Ness County Hospital

All Charges

Charge

Type

Setting

Price

D5 1/4 NS 1000ml

Facility

$66.00

Service Code	NDC 00990792409
Hospital Charge Code	2580454
Hospital Revenue Code	258
Min. Negotiated Rate	$30.49
Max. Negotiated Rate	$64.02
Rate for Payer: Cash Price	$49.95
Rate for Payer: Celtic Commercial/Exchange	$30.49
Rate for Payer: Health Partners Plans Commercial	$62.70
Rate for Payer: UnitedHealthcare Commercial	$64.02
Rate for Payer: WPPA Commercial	$55.44

D5 1/4 NSS 500 ml

Facility

$65.00

Service Code	NDC 00409792403
Hospital Charge Code	2518488
Hospital Revenue Code	258
Min. Negotiated Rate	$30.03
Max. Negotiated Rate	$63.05
Rate for Payer: Cash Price	$49.12
Rate for Payer: Celtic Commercial/Exchange	$30.03
Rate for Payer: Health Partners Plans Commercial	$61.75
Rate for Payer: UnitedHealthcare Commercial	$63.05
Rate for Payer: WPPA Commercial	$54.60

D5 1/4 NSS 500 ml

Facility

$65.00

Service Code	NDC 00409792403
Hospital Charge Code	2518488
Hospital Revenue Code	258
Min. Negotiated Rate	$53.30
Max. Negotiated Rate	$63.05
Rate for Payer: Cash Price	$49.12
Rate for Payer: Health Partners Plans Commercial	$61.75
Rate for Payer: UnitedHealthcare Commercial	$63.05
Rate for Payer: WPPA Commercial	$53.30

D5LR 1000 ML IV

Facility

$77.00

Service Code	NDC 00990792909
Hospital Charge Code	2580058
Hospital Revenue Code	258
Min. Negotiated Rate	$35.57
Max. Negotiated Rate	$74.69
Rate for Payer: Cash Price	$58.35
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

D5LR 1000 ML IV

Facility

$77.00

Service Code	NDC 00990792909
Hospital Charge Code	2580058
Hospital Revenue Code	258
Min. Negotiated Rate	$63.14
Max. Negotiated Rate	$74.69
Rate for Payer: Cash Price	$58.35
Rate for Payer: Health Partners Plans Commercial	$73.15
Rate for Payer: UnitedHealthcare Commercial	$74.69
Rate for Payer: WPPA Commercial	$63.14

D5 NS 500 ml inj.

Facility

$57.00

Service Code	NDC 00409794103
Hospital Charge Code	2517746
Hospital Revenue Code	258
Min. Negotiated Rate	$26.33
Max. Negotiated Rate	$55.29
Rate for Payer: Cash Price	$43.12
Rate for Payer: Celtic Commercial/Exchange	$26.33
Rate for Payer: Health Partners Plans Commercial	$54.15
Rate for Payer: UnitedHealthcare Commercial	$55.29
Rate for Payer: WPPA Commercial	$47.88

D5 NS 500 ml inj.

Facility

$57.00

Service Code	NDC 00409794103
Hospital Charge Code	2517746
Hospital Revenue Code	258
Min. Negotiated Rate	$46.74
Max. Negotiated Rate	$55.29
Rate for Payer: Cash Price	$43.12
Rate for Payer: Health Partners Plans Commercial	$54.15
Rate for Payer: UnitedHealthcare Commercial	$55.29
Rate for Payer: WPPA Commercial	$46.74

D5 NS INJ 1000 ML IV

Facility

$70.00

Service Code	HCPCS J7042
Hospital Charge Code	2580066
Hospital Revenue Code	636
Min. Negotiated Rate	$57.40
Max. Negotiated Rate	$67.90
Rate for Payer: Cash Price	$53.03
Rate for Payer: Health Partners Plans Commercial	$66.50
Rate for Payer: UnitedHealthcare Commercial	$67.90
Rate for Payer: WPPA Commercial	$57.40

D5 NS INJ 1000 ML IV

Facility

$70.00

Service Code	HCPCS J7042
Hospital Charge Code	2580066
Hospital Revenue Code	636
Min. Negotiated Rate	$1.62
Max. Negotiated Rate	$67.90
Rate for Payer: BCBS Commercial	$1.62
Rate for Payer: Cash Price	$53.03
Rate for Payer: Cash Price	$53.03
Rate for Payer: Celtic Commercial/Exchange	$32.34
Rate for Payer: Health Partners Plans Commercial	$66.50
Rate for Payer: UnitedHealthcare Commercial	$67.90
Rate for Payer: WPPA Commercial	$58.80

D5 NSS with 20 mEq KCL - 1,000 ml bag

Facility

$74.00

Service Code	NDC 00990710709
Hospital Charge Code	2518181
Hospital Revenue Code	258
Min. Negotiated Rate	$34.19
Max. Negotiated Rate	$71.78
Rate for Payer: Cash Price	$56.03
Rate for Payer: Celtic Commercial/Exchange	$34.19
Rate for Payer: Health Partners Plans Commercial	$70.30
Rate for Payer: UnitedHealthcare Commercial	$71.78
Rate for Payer: WPPA Commercial	$62.16

D5 NSS with 20 mEq KCL - 1,000 ml bag

Facility

$74.00

Service Code	NDC 00990710709
Hospital Charge Code	2518181
Hospital Revenue Code	258
Min. Negotiated Rate	$60.68
Max. Negotiated Rate	$71.78
Rate for Payer: Cash Price	$56.03
Rate for Payer: Health Partners Plans Commercial	$70.30
Rate for Payer: UnitedHealthcare Commercial	$71.78
Rate for Payer: WPPA Commercial	$60.68

D5 NSS with 40 mEq KCL - 1,000 ml bag

Facility

$75.00

Service Code	NDC 00409710909
Hospital Charge Code	2518199
Hospital Revenue Code	258
Min. Negotiated Rate	$34.65
Max. Negotiated Rate	$72.75
Rate for Payer: Cash Price	$56.78
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

D5 NSS with 40 mEq KCL - 1,000 ml bag

Facility

$75.00

Service Code	NDC 00409710909
Hospital Charge Code	2518199
Hospital Revenue Code	258
Min. Negotiated Rate	$61.50
Max. Negotiated Rate	$72.75
Rate for Payer: Cash Price	$56.78
Rate for Payer: Health Partners Plans Commercial	$71.25
Rate for Payer: UnitedHealthcare Commercial	$72.75
Rate for Payer: WPPA Commercial	$61.50

D5W 100 ml IV mini-bag

Facility

$50.00

Service Code	NDC 00338001748
Hospital Charge Code	2518330
Hospital Revenue Code	258
Min. Negotiated Rate	$41.00
Max. Negotiated Rate	$48.50
Rate for Payer: Cash Price	$37.80
Rate for Payer: Health Partners Plans Commercial	$47.50
Rate for Payer: UnitedHealthcare Commercial	$48.50
Rate for Payer: WPPA Commercial	$41.00

D5W 100 ml IV mini-bag

Facility

$50.00

Service Code	NDC 00338001748
Hospital Charge Code	2518330
Hospital Revenue Code	258
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$48.50
Rate for Payer: Cash Price	$37.80
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

D5W 50 ml IV mini-bag

Facility

$60.00

Service Code	NDC 00338001741
Hospital Charge Code	2518348
Hospital Revenue Code	258
Min. Negotiated Rate	$49.20
Max. Negotiated Rate	$58.20
Rate for Payer: Cash Price	$45.68
Rate for Payer: Health Partners Plans Commercial	$57.00
Rate for Payer: UnitedHealthcare Commercial	$58.20
Rate for Payer: WPPA Commercial	$49.20

D5W 50 ml IV mini-bag

Facility

$60.00

Service Code	NDC 00338001741
Hospital Charge Code	2518348
Hospital Revenue Code	258
Min. Negotiated Rate	$27.72
Max. Negotiated Rate	$58.20
Rate for Payer: Cash Price	$45.68
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

Dacriose (Eye Wash) Ophth 4 oz. Solution

Facility

$13.00

Service Code	NDC 10119000252
Hospital Charge Code	2510709
Hospital Revenue Code	270
Min. Negotiated Rate	$6.01
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$10.01
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

Dacriose (Eye Wash) Ophth 4 oz. Solution

Facility

$13.00

Service Code	NDC 10119000252
Hospital Charge Code	2510709
Hospital Revenue Code	270
Min. Negotiated Rate	$10.66
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$10.01
Rate for Payer: Health Partners Plans Commercial	$12.35
Rate for Payer: UnitedHealthcare Commercial	$12.61
Rate for Payer: WPPA Commercial	$10.66

DALIRESP 500 MCG TAB (ROFLUMILAST)

Facility

$50.00

Service Code	NDC 00310009530
Hospital Charge Code	2517829
Hospital Revenue Code	250
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$48.50
Rate for Payer: Cash Price	$37.69
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

DALIRESP 500 MCG TAB (ROFLUMILAST)

Facility

$50.00

Service Code	NDC 00310009530
Hospital Charge Code	2517829
Hospital Revenue Code	250
Min. Negotiated Rate	$41.00
Max. Negotiated Rate	$48.50
Rate for Payer: Cash Price	$37.69
Rate for Payer: Health Partners Plans Commercial	$47.50
Rate for Payer: UnitedHealthcare Commercial	$48.50
Rate for Payer: WPPA Commercial	$41.00

Dalvance (dalbavancin) 500 mg IV solution

Facility

$5,861.00

Service Code	NDC 57970010001
Hospital Charge Code	2510113
Hospital Revenue Code	250
Min. Negotiated Rate	$2,707.78
Max. Negotiated Rate	$5,685.17
Rate for Payer: Cash Price	$4,396.05
Rate for Payer: Celtic Commercial/Exchange	$2,707.78
Rate for Payer: Health Partners Plans Commercial	$5,567.95
Rate for Payer: UnitedHealthcare Commercial	$5,685.17
Rate for Payer: WPPA Commercial	$4,923.24

Dalvance (dalbavancin) 500 mg IV solution

Facility

$5,861.00

Service Code	NDC 57970010001
Hospital Charge Code	2510113
Hospital Revenue Code	250
Min. Negotiated Rate	$4,806.02
Max. Negotiated Rate	$5,685.17
Rate for Payer: Cash Price	$4,396.05
Rate for Payer: Health Partners Plans Commercial	$5,567.95
Rate for Payer: UnitedHealthcare Commercial	$5,685.17
Rate for Payer: WPPA Commercial	$4,806.02

DARK GLASSES

Facility

$21.00

Hospital Charge Code	2707822
Hospital Revenue Code	270
Min. Negotiated Rate	$9.70
Max. Negotiated Rate	$20.37
Rate for Payer: Cash Price	$15.75
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

DARK GLASSES

Facility

$21.00

Hospital Charge Code	2707822
Hospital Revenue Code	270
Min. Negotiated Rate	$17.22
Max. Negotiated Rate	$20.37
Rate for Payer: Cash Price	$15.75
Rate for Payer: Health Partners Plans Commercial	$19.95
Rate for Payer: UnitedHealthcare Commercial	$20.37
Rate for Payer: WPPA Commercial	$17.22

Know your out-of-pocket cost for care.

All Charges