75
Rate for Payer: Health Partners Plans Commercial	$107.35
Rate for Payer: UnitedHealthcare Commercial	$109.61
Rate for Payer: WPPA Commercial	$92.66

AQUACEL AG ADV 4X5

Facility

$29.00

Hospital Charge Code	2726478
Hospital Revenue Code	272
Min. Negotiated Rate	$13.40
Max. Negotiated Rate	$28.13
Rate for Payer: Cash Price	$21.75
Rate for Payer: Celtic Commercial/Exchange	$13.40
Rate for Payer: Health Partners Plans Commercial	$27.55
Rate for Payer: UnitedHealthcare Commercial	$28.13
Rate for Payer: WPPA Commercial	$24.36

AQUACEL AG ADV 4X5

Facility

$29.00

Hospital Charge Code	2726478
Hospital Revenue Code	272
Min. Negotiated Rate	$23.78
Max. Negotiated Rate	$28.13
Rate for Payer: Cash Price	$21.75
Rate for Payer: Health Partners Plans Commercial	$27.55
Rate for Payer: UnitedHealthcare Commercial	$28.13
Rate for Payer: WPPA Commercial	$23.78

AQUACELL

Facility

$20.00

Hospital Charge Code	2728321
Hospital Revenue Code	272
Min. Negotiated Rate	$16.40
Max. Negotiated Rate	$19.40
Rate for Payer: Cash Price	$15.00
Rate for Payer: Health Partners Plans Commercial	$19.00
Rate for Payer: UnitedHealthcare Commercial	$19.40
Rate for Payer: WPPA Commercial	$16.40

AQUACELL

Facility

$20.00

Hospital Charge Code	2728321
Hospital Revenue Code	272
Min. Negotiated Rate	$9.24
Max. Negotiated Rate	$19.40
Rate for Payer: Cash Price	$15.00
Rate for Payer: Celtic Commercial/Exchange	$9.24
Rate for Payer: Health Partners Plans Commercial	$19.00
Rate for Payer: UnitedHealthcare Commercial	$19.40
Rate for Payer: WPPA Commercial	$16.80

AQUAFOAM

Facility

$8.00

Hospital Charge Code	2709411
Hospital Revenue Code	270
Min. Negotiated Rate	$3.70
Max. Negotiated Rate	$7.76
Rate for Payer: Cash Price	$6.00
Rate for Payer: Celtic Commercial/Exchange	$3.70
Rate for Payer: Health Partners Plans Commercial	$7.60
Rate for Payer: UnitedHealthcare Commercial	$7.76
Rate for Payer: WPPA Commercial	$6.72

AQUAFOAM

Facility

$8.00

Hospital Charge Code	2709411
Hospital Revenue Code	270
Min. Negotiated Rate	$6.56
Max. Negotiated Rate	$7.76
Rate for Payer: Cash Price	$6.00
Rate for Payer: Health Partners Plans Commercial	$7.60
Rate for Payer: UnitedHealthcare Commercial	$7.76
Rate for Payer: WPPA Commercial	$6.56

AQUAMEPHYTON INJ NEONAT 1MG/.5

Facility

$18.00

Hospital Charge Code	2500619
Hospital Revenue Code	250
Min. Negotiated Rate	$8.32
Max. Negotiated Rate	$17.46
Rate for Payer: Cash Price	$14.06
Rate for Payer: Celtic Commercial/Exchange	$8.32
Rate for Payer: Health Partners Plans Commercial	$17.10
Rate for Payer: UnitedHealthcare Commercial	$17.46
Rate for Payer: WPPA Commercial	$15.12

AQUAMEPHYTON INJ NEONAT 1MG/.5

Facility

$18.00

Hospital Charge Code	2500619
Hospital Revenue Code	250
Min. Negotiated Rate	$14.76
Max. Negotiated Rate	$17.46
Rate for Payer: Cash Price	$14.06
Rate for Payer: Health Partners Plans Commercial	$17.10
Rate for Payer: UnitedHealthcare Commercial	$17.46
Rate for Payer: WPPA Commercial	$14.76

Aquaphor Healing (white petrolatum) top ointment

Facility

$21.00

Service Code	NDC 72140063377
Hospital Charge Code	2512150
Hospital Revenue Code	250
Min. Negotiated Rate	$17.22
Max. Negotiated Rate	$20.37
Rate for Payer: Cash Price	$16.34
Rate for Payer: Health Partners Plans Commercial	$19.95
Rate for Payer: UnitedHealthcare Commercial	$20.37
Rate for Payer: WPPA Commercial	$17.22

Aquaphor Healing (white petrolatum) top ointment

Facility

$21.00

Service Code	NDC 72140063377
Hospital Charge Code	2512150
Hospital Revenue Code	250
Min. Negotiated Rate	$9.70
Max. Negotiated Rate	$20.37
Rate for Payer: Cash Price	$16.34
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

ARANESP 40 MCG INJ (NO DIALYSI

Facility

$3,213.00

Hospital Charge Code	2517175
Hospital Revenue Code	250
Min. Negotiated Rate	$2,634.66
Max. Negotiated Rate	$3,116.61
Rate for Payer: Cash Price	$2,410.02
Rate for Payer: Health Partners Plans Commercial	$3,052.35
Rate for Payer: UnitedHealthcare Commercial	$3,116.61
Rate for Payer: WPPA Commercial	$2,634.66

ARANESP 40 MCG INJ (NO DIALYSI

Facility

$3,213.00

Hospital Charge Code	2517175
Hospital Revenue Code	250
Min. Negotiated Rate	$1,484.41
Max. Negotiated Rate	$3,116.61
Rate for Payer: Cash Price	$2,410.02
Rate for Payer: Celtic Commercial/Exchange	$1,484.41
Rate for Payer: Health Partners Plans Commercial	$3,052.35
Rate for Payer: UnitedHealthcare Commercial	$3,116.61
Rate for Payer: WPPA Commercial	$2,698.92

ARANESP 60MCG INJECT (DIALYSIS

Facility

$1,389.00

Hospital Charge Code	2513738
Hospital Revenue Code	250
Min. Negotiated Rate	$641.72
Max. Negotiated Rate	$1,347.33
Rate for Payer: Cash Price	$1,041.94
Rate for Payer: Celtic Commercial/Exchange	$641.72
Rate for Payer: Health Partners Plans Commercial	$1,319.55
Rate for Payer: UnitedHealthcare Commercial	$1,347.33
Rate for Payer: WPPA Commercial	$1,166.76

ARANESP 60MCG INJECT (DIALYSIS

Facility

$1,389.00

Hospital Charge Code	2513738
Hospital Revenue Code	250
Min. Negotiated Rate	$1,138.98
Max. Negotiated Rate	$1,347.33
Rate for Payer: Cash Price	$1,041.94
Rate for Payer: Health Partners Plans Commercial	$1,319.55
Rate for Payer: UnitedHealthcare Commercial	$1,347.33
Rate for Payer: WPPA Commercial	$1,138.98

ARANESP 60MCG INJECT (NO DIALY

Facility

$1,389.00

Hospital Charge Code	2513737
Hospital Revenue Code	250
Min. Negotiated Rate	$1,138.98
Max. Negotiated Rate	$1,347.33
Rate for Payer: Cash Price	$1,041.94
Rate for Payer: Health Partners Plans Commercial	$1,319.55
Rate for Payer: UnitedHealthcare Commercial	$1,347.33
Rate for Payer: WPPA Commercial	$1,138.98

Know your out-of-pocket cost for care.

All Charges