Ness County Hospital

All Charges

Charge

Type

Setting

Price

VISTARIL 25 MG CAP (HYDROXYZINE PAMOATE)

Facility

$2.00

Service Code	NDC 60687069611
Hospital Charge Code	2507838
Hospital Revenue Code	250
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.88
Rate for Payer: Celtic Commercial/Exchange	$0.92
Rate for Payer: Health Partners Plans Commercial	$1.90
Rate for Payer: UnitedHealthcare Commercial	$1.94
Rate for Payer: WPPA Commercial	$1.68

VISTARIL 50 MG/ML (HYDROXYZINE HCL)

Facility

$87.00

Service Code	NDC 00517560125
Hospital Charge Code	2507861
Hospital Revenue Code	250
Min. Negotiated Rate	$71.34
Max. Negotiated Rate	$84.39
Rate for Payer: Cash Price	$65.96
Rate for Payer: Health Partners Plans Commercial	$82.65
Rate for Payer: UnitedHealthcare Commercial	$84.39
Rate for Payer: WPPA Commercial	$71.34

VISTARIL 50 MG/ML (HYDROXYZINE HCL)

Facility

$87.00

Service Code	NDC 00517560125
Hospital Charge Code	2507861
Hospital Revenue Code	250
Min. Negotiated Rate	$40.19
Max. Negotiated Rate	$84.39
Rate for Payer: Cash Price	$65.96
Rate for Payer: Celtic Commercial/Exchange	$40.19
Rate for Payer: Health Partners Plans Commercial	$82.65
Rate for Payer: UnitedHealthcare Commercial	$84.39
Rate for Payer: WPPA Commercial	$73.08

Vitamin A & D ointment (vits A and D-white pet-lanolin)

Facility

$14.00

Service Code	NDC 41100081122
Hospital Charge Code	2500007
Hospital Revenue Code	250
Min. Negotiated Rate	$11.48
Max. Negotiated Rate	$13.58
Rate for Payer: Cash Price	$10.95
Rate for Payer: Health Partners Plans Commercial	$13.30
Rate for Payer: UnitedHealthcare Commercial	$13.58
Rate for Payer: WPPA Commercial	$11.48

Vitamin A & D ointment (vits A and D-white pet-lanolin)

Facility

$14.00

Service Code	NDC 41100081122
Hospital Charge Code	2500007
Hospital Revenue Code	250
Min. Negotiated Rate	$6.47
Max. Negotiated Rate	$13.58
Rate for Payer: Cash Price	$10.95
Rate for Payer: Celtic Commercial/Exchange	$6.47
Rate for Payer: Health Partners Plans Commercial	$13.30
Rate for Payer: UnitedHealthcare Commercial	$13.58
Rate for Payer: WPPA Commercial	$11.76

VITAMIN A LAB

Facility

$129.00

Service Code	HCPCS 84590
Hospital Charge Code	8459000
Hospital Revenue Code	301
Min. Negotiated Rate	$46.89
Max. Negotiated Rate	$125.13
Rate for Payer: BCBS Commercial	$46.89
Rate for Payer: Cash Price	$96.75
Rate for Payer: Cash Price	$96.75
Rate for Payer: Celtic Commercial/Exchange	$59.60
Rate for Payer: Health Partners Plans Commercial	$122.55
Rate for Payer: UnitedHealthcare Commercial	$125.13
Rate for Payer: WPPA Commercial	$108.36

VITAMIN A LAB

Facility

$129.00

Service Code	HCPCS 84590
Hospital Charge Code	8459000
Hospital Revenue Code	301
Min. Negotiated Rate	$105.78
Max. Negotiated Rate	$125.13
Rate for Payer: Cash Price	$96.75
Rate for Payer: Health Partners Plans Commercial	$122.55
Rate for Payer: UnitedHealthcare Commercial	$125.13
Rate for Payer: WPPA Commercial	$105.78

VITAMIN B-12 INJ. 1000 MCG/ML (CYANOCOBALAMIN)

Facility

$38.00

Service Code	NDC 63323004401
Hospital Charge Code	2507887
Hospital Revenue Code	250
Min. Negotiated Rate	$17.56
Max. Negotiated Rate	$36.86
Rate for Payer: Cash Price	$28.50
Rate for Payer: Celtic Commercial/Exchange	$17.56
Rate for Payer: Health Partners Plans Commercial	$36.10
Rate for Payer: UnitedHealthcare Commercial	$36.86
Rate for Payer: WPPA Commercial	$31.92

VITAMIN B-12 INJ. 1000 MCG/ML (CYANOCOBALAMIN)

Facility

$38.00

Service Code	NDC 63323004401
Hospital Charge Code	2507887
Hospital Revenue Code	250
Min. Negotiated Rate	$31.16
Max. Negotiated Rate	$36.86
Rate for Payer: Cash Price	$28.50
Rate for Payer: Health Partners Plans Commercial	$36.10
Rate for Payer: UnitedHealthcare Commercial	$36.86
Rate for Payer: WPPA Commercial	$31.16

VITAMIN B-6 100 MG TAB (PYRIDOXINE HYDROCHLORIDE)

Facility

$1.00

Service Code	NDC 50268085915
Hospital Charge Code	2513596
Hospital Revenue Code	250
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

VITAMIN B-6 100 MG TAB (PYRIDOXINE HYDROCHLORIDE)

Facility

$1.00

Service Code	NDC 50268085915
Hospital Charge Code	2513596
Hospital Revenue Code	250
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

VITAMIN B6, PLASMA

Facility

$164.00

Service Code	HCPCS 84207
Hospital Charge Code	8420700
Hospital Revenue Code	301
Min. Negotiated Rate	$75.77
Max. Negotiated Rate	$159.08
Rate for Payer: BCBS Commercial	$140.52
Rate for Payer: Cash Price	$123.00
Rate for Payer: Cash Price	$123.00
Rate for Payer: Celtic Commercial/Exchange	$75.77
Rate for Payer: Health Partners Plans Commercial	$155.80
Rate for Payer: UnitedHealthcare Commercial	$159.08
Rate for Payer: WPPA Commercial	$137.76

VITAMIN B6, PLASMA

Facility

$164.00

Service Code	HCPCS 84207
Hospital Charge Code	8420700
Hospital Revenue Code	301
Min. Negotiated Rate	$134.48
Max. Negotiated Rate	$159.08
Rate for Payer: Cash Price	$123.00
Rate for Payer: Health Partners Plans Commercial	$155.80
Rate for Payer: UnitedHealthcare Commercial	$159.08
Rate for Payer: WPPA Commercial	$134.48

VITAMIN B COMPLEX 100 MG TAB

Facility

$1.00

Service Code	NDC 00536478701
Hospital Charge Code	2511079
Hospital Revenue Code	250
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

VITAMIN B COMPLEX 100 MG TAB

Facility

$1.00

Service Code	NDC 00536478701
Hospital Charge Code	2511079
Hospital Revenue Code	250
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

VITAMIN C 500 MG TAB (ASCORBIC ACID)

Facility

$1.00

Service Code	NDC 87701040739
Hospital Charge Code	2507895
Hospital Revenue Code	250
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

VITAMIN C 500 MG TAB (ASCORBIC ACID)

Facility

$1.00

Service Code	NDC 87701040739
Hospital Charge Code	2507895
Hospital Revenue Code	250
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

VITAMIN D-3 25 MCG (1000 IU) TAB

Facility

$1.00

Service Code	NDC 20555003300
Hospital Charge Code	2511616
Hospital Revenue Code	250
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

VITAMIN D-3 25 MCG (1000 IU) TAB

Facility

$1.00

Service Code	NDC 20555003300
Hospital Charge Code	2511616
Hospital Revenue Code	250
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

VITAMIN E (TOCOPHEROL)

Facility

$107.00

Service Code	HCPCS 84446
Hospital Charge Code	8444600
Hospital Revenue Code	301
Min. Negotiated Rate	$49.43
Max. Negotiated Rate	$103.79
Rate for Payer: BCBS Commercial	$56.23
Rate for Payer: Cash Price	$80.25
Rate for Payer: Cash Price	$80.25
Rate for Payer: Celtic Commercial/Exchange	$49.43
Rate for Payer: Health Partners Plans Commercial	$101.65
Rate for Payer: UnitedHealthcare Commercial	$103.79
Rate for Payer: WPPA Commercial	$89.88

VITAMIN E (TOCOPHEROL)

Facility

$107.00

Service Code	HCPCS 84446
Hospital Charge Code	8444600
Hospital Revenue Code	301
Min. Negotiated Rate	$87.74
Max. Negotiated Rate	$103.79
Rate for Payer: Cash Price	$80.25
Rate for Payer: Health Partners Plans Commercial	$101.65
Rate for Payer: UnitedHealthcare Commercial	$103.79
Rate for Payer: WPPA Commercial	$87.74

VITAMIN K 10 MG/ML INJ. (PHYTONADIONE)

Facility

$181.00

Service Code	NDC 00409915801
Hospital Charge Code	2500627
Hospital Revenue Code	250
Min. Negotiated Rate	$83.62
Max. Negotiated Rate	$175.57
Rate for Payer: Cash Price	$135.94
Rate for Payer: Celtic Commercial/Exchange	$83.62
Rate for Payer: Health Partners Plans Commercial	$171.95
Rate for Payer: UnitedHealthcare Commercial	$175.57
Rate for Payer: WPPA Commercial	$152.04

VITAMIN K 10 MG/ML INJ. (PHYTONADIONE)

Facility

$181.00

Service Code	NDC 00409915801
Hospital Charge Code	2500627
Hospital Revenue Code	250
Min. Negotiated Rate	$148.42
Max. Negotiated Rate	$175.57
Rate for Payer: Cash Price	$135.94
Rate for Payer: Health Partners Plans Commercial	$171.95
Rate for Payer: UnitedHealthcare Commercial	$175.57
Rate for Payer: WPPA Commercial	$148.42

VIT B-12; UNSATURATED BINDING

Facility

$50.00

Service Code	HCPCS 82608
Hospital Charge Code	8260800
Hospital Revenue Code	301
Min. Negotiated Rate	$41.00
Max. Negotiated Rate	$48.50
Rate for Payer: Cash Price	$37.50
Rate for Payer: Health Partners Plans Commercial	$47.50
Rate for Payer: UnitedHealthcare Commercial	$48.50
Rate for Payer: WPPA Commercial	$41.00

VIT B-12; UNSATURATED BINDING

Facility

$50.00

Service Code	HCPCS 82608
Hospital Charge Code	8260800
Hospital Revenue Code	301
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$48.50
Rate for Payer: BCBS Commercial	$37.41
Rate for Payer: Cash Price	$37.50
Rate for Payer: Cash Price	$37.50
Rate for Payer: Celtic Commercial/Exchange	$23.10
Rate for Payer: Health Partners Plans Commercial	$47.50
Rate for Payer: UnitedHealthcare Commercial	$48.50
Rate for Payer: WPPA Commercial	$42.00

Know your out-of-pocket cost for care.

All Charges