Ness County Hospital

All Charges

Charge

Type

Setting

Price

PERQ DRAIN INSERT CATH PLEURA W/IMAGE

Facility

$1,700.00

Service Code	HCPCS 32557
Hospital Charge Code	3255700
Hospital Revenue Code	761
Min. Negotiated Rate	$785.40
Max. Negotiated Rate	$1,649.00
Rate for Payer: BCBS Commercial	$862.54
Rate for Payer: Cash Price	$1,275.00
Rate for Payer: Cash Price	$1,275.00
Rate for Payer: Celtic Commercial/Exchange	$785.40
Rate for Payer: Health Partners Plans Commercial	$1,615.00
Rate for Payer: UnitedHealthcare Commercial	$1,649.00
Rate for Payer: WPPA Commercial	$1,428.00

PERQ DRAIN INSERT CATH PLEURA W/IMAGE

Facility

$1,700.00

Service Code	HCPCS 32557
Hospital Charge Code	3255700
Hospital Revenue Code	761
Min. Negotiated Rate	$1,394.00
Max. Negotiated Rate	$1,649.00
Rate for Payer: Cash Price	$1,275.00
Rate for Payer: Health Partners Plans Commercial	$1,615.00
Rate for Payer: UnitedHealthcare Commercial	$1,649.00
Rate for Payer: WPPA Commercial	$1,394.00

PERSANTINE 25 MG TAB (DIPYRIDAMOLE)

Facility

$10.00

Service Code	NDC 64980013301
Hospital Charge Code	2505410
Hospital Revenue Code	250
Min. Negotiated Rate	$8.20
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$7.84
Rate for Payer: Health Partners Plans Commercial	$9.50
Rate for Payer: UnitedHealthcare Commercial	$9.70
Rate for Payer: WPPA Commercial	$8.20

PERSANTINE 25 MG TAB (DIPYRIDAMOLE)

Facility

$10.00

Service Code	NDC 64980013301
Hospital Charge Code	2505410
Hospital Revenue Code	250
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$7.84
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

PF DEBRIDEMENT WOUND<20SQCM

Facility

$185.00

Service Code	HCPCS 97597 GF
Hospital Charge Code	97597WC
Hospital Revenue Code	983
Min. Negotiated Rate	$151.70
Max. Negotiated Rate	$179.45
Rate for Payer: Cash Price	$138.75
Rate for Payer: Health Partners Plans Commercial	$175.75
Rate for Payer: UnitedHealthcare Commercial	$179.45
Rate for Payer: WPPA Commercial	$151.70

PF DEBRIDEMENT WOUND<20SQCM

Facility

$185.00

Service Code	HCPCS 97597 GF
Hospital Charge Code	97597WC
Hospital Revenue Code	983
Min. Negotiated Rate	$85.47
Max. Negotiated Rate	$278.76
Rate for Payer: BCBS Commercial	$278.76
Rate for Payer: Cash Price	$138.75
Rate for Payer: Cash Price	$138.75
Rate for Payer: Celtic Commercial/Exchange	$85.47
Rate for Payer: Health Partners Plans Commercial	$175.75
Rate for Payer: UnitedHealthcare Commercial	$179.45
Rate for Payer: WPPA Commercial	$155.40

PF DEBRIDEMENT WOUND ADDL 20SQ

Facility

$140.00

Service Code	HCPCS 97598 GF
Hospital Charge Code	97598WC
Hospital Revenue Code	983
Min. Negotiated Rate	$114.80
Max. Negotiated Rate	$135.80
Rate for Payer: Cash Price	$105.00
Rate for Payer: Health Partners Plans Commercial	$133.00
Rate for Payer: UnitedHealthcare Commercial	$135.80
Rate for Payer: WPPA Commercial	$114.80

PF DEBRIDEMENT WOUND ADDL 20SQ

Facility

$140.00

Service Code	HCPCS 97598 GF
Hospital Charge Code	97598WC
Hospital Revenue Code	983
Min. Negotiated Rate	$60.13
Max. Negotiated Rate	$135.80
Rate for Payer: BCBS Commercial	$60.13
Rate for Payer: Cash Price	$105.00
Rate for Payer: Cash Price	$105.00
Rate for Payer: Celtic Commercial/Exchange	$64.68
Rate for Payer: Health Partners Plans Commercial	$133.00
Rate for Payer: UnitedHealthcare Commercial	$135.80
Rate for Payer: WPPA Commercial	$117.60

P-FLEX MOUTHPIECE

Facility

$31.00

Hospital Charge Code	4100293
Hospital Revenue Code	270
Min. Negotiated Rate	$14.32
Max. Negotiated Rate	$30.07
Rate for Payer: Cash Price	$23.44
Rate for Payer: Celtic Commercial/Exchange	$14.32
Rate for Payer: Health Partners Plans Commercial	$29.45
Rate for Payer: UnitedHealthcare Commercial	$30.07
Rate for Payer: WPPA Commercial	$26.04

P-FLEX MOUTHPIECE

Facility

$31.00

Hospital Charge Code	4100293
Hospital Revenue Code	270
Min. Negotiated Rate	$25.42
Max. Negotiated Rate	$30.07
Rate for Payer: Cash Price	$23.44
Rate for Payer: Health Partners Plans Commercial	$29.45
Rate for Payer: UnitedHealthcare Commercial	$30.07
Rate for Payer: WPPA Commercial	$25.42

PHAZYME 180 MG CAP (SIMETHICONE)

Facility

$1.00

Service Code	NDC 00904557252
Hospital Charge Code	2513331
Hospital Revenue Code	250
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.75
Rate for Payer: Health Partners Plans Commercial	$0.95
Rate for Payer: UnitedHealthcare Commercial	$0.97
Rate for Payer: WPPA Commercial	$0.82

PHAZYME 180 MG CAP (SIMETHICONE)

Facility

$1.00

Service Code	NDC 00904557252
Hospital Charge Code	2513331
Hospital Revenue Code	250
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.75
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

PH BODY FLUID EXCEPT BLOOD

Facility

$42.00

Service Code	HCPCS 83986
Hospital Charge Code	8398600
Hospital Revenue Code	301
Min. Negotiated Rate	$34.44
Max. Negotiated Rate	$40.74
Rate for Payer: Cash Price	$31.50
Rate for Payer: Health Partners Plans Commercial	$39.90
Rate for Payer: UnitedHealthcare Commercial	$40.74
Rate for Payer: WPPA Commercial	$34.44

PH BODY FLUID EXCEPT BLOOD

Facility

$42.00

Service Code	HCPCS 83986
Hospital Charge Code	8398600
Hospital Revenue Code	301
Min. Negotiated Rate	$16.05
Max. Negotiated Rate	$40.74
Rate for Payer: BCBS Commercial	$16.05
Rate for Payer: Cash Price	$31.50
Rate for Payer: Cash Price	$31.50
Rate for Payer: Celtic Commercial/Exchange	$19.40
Rate for Payer: Health Partners Plans Commercial	$39.90
Rate for Payer: UnitedHealthcare Commercial	$40.74
Rate for Payer: WPPA Commercial	$35.28

PHENERGAN 12.5 MG SUPP (PROMETHAZINE HCL)

Facility

$53.00

Service Code	NDC 00713053612
Hospital Charge Code	2505519
Hospital Revenue Code	250
Min. Negotiated Rate	$43.46
Max. Negotiated Rate	$51.41
Rate for Payer: Cash Price	$39.83
Rate for Payer: Health Partners Plans Commercial	$50.35
Rate for Payer: UnitedHealthcare Commercial	$51.41
Rate for Payer: WPPA Commercial	$43.46

PHENERGAN 12.5 MG SUPP (PROMETHAZINE HCL)

Facility

$53.00

Service Code	NDC 00713053612
Hospital Charge Code	2505519
Hospital Revenue Code	250
Min. Negotiated Rate	$24.49
Max. Negotiated Rate	$51.41
Rate for Payer: Cash Price	$39.83
Rate for Payer: Celtic Commercial/Exchange	$24.49
Rate for Payer: Health Partners Plans Commercial	$50.35
Rate for Payer: UnitedHealthcare Commercial	$51.41
Rate for Payer: WPPA Commercial	$44.52

PHENERGAN 25 MG/ML INJ. (PROMETHAZINE HCL)

Facility

$8.00

Service Code	NDC 00641094831
Hospital Charge Code	2505493
Hospital Revenue Code	250
Min. Negotiated Rate	$6.56
Max. Negotiated Rate	$7.76
Rate for Payer: Cash Price	$6.30
Rate for Payer: Health Partners Plans Commercial	$7.60
Rate for Payer: UnitedHealthcare Commercial	$7.76
Rate for Payer: WPPA Commercial	$6.56

PHENERGAN 25 MG/ML INJ. (PROMETHAZINE HCL)

Facility

$8.00

Service Code	NDC 00641094831
Hospital Charge Code	2505493
Hospital Revenue Code	250
Min. Negotiated Rate	$3.70
Max. Negotiated Rate	$7.76
Rate for Payer: Cash Price	$6.30
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

PHENERGAN 25 MG SUPP (PROMETHAZINE HCL)

Facility

$54.00

Service Code	NDC 00713052612
Hospital Charge Code	2505527
Hospital Revenue Code	250
Min. Negotiated Rate	$24.95
Max. Negotiated Rate	$52.38
Rate for Payer: Cash Price	$40.50
Rate for Payer: Celtic Commercial/Exchange	$24.95
Rate for Payer: Health Partners Plans Commercial	$51.30
Rate for Payer: UnitedHealthcare Commercial	$52.38
Rate for Payer: WPPA Commercial	$45.36

PHENERGAN 25 MG SUPP (PROMETHAZINE HCL)

Facility

$54.00

Service Code	NDC 00713052612
Hospital Charge Code	2505527
Hospital Revenue Code	250
Min. Negotiated Rate	$44.28
Max. Negotiated Rate	$52.38
Rate for Payer: Cash Price	$40.50
Rate for Payer: Health Partners Plans Commercial	$51.30
Rate for Payer: UnitedHealthcare Commercial	$52.38
Rate for Payer: WPPA Commercial	$44.28

PHENERGAN 25 MG TAB (PROMETHAZINE HCL)

Facility

$3.00

Service Code	NDC 68084015501
Hospital Charge Code	2505543
Hospital Revenue Code	250
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.25
Rate for Payer: Celtic Commercial/Exchange	$1.39
Rate for Payer: Health Partners Plans Commercial	$2.85
Rate for Payer: UnitedHealthcare Commercial	$2.91
Rate for Payer: WPPA Commercial	$2.52

PHENERGAN 25 MG TAB (PROMETHAZINE HCL)

Facility

$3.00

Service Code	NDC 68084015501
Hospital Charge Code	2505543
Hospital Revenue Code	250
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.25
Rate for Payer: Health Partners Plans Commercial	$2.85
Rate for Payer: UnitedHealthcare Commercial	$2.91
Rate for Payer: WPPA Commercial	$2.46

PHENERGAN 50 MG/ML INJ. (PROMETHAZINE HCL)

Facility

$17.00

Service Code	NDC 00641095625
Hospital Charge Code	2514453
Hospital Revenue Code	250
Min. Negotiated Rate	$7.85
Max. Negotiated Rate	$16.49
Rate for Payer: Cash Price	$13.14
Rate for Payer: Celtic Commercial/Exchange	$7.85
Rate for Payer: Health Partners Plans Commercial	$16.15
Rate for Payer: UnitedHealthcare Commercial	$16.49
Rate for Payer: WPPA Commercial	$14.28

PHENERGAN 50 MG/ML INJ. (PROMETHAZINE HCL)

Facility

$17.00

Service Code	NDC 00641095625
Hospital Charge Code	2514453
Hospital Revenue Code	250
Min. Negotiated Rate	$13.94
Max. Negotiated Rate	$16.49
Rate for Payer: Cash Price	$13.14
Rate for Payer: Health Partners Plans Commercial	$16.15
Rate for Payer: UnitedHealthcare Commercial	$16.49
Rate for Payer: WPPA Commercial	$13.94

PHENERGAN 6.25 MG/5 ML OS (PROMETHAZINE HCL)

Facility

$1.00

Service Code	NDC 60432060816
Hospital Charge Code	2509073
Hospital Revenue Code	250
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$1.31
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

Know your out-of-pocket cost for care.

All Charges