Ness County Hospital

All Charges

Charge

Type

Setting

Price

VAGINAL PACKING

Facility

$15.00

Hospital Charge Code	2720753
Hospital Revenue Code	272
Min. Negotiated Rate	$12.30
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$11.25
Rate for Payer: Health Partners Plans Commercial	$14.25
Rate for Payer: UnitedHealthcare Commercial	$14.55
Rate for Payer: WPPA Commercial	$12.30

VAGINAL SPECULA SM

Facility

$10.00

Hospital Charge Code	2700731
Hospital Revenue Code	270
Min. Negotiated Rate	$8.20
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$7.69
Rate for Payer: Health Partners Plans Commercial	$9.50
Rate for Payer: UnitedHealthcare Commercial	$9.70
Rate for Payer: WPPA Commercial	$8.20

VAGINAL SPECULA SM

Facility

$10.00

Hospital Charge Code	2700731
Hospital Revenue Code	270
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$7.69
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

VA HOME SUPP AIDE VISIT 1/4 HR

Facility

$7.00

Service Code	HCPCS G0156
Hospital Charge Code	5710015
Hospital Revenue Code	571
Min. Negotiated Rate	$5.74
Max. Negotiated Rate	$6.79
Rate for Payer: Cash Price	$5.25
Rate for Payer: Health Partners Plans Commercial	$6.65
Rate for Payer: UnitedHealthcare Commercial	$6.79
Rate for Payer: WPPA Commercial	$5.74

VA HOME SUPP AIDE VISIT 1/4 HR

Facility

$7.00

Service Code	HCPCS G0156
Hospital Charge Code	5710015
Hospital Revenue Code	571
Min. Negotiated Rate	$3.23
Max. Negotiated Rate	$6.79
Rate for Payer: Cash Price	$5.25
Rate for Payer: Celtic Commercial/Exchange	$3.23
Rate for Payer: Health Partners Plans Commercial	$6.65
Rate for Payer: UnitedHealthcare Commercial	$6.79
Rate for Payer: WPPA Commercial	$5.88

VALIUM 10 MG/2 ML (DIAZEPAM) INJ. CPJ.

Facility

$104.00

Service Code	NDC 00409127332
Hospital Charge Code	2507655
Hospital Revenue Code	250
Min. Negotiated Rate	$85.28
Max. Negotiated Rate	$100.88
Rate for Payer: Cash Price	$78.04
Rate for Payer: Health Partners Plans Commercial	$98.80
Rate for Payer: UnitedHealthcare Commercial	$100.88
Rate for Payer: WPPA Commercial	$85.28

VALIUM 10 MG/2 ML (DIAZEPAM) INJ. CPJ.

Facility

$104.00

Service Code	NDC 00409127332
Hospital Charge Code	2507655
Hospital Revenue Code	250
Min. Negotiated Rate	$48.05
Max. Negotiated Rate	$100.88
Rate for Payer: Cash Price	$78.04
Rate for Payer: Celtic Commercial/Exchange	$48.05
Rate for Payer: Health Partners Plans Commercial	$98.80
Rate for Payer: UnitedHealthcare Commercial	$100.88
Rate for Payer: WPPA Commercial	$87.36

VALIUM 5MG/1ML 10 ML VIAL

Facility

$13.00

Hospital Charge Code	2519643
Hospital Revenue Code	250
Min. Negotiated Rate	$6.01
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$9.86
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

VALIUM 5MG/1ML 10 ML VIAL

Facility

$13.00

Hospital Charge Code	2519643
Hospital Revenue Code	250
Min. Negotiated Rate	$10.66
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$9.86
Rate for Payer: Health Partners Plans Commercial	$12.35
Rate for Payer: UnitedHealthcare Commercial	$12.61
Rate for Payer: WPPA Commercial	$10.66

VALIUM 5 MG TAB (DIAZEPAM)

Facility

$1.00

Service Code	NDC 51079028520
Hospital Charge Code	2507671
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

VALIUM 5 MG TAB (DIAZEPAM)

Facility

$1.00

Service Code	NDC 51079028520
Hospital Charge Code	2507671
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

VALTREX 500 MG TAB (VALACYCLOVIR)

Facility

$24.00

Service Code	NDC 50268078815
Hospital Charge Code	2514305
Hospital Revenue Code	250
Min. Negotiated Rate	$19.68
Max. Negotiated Rate	$23.28
Rate for Payer: Cash Price	$18.49
Rate for Payer: Health Partners Plans Commercial	$22.80
Rate for Payer: UnitedHealthcare Commercial	$23.28
Rate for Payer: WPPA Commercial	$19.68

VALTREX 500 MG TAB (VALACYCLOVIR)

Facility

$24.00

Service Code	NDC 50268078815
Hospital Charge Code	2514305
Hospital Revenue Code	250
Min. Negotiated Rate	$11.09
Max. Negotiated Rate	$23.28
Rate for Payer: Cash Price	$18.49
Rate for Payer: Celtic Commercial/Exchange	$11.09
Rate for Payer: Health Partners Plans Commercial	$22.80
Rate for Payer: UnitedHealthcare Commercial	$23.28
Rate for Payer: WPPA Commercial	$20.16

VANCOMYCIN

Facility

$153.00

Service Code	HCPCS 80202
Hospital Charge Code	8020200
Hospital Revenue Code	301
Min. Negotiated Rate	$125.46
Max. Negotiated Rate	$148.41
Rate for Payer: Cash Price	$114.75
Rate for Payer: Health Partners Plans Commercial	$145.35
Rate for Payer: UnitedHealthcare Commercial	$148.41
Rate for Payer: WPPA Commercial	$125.46

VANCOMYCIN

Facility

$153.00

Service Code	HCPCS 80202
Hospital Charge Code	8020200
Hospital Revenue Code	301
Min. Negotiated Rate	$58.96
Max. Negotiated Rate	$148.41
Rate for Payer: BCBS Commercial	$58.96
Rate for Payer: Cash Price	$114.75
Rate for Payer: Cash Price	$114.75
Rate for Payer: Celtic Commercial/Exchange	$70.69
Rate for Payer: Health Partners Plans Commercial	$145.35
Rate for Payer: UnitedHealthcare Commercial	$148.41
Rate for Payer: WPPA Commercial	$128.52

VANCOMYCIN 1.25 GM/250 ML - PREMIX

Facility

$135.00

Service Code	NDC 70594005701
Hospital Charge Code	2519858
Hospital Revenue Code	250
Min. Negotiated Rate	$110.70
Max. Negotiated Rate	$130.95
Rate for Payer: Cash Price	$101.25
Rate for Payer: Health Partners Plans Commercial	$128.25
Rate for Payer: UnitedHealthcare Commercial	$130.95
Rate for Payer: WPPA Commercial	$110.70

VANCOMYCIN 1.25 GM/250 ML - PREMIX

Facility

$135.00

Service Code	NDC 70594005701
Hospital Charge Code	2519858
Hospital Revenue Code	250
Min. Negotiated Rate	$62.37
Max. Negotiated Rate	$130.95
Rate for Payer: Cash Price	$101.25
Rate for Payer: Celtic Commercial/Exchange	$62.37
Rate for Payer: Health Partners Plans Commercial	$128.25
Rate for Payer: UnitedHealthcare Commercial	$130.95
Rate for Payer: WPPA Commercial	$113.40

VANCOMYCIN 1.5 GM/300 ML - PREMIX

Facility

$162.00

Service Code	NDC 70594004301
Hospital Charge Code	2519650
Hospital Revenue Code	250
Min. Negotiated Rate	$74.84
Max. Negotiated Rate	$157.14
Rate for Payer: Cash Price	$121.50
Rate for Payer: Celtic Commercial/Exchange	$74.84
Rate for Payer: Health Partners Plans Commercial	$153.90
Rate for Payer: UnitedHealthcare Commercial	$157.14
Rate for Payer: WPPA Commercial	$136.08

VANCOMYCIN 1.5 GM/300 ML - PREMIX

Facility

$162.00

Service Code	NDC 70594004301
Hospital Charge Code	2519650
Hospital Revenue Code	250
Min. Negotiated Rate	$132.84
Max. Negotiated Rate	$157.14
Rate for Payer: Cash Price	$121.50
Rate for Payer: Health Partners Plans Commercial	$153.90
Rate for Payer: UnitedHealthcare Commercial	$157.14
Rate for Payer: WPPA Commercial	$132.84

VANCOMYCIN 1 GM/200 ML - PREMIX

Facility

$108.00

Service Code	NDC 70594004201
Hospital Charge Code	2519452
Hospital Revenue Code	250
Min. Negotiated Rate	$49.90
Max. Negotiated Rate	$104.76
Rate for Payer: Cash Price	$81.00
Rate for Payer: Celtic Commercial/Exchange	$49.90
Rate for Payer: Health Partners Plans Commercial	$102.60
Rate for Payer: UnitedHealthcare Commercial	$104.76
Rate for Payer: WPPA Commercial	$90.72

VANCOMYCIN 1 GM/200 ML - PREMIX

Facility

$108.00

Service Code	NDC 70594004201
Hospital Charge Code	2519452
Hospital Revenue Code	250
Min. Negotiated Rate	$88.56
Max. Negotiated Rate	$104.76
Rate for Payer: Cash Price	$81.00
Rate for Payer: Health Partners Plans Commercial	$102.60
Rate for Payer: UnitedHealthcare Commercial	$104.76
Rate for Payer: WPPA Commercial	$88.56

VANCOMYCIN 1 GM ADV

Facility

$77.00

Hospital Charge Code	2517092
Hospital Revenue Code	250
Min. Negotiated Rate	$35.57
Max. Negotiated Rate	$74.69
Rate for Payer: Cash Price	$58.12
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

VANCOMYCIN 1 GM ADV

Facility

$77.00

Hospital Charge Code	2517092
Hospital Revenue Code	250
Min. Negotiated Rate	$63.14
Max. Negotiated Rate	$74.69
Rate for Payer: Cash Price	$58.12
Rate for Payer: Health Partners Plans Commercial	$73.15
Rate for Payer: UnitedHealthcare Commercial	$74.69
Rate for Payer: WPPA Commercial	$63.14

VANCOMYCIN 1 GM INJ.

Facility

$69.00

Service Code	NDC 67457034001
Hospital Charge Code	2513216
Hospital Revenue Code	250
Min. Negotiated Rate	$31.88
Max. Negotiated Rate	$66.93
Rate for Payer: Cash Price	$52.12
Rate for Payer: Celtic Commercial/Exchange	$31.88
Rate for Payer: Health Partners Plans Commercial	$65.55
Rate for Payer: UnitedHealthcare Commercial	$66.93
Rate for Payer: WPPA Commercial	$57.96

VANCOMYCIN 1 GM INJ.

Facility

$69.00

Service Code	NDC 67457034001
Hospital Charge Code	2513216
Hospital Revenue Code	250
Min. Negotiated Rate	$56.58
Max. Negotiated Rate	$66.93
Rate for Payer: Cash Price	$52.12
Rate for Payer: Health Partners Plans Commercial	$65.55
Rate for Payer: UnitedHealthcare Commercial	$66.93
Rate for Payer: WPPA Commercial	$56.58

Know your out-of-pocket cost for care.

All Charges