Ness County Hospital

All Charges

Charge

Type

Setting

Price

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	$0.46
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$1.42
Rate for Payer: Celtic Commercial/Exchange	$0.46
Rate for Payer: Health Partners Plans Commercial	$0.95
Rate for Payer: UnitedHealthcare Commercial	$0.97
Rate for Payer: WPPA Commercial	$0.84

DILANTIN 125 MG/5 ML OS (PHENYTOIN)

Facility

$2.00

Service Code	NDC 51672406901
Hospital Charge Code	2502235
Hospital Revenue Code	250
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.80
Rate for Payer: Health Partners Plans Commercial	$1.90
Rate for Payer: UnitedHealthcare Commercial	$1.94
Rate for Payer: WPPA Commercial	$1.64

DILANTIN 125 MG/5 ML OS (PHENYTOIN)

Facility

$2.00

Service Code	NDC 51672406901
Hospital Charge Code	2502235
Hospital Revenue Code	250
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.80
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

DILANTIN INFATABS 50 MG TAB (PHENYTOIN)

Facility

$6.00

Service Code	NDC 60687015625
Hospital Charge Code	2502193
Hospital Revenue Code	250
Min. Negotiated Rate	$2.77
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$4.65
Rate for Payer: Celtic Commercial/Exchange	$2.77
Rate for Payer: Health Partners Plans Commercial	$5.70
Rate for Payer: UnitedHealthcare Commercial	$5.82
Rate for Payer: WPPA Commercial	$5.04

DILANTIN INFATABS 50 MG TAB (PHENYTOIN)

Facility

$6.00

Service Code	NDC 60687015625
Hospital Charge Code	2502193
Hospital Revenue Code	250
Min. Negotiated Rate	$4.92
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$4.65
Rate for Payer: Health Partners Plans Commercial	$5.70
Rate for Payer: UnitedHealthcare Commercial	$5.82
Rate for Payer: WPPA Commercial	$4.92

DILTIAZEM, SERUM/PLASMA

Facility

$108.00

Service Code	HCPCS 80299
Hospital Charge Code	8029907
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

DILTIAZEM, SERUM/PLASMA

Facility

$108.00

Service Code	HCPCS 80299
Hospital Charge Code	8029907
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

DINNER GUEST TRAY

Facility

$4.00

Hospital Charge Code	9910019
Hospital Revenue Code	990
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$3.56
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

DINNER GUEST TRAY

Facility

$4.00

Hospital Charge Code	9910019
Hospital Revenue Code	990
Min. Negotiated Rate	$3.28
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$3.56
Rate for Payer: Health Partners Plans Commercial	$3.80
Rate for Payer: UnitedHealthcare Commercial	$3.88
Rate for Payer: WPPA Commercial	$3.28

DIOVAN 40 MG TAB (VALSARTAN)

Facility

$13.00

Service Code	NDC 60687061211
Hospital Charge Code	2518892
Hospital Revenue Code	250
Min. Negotiated Rate	$10.66
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$9.75
Rate for Payer: Health Partners Plans Commercial	$12.35
Rate for Payer: UnitedHealthcare Commercial	$12.61
Rate for Payer: WPPA Commercial	$10.66

DIOVAN 40 MG TAB (VALSARTAN)

Facility

$13.00

Service Code	NDC 60687061211
Hospital Charge Code	2518892
Hospital Revenue Code	250
Min. Negotiated Rate	$6.01
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$9.75
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

Diprivan 200mg/20ml inj. (propofol)

Facility

$34.00

Service Code	NDC 63323026937
Hospital Charge Code	2500114
Hospital Revenue Code	250
Min. Negotiated Rate	$15.71
Max. Negotiated Rate	$32.98
Rate for Payer: Cash Price	$25.50
Rate for Payer: Celtic Commercial/Exchange	$15.71
Rate for Payer: Health Partners Plans Commercial	$32.30
Rate for Payer: UnitedHealthcare Commercial	$32.98
Rate for Payer: WPPA Commercial	$28.56

Diprivan 200mg/20ml inj. (propofol)

Facility

$34.00

Service Code	NDC 63323026937
Hospital Charge Code	2500114
Hospital Revenue Code	250
Min. Negotiated Rate	$27.88
Max. Negotiated Rate	$32.98
Rate for Payer: Cash Price	$25.50
Rate for Payer: Health Partners Plans Commercial	$32.30
Rate for Payer: UnitedHealthcare Commercial	$32.98
Rate for Payer: WPPA Commercial	$27.88

DIPROPYLACETIC ACID (VALPROIC)

Facility

$162.00

Service Code	HCPCS 80164
Hospital Charge Code	8016400
Hospital Revenue Code	301
Min. Negotiated Rate	$65.50
Max. Negotiated Rate	$157.14
Rate for Payer: BCBS Commercial	$65.50
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cash Price	$121.50
Rate for Payer: Celtic Commercial/Exchange	$74.84
Rate for Payer: Health Partners Plans Commercial	$153.90
Rate for Payer: UnitedHealthcare Commercial	$157.14
Rate for Payer: WPPA Commercial	$136.08

DIPROPYLACETIC ACID (VALPROIC)

Facility

$162.00

Service Code	HCPCS 80164
Hospital Charge Code	8016400
Hospital Revenue Code	301
Min. Negotiated Rate	$132.84
Max. Negotiated Rate	$157.14
Rate for Payer: Cash Price	$121.50
Rate for Payer: Health Partners Plans Commercial	$153.90
Rate for Payer: UnitedHealthcare Commercial	$157.14
Rate for Payer: WPPA Commercial	$132.84

DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC

Facility

$8,874.93

Service Code	MSDRG 442
Min. Negotiated Rate	$8,874.93
Max. Negotiated Rate	$8,874.93
Rate for Payer: BCBS Commercial	$8,874.93

DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC

Facility

$16,681.50

Service Code	MSDRG 441
Min. Negotiated Rate	$16,681.50
Max. Negotiated Rate	$16,681.50
Rate for Payer: BCBS Commercial	$16,681.50

DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CC/MCC

Facility

$5,946.41

Service Code	MSDRG 443
Min. Negotiated Rate	$5,946.41
Max. Negotiated Rate	$5,946.41
Rate for Payer: BCBS Commercial	$5,946.41

DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC

Facility

$7,501.56

Service Code	MSDRG 439
Min. Negotiated Rate	$7,501.56
Max. Negotiated Rate	$7,501.56
Rate for Payer: BCBS Commercial	$7,501.56

DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC

Facility

$14,326.26

Service Code	MSDRG 438
Min. Negotiated Rate	$14,326.26
Max. Negotiated Rate	$14,326.26
Rate for Payer: BCBS Commercial	$14,326.26

DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC

Facility

$5,986.94

Service Code	MSDRG 440
Min. Negotiated Rate	$5,986.94
Max. Negotiated Rate	$5,986.94
Rate for Payer: BCBS Commercial	$5,986.94

DISORDERS OF PERSONALITY AND IMPULSE CONTROL

Facility

$17,037.96

Service Code	MSDRG 883
Min. Negotiated Rate	$17,037.96
Max. Negotiated Rate	$17,037.96
Rate for Payer: BCBS Commercial	$17,037.96

DISORDERS OF THE BILIARY TRACT WITH CC

Facility

$9,563.35

Service Code	MSDRG 445
Min. Negotiated Rate	$9,563.35
Max. Negotiated Rate	$9,563.35
Rate for Payer: BCBS Commercial	$9,563.35

DISORDERS OF THE BILIARY TRACT WITH MCC

Facility

$14,836.28

Service Code	MSDRG 444
Min. Negotiated Rate	$14,836.28
Max. Negotiated Rate	$14,836.28
Rate for Payer: BCBS Commercial	$14,836.28

DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC

Facility

$7,247.72

Service Code	MSDRG 446
Min. Negotiated Rate	$7,247.72
Max. Negotiated Rate	$7,247.72
Rate for Payer: BCBS Commercial	$7,247.72

Know your out-of-pocket cost for care.

All Charges