Ness County Hospital

All Charges

Charge

Type

Setting

Price

DEXTROSE 5% (D5W) ADV 250 ML

Facility

$52.00

Service Code	NDC 00409710002
Hospital Charge Code	2516912
Hospital Revenue Code	258
Min. Negotiated Rate	$24.02
Max. Negotiated Rate	$50.44
Rate for Payer: Cash Price	$39.00
Rate for Payer: Celtic Commercial/Exchange	$24.02
Rate for Payer: Health Partners Plans Commercial	$49.40
Rate for Payer: UnitedHealthcare Commercial	$50.44
Rate for Payer: WPPA Commercial	$43.68

DEXTROSE 5% (D5W) ADV 50 ML IV

Facility

$50.00

Service Code	NDC 00409710066
Hospital Charge Code	2516920
Hospital Revenue Code	258
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

DEXTROSE 5% (D5W) ADV 50 ML IV

Facility

$50.00

Service Code	NDC 00409710066
Hospital Charge Code	2516920
Hospital Revenue Code	258
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$48.50
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

DEXTROSE 5% (D5W) INJ 250 ML IV

Facility

$92.00

Service Code	NDC 00990792202
Hospital Charge Code	2580108
Hospital Revenue Code	250
Min. Negotiated Rate	$42.50
Max. Negotiated Rate	$89.24
Rate for Payer: Cash Price	$69.07
Rate for Payer: Celtic Commercial/Exchange	$42.50
Rate for Payer: Health Partners Plans Commercial	$87.40
Rate for Payer: UnitedHealthcare Commercial	$89.24
Rate for Payer: WPPA Commercial	$77.28

DEXTROSE 5% (D5W) INJ 250 ML IV

Facility

$92.00

Service Code	NDC 00990792202
Hospital Charge Code	2580108
Hospital Revenue Code	250
Min. Negotiated Rate	$75.44
Max. Negotiated Rate	$89.24
Rate for Payer: Cash Price	$69.07
Rate for Payer: Health Partners Plans Commercial	$87.40
Rate for Payer: UnitedHealthcare Commercial	$89.24
Rate for Payer: WPPA Commercial	$75.44

DEXTROSE 5% (D5W) INJ 500 ML IV

Facility

$57.00

Service Code	HCPCS J7060
Hospital Charge Code	2580116
Hospital Revenue Code	636
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$55.29
Rate for Payer: BCBS Commercial	$2.34
Rate for Payer: Cash Price	$43.35
Rate for Payer: Cash Price	$43.35
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

DEXTROSE 5% (D5W) INJ 500 ML IV

Facility

$57.00

Service Code	HCPCS J7060
Hospital Charge Code	2580116
Hospital Revenue Code	636
Min. Negotiated Rate	$46.74
Max. Negotiated Rate	$55.29
Rate for Payer: Cash Price	$43.35
Rate for Payer: Health Partners Plans Commercial	$54.15
Rate for Payer: UnitedHealthcare Commercial	$55.29
Rate for Payer: WPPA Commercial	$46.74

DEXTROSE 5% (D5W) INJ 50 ML IV

Facility

$48.00

Service Code	NDC 00990792336
Hospital Charge Code	2580082
Hospital Revenue Code	258
Min. Negotiated Rate	$39.36
Max. Negotiated Rate	$46.56
Rate for Payer: Cash Price	$36.00
Rate for Payer: Health Partners Plans Commercial	$45.60
Rate for Payer: UnitedHealthcare Commercial	$46.56
Rate for Payer: WPPA Commercial	$39.36

DEXTROSE 5% (D5W) INJ 50 ML IV

Facility

$48.00

Service Code	NDC 00990792336
Hospital Charge Code	2580082
Hospital Revenue Code	258
Min. Negotiated Rate	$22.18
Max. Negotiated Rate	$46.56
Rate for Payer: Cash Price	$36.00
Rate for Payer: Celtic Commercial/Exchange	$22.18
Rate for Payer: Health Partners Plans Commercial	$45.60
Rate for Payer: UnitedHealthcare Commercial	$46.56
Rate for Payer: WPPA Commercial	$40.32

DEXTROSE (D5W) 1,000 ml IV fluids

Facility

$66.00

Service Code	HCPCS J7060
Hospital Charge Code	2580124
Hospital Revenue Code	258
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$64.02
Rate for Payer: BCBS Commercial	$2.34
Rate for Payer: Cash Price	$49.95
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

DEXTROSE (D5W) 1,000 ml IV fluids

Facility

$66.00

Service Code	HCPCS J7060
Hospital Charge Code	2580124
Hospital Revenue Code	258
Min. Negotiated Rate	$54.12
Max. Negotiated Rate	$64.02
Rate for Payer: Cash Price	$49.95
Rate for Payer: Health Partners Plans Commercial	$62.70
Rate for Payer: UnitedHealthcare Commercial	$64.02
Rate for Payer: WPPA Commercial	$54.12

DEXTROSE (D5W) 5% ADV 100 ML

Facility

$50.00

Service Code	NDC 00409710067
Hospital Charge Code	2516805
Hospital Revenue Code	258
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

DEXTROSE (D5W) 5% ADV 100 ML

Facility

$50.00

Service Code	NDC 00409710067
Hospital Charge Code	2516805
Hospital Revenue Code	258
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$48.50
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

DEXTROSTIX

Facility

$10.00

Hospital Charge Code	2502128
Hospital Revenue Code	270
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$7.88
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

DEXTROSTIX

Facility

$10.00

Hospital Charge Code	2502128
Hospital Revenue Code	270
Min. Negotiated Rate	$8.20
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$7.88
Rate for Payer: Health Partners Plans Commercial	$9.50
Rate for Payer: UnitedHealthcare Commercial	$9.70
Rate for Payer: WPPA Commercial	$8.20

DHE 1 MG/ML INJ. (DIHYDROERGOTAMINE MESYLATE)

Facility

$538.00

Service Code	NDC 61990041102
Hospital Charge Code	2518660
Hospital Revenue Code	250
Min. Negotiated Rate	$441.16
Max. Negotiated Rate	$521.86
Rate for Payer: Cash Price	$403.65
Rate for Payer: Health Partners Plans Commercial	$511.10
Rate for Payer: UnitedHealthcare Commercial	$521.86
Rate for Payer: WPPA Commercial	$441.16

DHE 1 MG/ML INJ. (DIHYDROERGOTAMINE MESYLATE)

Facility

$538.00

Service Code	NDC 61990041102
Hospital Charge Code	2518660
Hospital Revenue Code	250
Min. Negotiated Rate	$248.56
Max. Negotiated Rate	$521.86
Rate for Payer: Cash Price	$403.65
Rate for Payer: Celtic Commercial/Exchange	$248.56
Rate for Payer: Health Partners Plans Commercial	$511.10
Rate for Payer: UnitedHealthcare Commercial	$521.86
Rate for Payer: WPPA Commercial	$451.92

DIABETA 2.5 MG TAB (GLYBURIDE)

Facility

$2.00

Service Code	NDC 72241003905
Hospital Charge Code	2508299
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

DIABETA 2.5 MG TAB (GLYBURIDE)

Facility

$2.00

Service Code	NDC 72241003905
Hospital Charge Code	2508299
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

DIABETES OP SELF MGMT TRAINING, EA 30 MIN

Facility

$38.00

Service Code	HCPCS G0108
Hospital Charge Code	G0108
Hospital Revenue Code	761
Min. Negotiated Rate	$17.56
Max. Negotiated Rate	$36.86
Rate for Payer: BCBS Commercial	$29.29
Rate for Payer: Cash Price	$28.50
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

DIABETES OP SELF MGMT TRAINING, EA 30 MIN

Facility

$38.00

Service Code	HCPCS G0108
Hospital Charge Code	G0108
Hospital Revenue Code	761
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

DIABETES WITH CC

Facility

$8,213.82

Service Code	MSDRG 638
Min. Negotiated Rate	$8,213.82
Max. Negotiated Rate	$8,213.82
Rate for Payer: BCBS Commercial	$8,213.82

DIABETES WITH MCC

Facility

$12,342.94

Service Code	MSDRG 637
Min. Negotiated Rate	$12,342.94
Max. Negotiated Rate	$12,342.94
Rate for Payer: BCBS Commercial	$12,342.94

DIABETES WITHOUT CC/MCC

Facility

$5,953.27

Service Code	MSDRG 639
Min. Negotiated Rate	$5,953.27
Max. Negotiated Rate	$5,953.27
Rate for Payer: BCBS Commercial	$5,953.27

DIAMOX 250MG TABLET

Facility

$9.00

Hospital Charge Code	2502169
Hospital Revenue Code	250
Min. Negotiated Rate	$7.38
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$7.43
Rate for Payer: Health Partners Plans Commercial	$8.55
Rate for Payer: UnitedHealthcare Commercial	$8.73
Rate for Payer: WPPA Commercial	$7.38

Know your out-of-pocket cost for care.

All Charges