Ness County Hospital

All Charges

Charge

Type

Setting

Price

DIAMOX 250MG TABLET

Facility

$9.00

Hospital Charge Code	2502169
Hospital Revenue Code	250
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$7.43
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

DIAPER, BABY, SIZE 1

Facility

$20.00

Hospital Charge Code	2730000
Hospital Revenue Code	272
Min. Negotiated Rate	$16.40
Max. Negotiated Rate	$19.40
Rate for Payer: Cash Price	$15.00
Rate for Payer: Health Partners Plans Commercial	$19.00
Rate for Payer: UnitedHealthcare Commercial	$19.40
Rate for Payer: WPPA Commercial	$16.40

DIAPER, BABY, SIZE 1

Facility

$20.00

Hospital Charge Code	2730000
Hospital Revenue Code	272
Min. Negotiated Rate	$9.24
Max. Negotiated Rate	$19.40
Rate for Payer: Cash Price	$15.00
Rate for Payer: Celtic Commercial/Exchange	$9.24
Rate for Payer: Health Partners Plans Commercial	$19.00
Rate for Payer: UnitedHealthcare Commercial	$19.40
Rate for Payer: WPPA Commercial	$16.80

DIAPER, BABY, SIZE 2

Facility

$20.00

Hospital Charge Code	2730001
Hospital Revenue Code	272
Min. Negotiated Rate	$16.40
Max. Negotiated Rate	$19.40
Rate for Payer: Cash Price	$15.00
Rate for Payer: Health Partners Plans Commercial	$19.00
Rate for Payer: UnitedHealthcare Commercial	$19.40
Rate for Payer: WPPA Commercial	$16.40

DIAPER, BABY, SIZE 2

Facility

$20.00

Hospital Charge Code	2730001
Hospital Revenue Code	272
Min. Negotiated Rate	$9.24
Max. Negotiated Rate	$19.40
Rate for Payer: Cash Price	$15.00
Rate for Payer: Celtic Commercial/Exchange	$9.24
Rate for Payer: Health Partners Plans Commercial	$19.00
Rate for Payer: UnitedHealthcare Commercial	$19.40
Rate for Payer: WPPA Commercial	$16.80

DIFLUCAN 100 MG TAB (FLUCONAZOLE)

Facility

$29.00

Service Code	NDC 50268033711
Hospital Charge Code	2512564
Hospital Revenue Code	250
Min. Negotiated Rate	$13.40
Max. Negotiated Rate	$28.13
Rate for Payer: Cash Price	$22.01
Rate for Payer: Celtic Commercial/Exchange	$13.40
Rate for Payer: Health Partners Plans Commercial	$27.55
Rate for Payer: UnitedHealthcare Commercial	$28.13
Rate for Payer: WPPA Commercial	$24.36

DIFLUCAN 100 MG TAB (FLUCONAZOLE)

Facility

$29.00

Service Code	NDC 50268033711
Hospital Charge Code	2512564
Hospital Revenue Code	250
Min. Negotiated Rate	$23.78
Max. Negotiated Rate	$28.13
Rate for Payer: Cash Price	$22.01
Rate for Payer: Health Partners Plans Commercial	$27.55
Rate for Payer: UnitedHealthcare Commercial	$28.13
Rate for Payer: WPPA Commercial	$23.78

DIFLUCAN 200 MG/100 ML PREMIX (FLUCONAZOLE) IV

Facility

$56.00

Service Code	NDC 25021018466
Hospital Charge Code	2512994
Hospital Revenue Code	250
Min. Negotiated Rate	$25.87
Max. Negotiated Rate	$54.32
Rate for Payer: Cash Price	$42.53
Rate for Payer: Celtic Commercial/Exchange	$25.87
Rate for Payer: Health Partners Plans Commercial	$53.20
Rate for Payer: UnitedHealthcare Commercial	$54.32
Rate for Payer: WPPA Commercial	$47.04

DIFLUCAN 200 MG/100 ML PREMIX (FLUCONAZOLE) IV

Facility

$56.00

Service Code	NDC 25021018466
Hospital Charge Code	2512994
Hospital Revenue Code	250
Min. Negotiated Rate	$45.92
Max. Negotiated Rate	$54.32
Rate for Payer: Cash Price	$42.53
Rate for Payer: Health Partners Plans Commercial	$53.20
Rate for Payer: UnitedHealthcare Commercial	$54.32
Rate for Payer: WPPA Commercial	$45.92

DIFLUCAN 40 MG/ML OS (FLUCONAZOLE)

Facility

$391.00

Service Code	NDC 59762503001
Hospital Charge Code	2518801
Hospital Revenue Code	250
Min. Negotiated Rate	$320.62
Max. Negotiated Rate	$379.27
Rate for Payer: Cash Price	$293.40
Rate for Payer: Health Partners Plans Commercial	$371.45
Rate for Payer: UnitedHealthcare Commercial	$379.27
Rate for Payer: WPPA Commercial	$320.62

DIFLUCAN 40 MG/ML OS (FLUCONAZOLE)

Facility

$391.00

Service Code	NDC 59762503001
Hospital Charge Code	2518801
Hospital Revenue Code	250
Min. Negotiated Rate	$180.64
Max. Negotiated Rate	$379.27
Rate for Payer: Cash Price	$293.40
Rate for Payer: Celtic Commercial/Exchange	$180.64
Rate for Payer: Health Partners Plans Commercial	$371.45
Rate for Payer: UnitedHealthcare Commercial	$379.27
Rate for Payer: WPPA Commercial	$328.44

DIGESTIVE MALIGNANCY WITH CC

Facility

$10,794.40

Service Code	MSDRG 375
Min. Negotiated Rate	$10,794.40
Max. Negotiated Rate	$10,794.40
Rate for Payer: BCBS Commercial	$10,794.40

DIGESTIVE MALIGNANCY WITH MCC

Facility

$18,405.12

Service Code	MSDRG 374
Min. Negotiated Rate	$18,405.12
Max. Negotiated Rate	$18,405.12
Rate for Payer: BCBS Commercial	$18,405.12

DIGESTIVE MALIGNANCY WITHOUT CC/MCC

Facility

$7,978.18

Service Code	MSDRG 376
Min. Negotiated Rate	$7,978.18
Max. Negotiated Rate	$7,978.18
Rate for Payer: BCBS Commercial	$7,978.18

DIGOXIN

Facility

$123.00

Service Code	HCPCS 80162
Hospital Charge Code	8016200
Hospital Revenue Code	301
Min. Negotiated Rate	$54.39
Max. Negotiated Rate	$119.31
Rate for Payer: Cash Price	$92.25
Rate for Payer: BCBS Commercial	$54.39
Rate for Payer: Cash Price	$92.25
Rate for Payer: Celtic Commercial/Exchange	$56.83
Rate for Payer: Health Partners Plans Commercial	$116.85
Rate for Payer: UnitedHealthcare Commercial	$119.31
Rate for Payer: WPPA Commercial	$103.32

DIGOXIN

Facility

$123.00

Service Code	HCPCS 80162
Hospital Charge Code	8016200
Hospital Revenue Code	301
Min. Negotiated Rate	$100.86
Max. Negotiated Rate	$119.31
Rate for Payer: Cash Price	$92.25
Rate for Payer: Health Partners Plans Commercial	$116.85
Rate for Payer: UnitedHealthcare Commercial	$119.31
Rate for Payer: WPPA Commercial	$100.86

DIGOXIN 0.125 MG TAB (LANOXIN)

Facility

$8.00

Service Code	NDC 60687054011
Hospital Charge Code	2503886
Hospital Revenue Code	250
Min. Negotiated Rate	$6.56
Max. Negotiated Rate	$7.76
Rate for Payer: Cash Price	$6.49
Rate for Payer: Health Partners Plans Commercial	$7.60
Rate for Payer: UnitedHealthcare Commercial	$7.76
Rate for Payer: WPPA Commercial	$6.56

DIGOXIN 0.125 MG TAB (LANOXIN)

Facility

$8.00

Service Code	NDC 60687054011
Hospital Charge Code	2503886
Hospital Revenue Code	250
Min. Negotiated Rate	$3.70
Max. Negotiated Rate	$7.76
Rate for Payer: Cash Price	$6.49
Rate for Payer: Celtic Commercial/Exchange	$3.70
Rate for Payer: Health Partners Plans Commercial	$7.60
Rate for Payer: UnitedHealthcare Commercial	$7.76
Rate for Payer: WPPA Commercial	$6.72

DIGOXIN 0.5 MG/2 ML INJ. (LANOXIN)

Facility

$20.00

Service Code	NDC 00641618425
Hospital Charge Code	2502185
Hospital Revenue Code	250
Min. Negotiated Rate	$9.24
Max. Negotiated Rate	$19.40
Rate for Payer: Cash Price	$15.56
Rate for Payer: Celtic Commercial/Exchange	$9.24
Rate for Payer: Health Partners Plans Commercial	$19.00
Rate for Payer: UnitedHealthcare Commercial	$19.40
Rate for Payer: WPPA Commercial	$16.80

DIGOXIN 0.5 MG/2 ML INJ. (LANOXIN)

Facility

$20.00

Service Code	NDC 00641618425
Hospital Charge Code	2502185
Hospital Revenue Code	250
Min. Negotiated Rate	$16.40
Max. Negotiated Rate	$19.40
Rate for Payer: Cash Price	$15.56
Rate for Payer: Health Partners Plans Commercial	$19.00
Rate for Payer: UnitedHealthcare Commercial	$19.40
Rate for Payer: WPPA Commercial	$16.40

DIHYDROXYVITAMIN D,A,25-

Facility

$166.00

Service Code	HCPCS 82652
Hospital Charge Code	8265200
Hospital Revenue Code	301
Min. Negotiated Rate	$76.69
Max. Negotiated Rate	$161.02
Rate for Payer: BCBS Commercial	$88.45
Rate for Payer: Cash Price	$124.50
Rate for Payer: Cash Price	$124.50
Rate for Payer: Celtic Commercial/Exchange	$76.69
Rate for Payer: Health Partners Plans Commercial	$157.70
Rate for Payer: UnitedHealthcare Commercial	$161.02
Rate for Payer: WPPA Commercial	$139.44

DIHYDROXYVITAMIN D,A,25-

Facility

$166.00

Service Code	HCPCS 82652
Hospital Charge Code	8265200
Hospital Revenue Code	301
Min. Negotiated Rate	$136.12
Max. Negotiated Rate	$161.02
Rate for Payer: Cash Price	$124.50
Rate for Payer: Health Partners Plans Commercial	$157.70
Rate for Payer: UnitedHealthcare Commercial	$161.02
Rate for Payer: WPPA Commercial	$136.12

DILANTIN 100 MG/2 ML INJ. (PHENYTOIN SODIUM)

Facility

$10.00

Service Code	NDC 00641613825
Hospital Charge Code	2502227
Hospital Revenue Code	250
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$7.50
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

DILANTIN 100 MG/2 ML INJ. (PHENYTOIN SODIUM)

Facility

$10.00

Service Code	NDC 00641613825
Hospital Charge Code	2502227
Hospital Revenue Code	250
Min. Negotiated Rate	$8.20
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$7.50
Rate for Payer: Health Partners Plans Commercial	$9.50
Rate for Payer: UnitedHealthcare Commercial	$9.70
Rate for Payer: WPPA Commercial	$8.20

DILANTIN 100 MG CAP (EXTENDED PHENYTOIN SODIUM)

Facility

$1.00

Service Code	NDC 68084037601
Hospital Charge Code	2502219
Hospital Revenue Code	250
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$1.42
Rate for Payer: Health Partners Plans Commercial	$0.95
Rate for Payer: UnitedHealthcare Commercial	$0.97
Rate for Payer: WPPA Commercial	$0.82

Know your out-of-pocket cost for care.

All Charges