Ness County Hospital

All Charges

Charge

Type

Setting

Price

VOLATILES (ACETIC ANHYDRIDE,

Facility

$75.00

Service Code	HCPCS 84600
Hospital Charge Code	8460000
Hospital Revenue Code	301
Min. Negotiated Rate	$61.50
Max. Negotiated Rate	$72.75
Rate for Payer: Cash Price	$56.25
Rate for Payer: Health Partners Plans Commercial	$71.25
Rate for Payer: UnitedHealthcare Commercial	$72.75
Rate for Payer: WPPA Commercial	$61.50

VOLATILES (ACETIC ANHYDRIDE,

Facility

$75.00

Service Code	HCPCS 84600
Hospital Charge Code	8460000
Hospital Revenue Code	301
Min. Negotiated Rate	$34.65
Max. Negotiated Rate	$72.75
Rate for Payer: BCBS Commercial	$60.32
Rate for Payer: Cash Price	$56.25
Rate for Payer: Cash Price	$56.25
Rate for Payer: Celtic Commercial/Exchange	$34.65
Rate for Payer: Health Partners Plans Commercial	$71.25
Rate for Payer: UnitedHealthcare Commercial	$72.75
Rate for Payer: WPPA Commercial	$63.00

VOLTAREN 0.1 % - 2.5 ML OPTHALMIC SOLUTION (DICLOFENAC SODIUM)

Facility

$151.00

Service Code	NDC 61314001425
Hospital Charge Code	2510501
Hospital Revenue Code	250
Min. Negotiated Rate	$123.82
Max. Negotiated Rate	$146.47
Rate for Payer: Cash Price	$113.25
Rate for Payer: Health Partners Plans Commercial	$143.45
Rate for Payer: UnitedHealthcare Commercial	$146.47
Rate for Payer: WPPA Commercial	$123.82

VOLTAREN 0.1 % - 2.5 ML OPTHALMIC SOLUTION (DICLOFENAC SODIUM)

Facility

$151.00

Service Code	NDC 61314001425
Hospital Charge Code	2510501
Hospital Revenue Code	250
Min. Negotiated Rate	$69.76
Max. Negotiated Rate	$146.47
Rate for Payer: Cash Price	$113.25
Rate for Payer: Celtic Commercial/Exchange	$69.76
Rate for Payer: Health Partners Plans Commercial	$143.45
Rate for Payer: UnitedHealthcare Commercial	$146.47
Rate for Payer: WPPA Commercial	$126.84

VOLTAREN DR 50 MG TAB (DICLOFENAC)

Facility

$4.00

Service Code	NDC 61442010260
Hospital Charge Code	2518728
Hospital Revenue Code	250
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$3.34
Rate for Payer: Celtic Commercial/Exchange	$1.85
Rate for Payer: Health Partners Plans Commercial	$3.80
Rate for Payer: UnitedHealthcare Commercial	$3.88
Rate for Payer: WPPA Commercial	$3.36

VOLTAREN DR 50 MG TAB (DICLOFENAC)

Facility

$4.00

Service Code	NDC 61442010260
Hospital Charge Code	2518728
Hospital Revenue Code	250
Min. Negotiated Rate	$3.28
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$3.34
Rate for Payer: Health Partners Plans Commercial	$3.80
Rate for Payer: UnitedHealthcare Commercial	$3.88
Rate for Payer: WPPA Commercial	$3.28

VOLTAREN TOP GEL - 100 GM TUBE (DICLOFENAC SODIUM)

Facility

$194.00

Service Code	NDC 21922000909
Hospital Charge Code	2515203
Hospital Revenue Code	250
Min. Negotiated Rate	$159.08
Max. Negotiated Rate	$188.18
Rate for Payer: Cash Price	$145.84
Rate for Payer: Health Partners Plans Commercial	$184.30
Rate for Payer: UnitedHealthcare Commercial	$188.18
Rate for Payer: WPPA Commercial	$159.08

VOLTAREN TOP GEL - 100 GM TUBE (DICLOFENAC SODIUM)

Facility

$194.00

Service Code	NDC 21922000909
Hospital Charge Code	2515203
Hospital Revenue Code	250
Min. Negotiated Rate	$89.63
Max. Negotiated Rate	$188.18
Rate for Payer: Cash Price	$145.84
Rate for Payer: Celtic Commercial/Exchange	$89.63
Rate for Payer: Health Partners Plans Commercial	$184.30
Rate for Payer: UnitedHealthcare Commercial	$188.18
Rate for Payer: WPPA Commercial	$162.96

VON WILLEBRAND ANTIGEN,

Facility

$44.00

Service Code	HCPCS 85247
Hospital Charge Code	8524700
Hospital Revenue Code	305
Min. Negotiated Rate	$36.08
Max. Negotiated Rate	$42.68
Rate for Payer: Cash Price	$33.00
Rate for Payer: Health Partners Plans Commercial	$41.80
Rate for Payer: UnitedHealthcare Commercial	$42.68
Rate for Payer: WPPA Commercial	$36.08

VON WILLEBRAND ANTIGEN,

Facility

$44.00

Service Code	HCPCS 85247
Hospital Charge Code	8524700
Hospital Revenue Code	305
Min. Negotiated Rate	$18.59
Max. Negotiated Rate	$42.68
Rate for Payer: BCBS Commercial	$18.59
Rate for Payer: Cash Price	$33.00
Rate for Payer: Cash Price	$33.00
Rate for Payer: Celtic Commercial/Exchange	$20.33
Rate for Payer: Health Partners Plans Commercial	$41.80
Rate for Payer: UnitedHealthcare Commercial	$42.68
Rate for Payer: WPPA Commercial	$36.96

VON WILLEBRAND FACTOR ANTIGEN

Facility

$44.00

Service Code	HCPCS 85246
Hospital Charge Code	8524601
Hospital Revenue Code	305
Min. Negotiated Rate	$18.60
Max. Negotiated Rate	$42.68
Rate for Payer: BCBS Commercial	$18.60
Rate for Payer: Cash Price	$33.00
Rate for Payer: Cash Price	$33.00
Rate for Payer: Celtic Commercial/Exchange	$20.33
Rate for Payer: Health Partners Plans Commercial	$41.80
Rate for Payer: UnitedHealthcare Commercial	$42.68
Rate for Payer: WPPA Commercial	$36.96

VON WILLEBRAND FACTOR ANTIGEN

Facility

$44.00

Service Code	HCPCS 85246
Hospital Charge Code	8524601
Hospital Revenue Code	305
Min. Negotiated Rate	$36.08
Max. Negotiated Rate	$42.68
Rate for Payer: Cash Price	$33.00
Rate for Payer: Health Partners Plans Commercial	$41.80
Rate for Payer: UnitedHealthcare Commercial	$42.68
Rate for Payer: WPPA Commercial	$36.08

VON WILLEBRAND FACTOR COLLAGEN

Facility

$159.00

Service Code	HCPCS 83520
Hospital Charge Code	8352003
Hospital Revenue Code	301
Min. Negotiated Rate	$36.48
Max. Negotiated Rate	$154.23
Rate for Payer: BCBS Commercial	$36.48
Rate for Payer: Cash Price	$119.25
Rate for Payer: Cash Price	$119.25
Rate for Payer: Celtic Commercial/Exchange	$73.46
Rate for Payer: Health Partners Plans Commercial	$151.05
Rate for Payer: UnitedHealthcare Commercial	$154.23
Rate for Payer: WPPA Commercial	$133.56

VON WILLEBRAND FACTOR COLLAGEN

Facility

$159.00

Service Code	HCPCS 83520
Hospital Charge Code	8352003
Hospital Revenue Code	301
Min. Negotiated Rate	$130.38
Max. Negotiated Rate	$154.23
Rate for Payer: Cash Price	$119.25
Rate for Payer: Health Partners Plans Commercial	$151.05
Rate for Payer: UnitedHealthcare Commercial	$154.23
Rate for Payer: WPPA Commercial	$130.38

VORICONAZOLE

Facility

$108.00

Service Code	HCPCS 80299
Hospital Charge Code	8029914
Hospital Revenue Code	301
Min. Negotiated Rate	$49.90
Max. Negotiated Rate	$104.76
Rate for Payer: BCBS Commercial	$65.71
Rate for Payer: Cash Price	$81.00
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

VORICONAZOLE

Facility

$108.00

Service Code	HCPCS 80299
Hospital Charge Code	8029914
Hospital Revenue Code	301
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

VOSOL HC OTIC DROPS - 10 ML (HYDROCORTISONE + ACETIC ACID)

Facility

$677.00

Service Code	NDC 50383090110
Hospital Charge Code	2510790
Hospital Revenue Code	250
Min. Negotiated Rate	$312.77
Max. Negotiated Rate	$656.69
Rate for Payer: Cash Price	$507.98
Rate for Payer: Celtic Commercial/Exchange	$312.77
Rate for Payer: Health Partners Plans Commercial	$643.15
Rate for Payer: UnitedHealthcare Commercial	$656.69
Rate for Payer: WPPA Commercial	$568.68

VOSOL HC OTIC DROPS - 10 ML (HYDROCORTISONE + ACETIC ACID)

Facility

$677.00

Service Code	NDC 50383090110
Hospital Charge Code	2510790
Hospital Revenue Code	250
Min. Negotiated Rate	$555.14
Max. Negotiated Rate	$656.69
Rate for Payer: Cash Price	$507.98
Rate for Payer: Health Partners Plans Commercial	$643.15
Rate for Payer: UnitedHealthcare Commercial	$656.69
Rate for Payer: WPPA Commercial	$555.14

VRE(VANCO RESISTANT ENTER CULT

Facility

$44.00

Service Code	HCPCS 87081
Hospital Charge Code	8708103
Hospital Revenue Code	306
Min. Negotiated Rate	$36.08
Max. Negotiated Rate	$42.68
Rate for Payer: Cash Price	$33.00
Rate for Payer: Health Partners Plans Commercial	$41.80
Rate for Payer: UnitedHealthcare Commercial	$42.68
Rate for Payer: WPPA Commercial	$36.08

VRE(VANCO RESISTANT ENTER CULT

Facility

$44.00

Service Code	HCPCS 87081
Hospital Charge Code	8708103
Hospital Revenue Code	306
Min. Negotiated Rate	$20.33
Max. Negotiated Rate	$42.68
Rate for Payer: BCBS Commercial	$23.96
Rate for Payer: Cash Price	$33.00
Rate for Payer: Cash Price	$33.00
Rate for Payer: Celtic Commercial/Exchange	$20.33
Rate for Payer: Health Partners Plans Commercial	$41.80
Rate for Payer: UnitedHealthcare Commercial	$42.68
Rate for Payer: WPPA Commercial	$36.96

WALKER

Facility

$149.00

Hospital Charge Code	2910016
Hospital Revenue Code	290
Min. Negotiated Rate	$68.84
Max. Negotiated Rate	$144.53
Rate for Payer: Cash Price	$112.12
Rate for Payer: Celtic Commercial/Exchange	$68.84
Rate for Payer: Health Partners Plans Commercial	$141.55
Rate for Payer: UnitedHealthcare Commercial	$144.53
Rate for Payer: WPPA Commercial	$125.16

WALKER

Facility

$149.00

Hospital Charge Code	2910016
Hospital Revenue Code	290
Min. Negotiated Rate	$122.18
Max. Negotiated Rate	$144.53
Rate for Payer: Cash Price	$112.12
Rate for Payer: Health Partners Plans Commercial	$141.55
Rate for Payer: UnitedHealthcare Commercial	$144.53
Rate for Payer: WPPA Commercial	$122.18

WALKER MAXTRAX 2.0 AIR TALL LARGE

Facility

$136.00

Hospital Charge Code	2702398
Hospital Revenue Code	270
Min. Negotiated Rate	$111.52
Max. Negotiated Rate	$131.92
Rate for Payer: Cash Price	$102.00
Rate for Payer: Health Partners Plans Commercial	$129.20
Rate for Payer: UnitedHealthcare Commercial	$131.92
Rate for Payer: WPPA Commercial	$111.52

WALKER MAXTRAX 2.0 AIR TALL LARGE

Facility

$136.00

Hospital Charge Code	2702398
Hospital Revenue Code	270
Min. Negotiated Rate	$62.83
Max. Negotiated Rate	$131.92
Rate for Payer: Cash Price	$102.00
Rate for Payer: Celtic Commercial/Exchange	$62.83
Rate for Payer: Health Partners Plans Commercial	$129.20
Rate for Payer: UnitedHealthcare Commercial	$131.92
Rate for Payer: WPPA Commercial	$114.24

WALKER MAXTRAX 2.0 AIR TALL MEDIUM

Facility

$136.00

Hospital Charge Code	2702397
Hospital Revenue Code	270
Min. Negotiated Rate	$62.83
Max. Negotiated Rate	$131.92
Rate for Payer: Cash Price	$102.00
Rate for Payer: Celtic Commercial/Exchange	$62.83
Rate for Payer: Health Partners Plans Commercial	$129.20
Rate for Payer: UnitedHealthcare Commercial	$131.92
Rate for Payer: WPPA Commercial	$114.24

Know your out-of-pocket cost for care.

All Charges