Ness County Hospital

All Charges

Charge

Type

Setting

Price

Versed 5 mg/ml vial (midazolam)

Facility

$36.00

Service Code	NDC 00409230801
Hospital Charge Code	2509479
Hospital Revenue Code	250
Min. Negotiated Rate	$29.52
Max. Negotiated Rate	$34.92
Rate for Payer: Cash Price	$27.45
Rate for Payer: Health Partners Plans Commercial	$34.20
Rate for Payer: UnitedHealthcare Commercial	$34.92
Rate for Payer: WPPA Commercial	$29.52

Versed 5 mg/ml vial (midazolam)

Facility

$36.00

Service Code	NDC 00409230801
Hospital Charge Code	2509479
Hospital Revenue Code	250
Min. Negotiated Rate	$16.63
Max. Negotiated Rate	$34.92
Rate for Payer: Cash Price	$27.45
Rate for Payer: Celtic Commercial/Exchange	$16.63
Rate for Payer: Health Partners Plans Commercial	$34.20
Rate for Payer: UnitedHealthcare Commercial	$34.92
Rate for Payer: WPPA Commercial	$30.24

VERS FOAM DRESSING

Facility

$21.00

Hospital Charge Code	2725037
Hospital Revenue Code	272
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

VERS FOAM DRESSING

Facility

$21.00

Hospital Charge Code	2725037
Hospital Revenue Code	272
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

VIBRAMYCIN 50 MG CAP (DOXYCYCLINE HYCLATE)

Facility

$8.00

Service Code	NDC 50268027711
Hospital Charge Code	2519049
Hospital Revenue Code	250
Min. Negotiated Rate	$6.56
Max. Negotiated Rate	$7.76
Rate for Payer: Cash Price	$6.30
Rate for Payer: Health Partners Plans Commercial	$7.60
Rate for Payer: UnitedHealthcare Commercial	$7.76
Rate for Payer: WPPA Commercial	$6.56

VIBRAMYCIN 50 MG CAP (DOXYCYCLINE HYCLATE)

Facility

$8.00

Service Code	NDC 50268027711
Hospital Charge Code	2519049
Hospital Revenue Code	250
Min. Negotiated Rate	$3.70
Max. Negotiated Rate	$7.76
Rate for Payer: Cash Price	$6.30
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

VICRYL SUTURE

Facility

$10.00

Hospital Charge Code	2722411
Hospital Revenue Code	270
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$7.50
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

VICRYL SUTURE

Facility

$10.00

Hospital Charge Code	2722411
Hospital Revenue Code	270
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

VICRYL SUTURE-J392H

Facility

$10.00

Hospital Charge Code	2725278
Hospital Revenue Code	270
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$7.50
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

VICRYL SUTURE-J392H

Facility

$10.00

Hospital Charge Code	2725278
Hospital Revenue Code	270
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

VICRYL SUTURE-J493G

Facility

$15.00

Hospital Charge Code	2725396
Hospital Revenue Code	270
Min. Negotiated Rate	$6.93
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$11.25
Rate for Payer: Celtic Commercial/Exchange	$6.93
Rate for Payer: Health Partners Plans Commercial	$14.25
Rate for Payer: UnitedHealthcare Commercial	$14.55
Rate for Payer: WPPA Commercial	$12.60

VICRYL SUTURE-J493G

Facility

$15.00

Hospital Charge Code	2725396
Hospital Revenue Code	270
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

VIRAL ILLNESS WITH MCC

Facility

$11,884.86

Service Code	MSDRG 865
Min. Negotiated Rate	$11,884.86
Max. Negotiated Rate	$11,884.86
Rate for Payer: BCBS Commercial	$11,884.86

VIRAL ILLNESS WITHOUT MCC

Facility

$7,522.67

Service Code	MSDRG 866
Min. Negotiated Rate	$7,522.67
Max. Negotiated Rate	$7,522.67
Rate for Payer: BCBS Commercial	$7,522.67

VIRAL MENINGITIS WITH CC/MCC

Facility

$14,580.64

Service Code	MSDRG 075
Min. Negotiated Rate	$14,580.64
Max. Negotiated Rate	$14,580.64
Rate for Payer: BCBS Commercial	$14,580.64

VIRAL MENINGITIS WITHOUT CC/MCC

Facility

$8,741.48

Service Code	MSDRG 076
Min. Negotiated Rate	$8,741.48
Max. Negotiated Rate	$8,741.48
Rate for Payer: BCBS Commercial	$8,741.48

VIRUS ISOLAT CENTRIFUGE ENHANC

Facility

$88.00

Service Code	HCPCS 87254
Hospital Charge Code	8725400
Hospital Revenue Code	306
Min. Negotiated Rate	$40.66
Max. Negotiated Rate	$85.36
Rate for Payer: BCBS Commercial	$72.48
Rate for Payer: Cash Price	$66.00
Rate for Payer: Cash Price	$66.00
Rate for Payer: Celtic Commercial/Exchange	$40.66
Rate for Payer: Health Partners Plans Commercial	$83.60
Rate for Payer: UnitedHealthcare Commercial	$85.36
Rate for Payer: WPPA Commercial	$73.92

VIRUS ISOLAT CENTRIFUGE ENHANC

Facility

$88.00

Service Code	HCPCS 87254
Hospital Charge Code	8725400
Hospital Revenue Code	306
Min. Negotiated Rate	$72.16
Max. Negotiated Rate	$85.36
Rate for Payer: Cash Price	$66.00
Rate for Payer: Health Partners Plans Commercial	$83.60
Rate for Payer: UnitedHealthcare Commercial	$85.36
Rate for Payer: WPPA Commercial	$72.16

VIRUS ISOLATN ID NON-IMMUNOLOG

Facility

$133.00

Service Code	HCPCS 87255
Hospital Charge Code	8725500
Hospital Revenue Code	306
Min. Negotiated Rate	$61.45
Max. Negotiated Rate	$129.01
Rate for Payer: BCBS Commercial	$80.54
Rate for Payer: Cash Price	$99.75
Rate for Payer: Cash Price	$99.75
Rate for Payer: Celtic Commercial/Exchange	$61.45
Rate for Payer: Health Partners Plans Commercial	$126.35
Rate for Payer: UnitedHealthcare Commercial	$129.01
Rate for Payer: WPPA Commercial	$111.72

VIRUS ISOLATN ID NON-IMMUNOLOG

Facility

$133.00

Service Code	HCPCS 87255
Hospital Charge Code	8725500
Hospital Revenue Code	306
Min. Negotiated Rate	$109.06
Max. Negotiated Rate	$129.01
Rate for Payer: Cash Price	$99.75
Rate for Payer: Health Partners Plans Commercial	$126.35
Rate for Payer: UnitedHealthcare Commercial	$129.01
Rate for Payer: WPPA Commercial	$109.06

VIRUS ISOLAT,TISSUE CULT INOCU

Facility

$173.00

Service Code	HCPCS 87252
Hospital Charge Code	8725200
Hospital Revenue Code	306
Min. Negotiated Rate	$79.93
Max. Negotiated Rate	$167.81
Rate for Payer: BCBS Commercial	$93.01
Rate for Payer: Cash Price	$129.75
Rate for Payer: Cash Price	$129.75
Rate for Payer: Celtic Commercial/Exchange	$79.93
Rate for Payer: Health Partners Plans Commercial	$164.35
Rate for Payer: UnitedHealthcare Commercial	$167.81
Rate for Payer: WPPA Commercial	$145.32

VIRUS ISOLAT,TISSUE CULT INOCU

Facility

$173.00

Service Code	HCPCS 87252
Hospital Charge Code	8725200
Hospital Revenue Code	306
Min. Negotiated Rate	$141.86
Max. Negotiated Rate	$167.81
Rate for Payer: Cash Price	$129.75
Rate for Payer: Health Partners Plans Commercial	$164.35
Rate for Payer: UnitedHealthcare Commercial	$167.81
Rate for Payer: WPPA Commercial	$141.86

VISCOSITY

Facility

$60.00

Service Code	HCPCS 85810
Hospital Charge Code	8581000
Hospital Revenue Code	305
Min. Negotiated Rate	$27.72
Max. Negotiated Rate	$58.20
Rate for Payer: BCBS Commercial	$37.51
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Celtic Commercial/Exchange	$27.72
Rate for Payer: Health Partners Plans Commercial	$57.00
Rate for Payer: UnitedHealthcare Commercial	$58.20
Rate for Payer: WPPA Commercial	$50.40

VISCOSITY

Facility

$60.00

Service Code	HCPCS 85810
Hospital Charge Code	8581000
Hospital Revenue Code	305
Min. Negotiated Rate	$49.20
Max. Negotiated Rate	$58.20
Rate for Payer: Cash Price	$45.00
Rate for Payer: Health Partners Plans Commercial	$57.00
Rate for Payer: UnitedHealthcare Commercial	$58.20
Rate for Payer: WPPA Commercial	$49.20

VISTARIL 25 MG CAP (HYDROXYZINE PAMOATE)

Facility

$2.00

Service Code	NDC 60687069611
Hospital Charge Code	2507838
Hospital Revenue Code	250
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.88
Rate for Payer: Health Partners Plans Commercial	$1.90
Rate for Payer: UnitedHealthcare Commercial	$1.94
Rate for Payer: WPPA Commercial	$1.64

Know your out-of-pocket cost for care.

All Charges