Ness County Hospital

All Charges

Charge

Type

Setting

Price

WRIST SUPPORT

Facility

$19.00

Hospital Charge Code	2701282
Hospital Revenue Code	270
Min. Negotiated Rate	$15.58
Max. Negotiated Rate	$18.43
Rate for Payer: Cash Price	$14.81
Rate for Payer: Health Partners Plans Commercial	$18.05
Rate for Payer: UnitedHealthcare Commercial	$18.43
Rate for Payer: WPPA Commercial	$15.58

WRIST & THUMB SPLINT SM RIGHT

Facility

$25.00

Hospital Charge Code	2702335
Hospital Revenue Code	272
Min. Negotiated Rate	$20.50
Max. Negotiated Rate	$24.25
Rate for Payer: Cash Price	$18.75
Rate for Payer: Health Partners Plans Commercial	$23.75
Rate for Payer: UnitedHealthcare Commercial	$24.25
Rate for Payer: WPPA Commercial	$20.50

WRIST & THUMB SPLINT SM RIGHT

Facility

$25.00

Hospital Charge Code	2702335
Hospital Revenue Code	272
Min. Negotiated Rate	$11.55
Max. Negotiated Rate	$24.25
Rate for Payer: Cash Price	$18.75
Rate for Payer: Celtic Commercial/Exchange	$11.55
Rate for Payer: Health Partners Plans Commercial	$23.75
Rate for Payer: UnitedHealthcare Commercial	$24.25
Rate for Payer: WPPA Commercial	$21.00

WRIST & THUMB SPLINT SM/RIGHT

Facility

$25.00

Hospital Charge Code	2701015
Hospital Revenue Code	272
Min. Negotiated Rate	$20.50
Max. Negotiated Rate	$24.25
Rate for Payer: Cash Price	$18.75
Rate for Payer: Health Partners Plans Commercial	$23.75
Rate for Payer: UnitedHealthcare Commercial	$24.25
Rate for Payer: WPPA Commercial	$20.50

WRIST & THUMB SPLINT SM/RIGHT

Facility

$25.00

Hospital Charge Code	2701015
Hospital Revenue Code	272
Min. Negotiated Rate	$11.55
Max. Negotiated Rate	$24.25
Rate for Payer: Cash Price	$18.75
Rate for Payer: Celtic Commercial/Exchange	$11.55
Rate for Payer: Health Partners Plans Commercial	$23.75
Rate for Payer: UnitedHealthcare Commercial	$24.25
Rate for Payer: WPPA Commercial	$21.00

XANAX 0.25 MG TAB (ALPRAZOLAM)

Facility

$4.00

Service Code	NDC 49884011052
Hospital Charge Code	2509214
Hospital Revenue Code	250
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$3.41
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

XANAX 0.25 MG TAB (ALPRAZOLAM)

Facility

$4.00

Service Code	NDC 49884011052
Hospital Charge Code	2509214
Hospital Revenue Code	250
Min. Negotiated Rate	$3.28
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$3.41
Rate for Payer: Health Partners Plans Commercial	$3.80
Rate for Payer: UnitedHealthcare Commercial	$3.88
Rate for Payer: WPPA Commercial	$3.28

XANAX 0.5 MG TAB (ALPRAZOLAM)

Facility

$2.00

Service Code	NDC 00228202910
Hospital Charge Code	2507994
Hospital Revenue Code	250
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.91
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

XANAX 0.5 MG TAB (ALPRAZOLAM)

Facility

$2.00

Service Code	NDC 00228202910
Hospital Charge Code	2507994
Hospital Revenue Code	250
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.91
Rate for Payer: Health Partners Plans Commercial	$1.90
Rate for Payer: UnitedHealthcare Commercial	$1.94
Rate for Payer: WPPA Commercial	$1.64

XARELTO 10 MG TAB (RIVAROXABAN)

Facility

$59.00

Service Code	NDC 50458058030
Hospital Charge Code	2519031
Hospital Revenue Code	250
Min. Negotiated Rate	$48.38
Max. Negotiated Rate	$57.23
Rate for Payer: Cash Price	$44.32
Rate for Payer: Health Partners Plans Commercial	$56.05
Rate for Payer: UnitedHealthcare Commercial	$57.23
Rate for Payer: WPPA Commercial	$48.38

XARELTO 10 MG TAB (RIVAROXABAN)

Facility

$59.00

Service Code	NDC 50458058030
Hospital Charge Code	2519031
Hospital Revenue Code	250
Min. Negotiated Rate	$27.26
Max. Negotiated Rate	$57.23
Rate for Payer: Cash Price	$44.32
Rate for Payer: Celtic Commercial/Exchange	$27.26
Rate for Payer: Health Partners Plans Commercial	$56.05
Rate for Payer: UnitedHealthcare Commercial	$57.23
Rate for Payer: WPPA Commercial	$49.56

XEROFORM DRESSING

Facility

$14.00

Service Code	NDC 88844033605
Hospital Charge Code	2510659
Hospital Revenue Code	270
Min. Negotiated Rate	$11.48
Max. Negotiated Rate	$13.58
Rate for Payer: Cash Price	$11.10
Rate for Payer: Health Partners Plans Commercial	$13.30
Rate for Payer: UnitedHealthcare Commercial	$13.58
Rate for Payer: WPPA Commercial	$11.48

XEROFORM DRESSING

Facility

$14.00

Service Code	NDC 88844033605
Hospital Charge Code	2510659
Hospital Revenue Code	270
Min. Negotiated Rate	$6.47
Max. Negotiated Rate	$13.58
Rate for Payer: Cash Price	$11.10
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

XEROFORM OCCLUXIVE 2X2

Facility

$9.00

Hospital Charge Code	2725064
Hospital Revenue Code	272
Min. Negotiated Rate	$7.38
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$6.75
Rate for Payer: Health Partners Plans Commercial	$8.55
Rate for Payer: UnitedHealthcare Commercial	$8.73
Rate for Payer: WPPA Commercial	$7.38

XEROFORM OCCLUXIVE 2X2

Facility

$9.00

Hospital Charge Code	2725064
Hospital Revenue Code	272
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$6.75
Rate for Payer: Celtic Commercial/Exchange	$4.16
Rate for Payer: Health Partners Plans Commercial	$8.55
Rate for Payer: UnitedHealthcare Commercial	$8.73
Rate for Payer: WPPA Commercial	$7.56

XEROFORM OCCLUXIVE 5X9

Facility

$9.00

Hospital Charge Code	2725065
Hospital Revenue Code	272
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$6.75
Rate for Payer: Celtic Commercial/Exchange	$4.16
Rate for Payer: Health Partners Plans Commercial	$8.55
Rate for Payer: UnitedHealthcare Commercial	$8.73
Rate for Payer: WPPA Commercial	$7.56

XEROFORM OCCLUXIVE 5X9

Facility

$9.00

Hospital Charge Code	2725065
Hospital Revenue Code	272
Min. Negotiated Rate	$7.38
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$6.75
Rate for Payer: Health Partners Plans Commercial	$8.55
Rate for Payer: UnitedHealthcare Commercial	$8.73
Rate for Payer: WPPA Commercial	$7.38

Xgeva 120 mg/ 1.7 ml vial(denosumab)

Facility

$8,967.00

Service Code	NDC 55513073001
Hospital Charge Code	2519288
Hospital Revenue Code	250
Min. Negotiated Rate	$7,352.94
Max. Negotiated Rate	$8,697.99
Rate for Payer: Cash Price	$6,725.85
Rate for Payer: Health Partners Plans Commercial	$8,518.65
Rate for Payer: UnitedHealthcare Commercial	$8,697.99
Rate for Payer: WPPA Commercial	$7,352.94

Xgeva 120 mg/ 1.7 ml vial(denosumab)

Facility

$8,967.00

Service Code	NDC 55513073001
Hospital Charge Code	2519288
Hospital Revenue Code	250
Min. Negotiated Rate	$4,142.75
Max. Negotiated Rate	$8,697.99
Rate for Payer: Cash Price	$6,725.85
Rate for Payer: Celtic Commercial/Exchange	$4,142.75
Rate for Payer: Health Partners Plans Commercial	$8,518.65
Rate for Payer: UnitedHealthcare Commercial	$8,697.99
Rate for Payer: WPPA Commercial	$7,532.28

XOFLUZA 40 MG TAB (BALOXAVIR MARBOXIL)

Facility

$834.00

Service Code	NDC 50242086001
Hospital Charge Code	2510253
Hospital Revenue Code	250
Min. Negotiated Rate	$385.31
Max. Negotiated Rate	$808.98
Rate for Payer: Cash Price	$625.72
Rate for Payer: Celtic Commercial/Exchange	$385.31
Rate for Payer: Health Partners Plans Commercial	$792.30
Rate for Payer: UnitedHealthcare Commercial	$808.98
Rate for Payer: WPPA Commercial	$700.56

XOFLUZA 40 MG TAB (BALOXAVIR MARBOXIL)

Facility

$834.00

Service Code	NDC 50242086001
Hospital Charge Code	2510253
Hospital Revenue Code	250
Min. Negotiated Rate	$683.88
Max. Negotiated Rate	$808.98
Rate for Payer: Cash Price	$625.72
Rate for Payer: Health Partners Plans Commercial	$792.30
Rate for Payer: UnitedHealthcare Commercial	$808.98
Rate for Payer: WPPA Commercial	$683.88

XYZAL 5 MG TAB (LEVOCETIRIZINE)

Facility

$9.00

Service Code	NDC 42571012290
Hospital Charge Code	2510022
Hospital Revenue Code	250
Min. Negotiated Rate	$7.38
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$6.94
Rate for Payer: Health Partners Plans Commercial	$8.55
Rate for Payer: UnitedHealthcare Commercial	$8.73
Rate for Payer: WPPA Commercial	$7.38

XYZAL 5 MG TAB (LEVOCETIRIZINE)

Facility

$9.00

Service Code	NDC 42571012290
Hospital Charge Code	2510022
Hospital Revenue Code	250
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$6.94
Rate for Payer: Celtic Commercial/Exchange	$4.16
Rate for Payer: Health Partners Plans Commercial	$8.55
Rate for Payer: UnitedHealthcare Commercial	$8.73
Rate for Payer: WPPA Commercial	$7.56

ZANAFLEX 2 MG TAB (TIZANIDINE)

Facility

$5.00

Service Code	NDC 50268075911
Hospital Charge Code	2519437
Hospital Revenue Code	250
Min. Negotiated Rate	$4.10
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$3.94
Rate for Payer: Health Partners Plans Commercial	$4.75
Rate for Payer: UnitedHealthcare Commercial	$4.85
Rate for Payer: WPPA Commercial	$4.10

ZANAFLEX 2 MG TAB (TIZANIDINE)

Facility

$5.00

Service Code	NDC 50268075911
Hospital Charge Code	2519437
Hospital Revenue Code	250
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$3.94
Rate for Payer: Celtic Commercial/Exchange	$2.31
Rate for Payer: Health Partners Plans Commercial	$4.75
Rate for Payer: UnitedHealthcare Commercial	$4.85
Rate for Payer: WPPA Commercial	$4.20

Know your out-of-pocket cost for care.

All Charges