Ness County Hospital

All Charges

Charge

Type

Setting

Price

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	$0.82
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$1.31
Rate for Payer: Health Partners Plans Commercial	$0.95
Rate for Payer: UnitedHealthcare Commercial	$0.97
Rate for Payer: WPPA Commercial	$0.82

PHENERGAN/CODEINE 6.25 MG/10 MG/5 ML OS (PROMETHAZINE HCL + CODEINE)

Facility

$3.00

Service Code	NDC 00121092816
Hospital Charge Code	2505469
Hospital Revenue Code	250
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.89
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/CODEINE 6.25 MG/10 MG/5 ML OS (PROMETHAZINE HCL + CODEINE)

Facility

$3.00

Service Code	NDC 00121092816
Hospital Charge Code	2505469
Hospital Revenue Code	250
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.89
Rate for Payer: Health Partners Plans Commercial	$2.85
Rate for Payer: UnitedHealthcare Commercial	$2.91
Rate for Payer: WPPA Commercial	$2.46

PHENOBARBITAL 20MG/5ML OS

Facility

$2.00

Hospital Charge Code	2505550
Hospital Revenue Code	250
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$2.21
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

PHENOBARBITAL 20MG/5ML OS

Facility

$2.00

Hospital Charge Code	2505550
Hospital Revenue Code	250
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$2.21
Rate for Payer: Health Partners Plans Commercial	$1.90
Rate for Payer: UnitedHealthcare Commercial	$1.94
Rate for Payer: WPPA Commercial	$1.64

PHENOBARBITAL 65MG/ML INJ

Facility

$86.00

Hospital Charge Code	2515955
Hospital Revenue Code	250
Min. Negotiated Rate	$39.73
Max. Negotiated Rate	$83.42
Rate for Payer: Cash Price	$64.72
Rate for Payer: Celtic Commercial/Exchange	$39.73
Rate for Payer: Health Partners Plans Commercial	$81.70
Rate for Payer: UnitedHealthcare Commercial	$83.42
Rate for Payer: WPPA Commercial	$72.24

PHENOBARBITAL 65MG/ML INJ

Facility

$86.00

Hospital Charge Code	2515955
Hospital Revenue Code	250
Min. Negotiated Rate	$70.52
Max. Negotiated Rate	$83.42
Rate for Payer: Cash Price	$64.72
Rate for Payer: Health Partners Plans Commercial	$81.70
Rate for Payer: UnitedHealthcare Commercial	$83.42
Rate for Payer: WPPA Commercial	$70.52

PHENOBARITAL

Facility

$167.00

Service Code	HCPCS 80184
Hospital Charge Code	8018400
Hospital Revenue Code	301
Min. Negotiated Rate	$136.94
Max. Negotiated Rate	$161.99
Rate for Payer: Cash Price	$125.25
Rate for Payer: Health Partners Plans Commercial	$158.65
Rate for Payer: UnitedHealthcare Commercial	$161.99
Rate for Payer: WPPA Commercial	$136.94

PHENOBARITAL

Facility

$167.00

Service Code	HCPCS 80184
Hospital Charge Code	8018400
Hospital Revenue Code	301
Min. Negotiated Rate	$53.99
Max. Negotiated Rate	$161.99
Rate for Payer: BCBS Commercial	$53.99
Rate for Payer: Cash Price	$125.25
Rate for Payer: Cash Price	$125.25
Rate for Payer: Celtic Commercial/Exchange	$77.15
Rate for Payer: Health Partners Plans Commercial	$158.65
Rate for Payer: UnitedHealthcare Commercial	$161.99
Rate for Payer: WPPA Commercial	$140.28

PHENYLALANINE (PKU), BLOOD

Facility

$113.00

Service Code	HCPCS 84030
Hospital Charge Code	8403000
Hospital Revenue Code	301
Min. Negotiated Rate	$92.66
Max. Negotiated Rate	$109.61
Rate for Payer: Cash Price	$84.75
Rate for Payer: Health Partners Plans Commercial	$107.35
Rate for Payer: UnitedHealthcare Commercial	$109.61
Rate for Payer: WPPA Commercial	$92.66

PHENYLALANINE (PKU), BLOOD

Facility

$113.00

Service Code	HCPCS 84030
Hospital Charge Code	8403000
Hospital Revenue Code	301
Min. Negotiated Rate	$16.96
Max. Negotiated Rate	$109.61
Rate for Payer: BCBS Commercial	$16.96
Rate for Payer: Cash Price	$84.75
Rate for Payer: Cash Price	$84.75
Rate for Payer: Celtic Commercial/Exchange	$52.21
Rate for Payer: Health Partners Plans Commercial	$107.35
Rate for Payer: UnitedHealthcare Commercial	$109.61
Rate for Payer: WPPA Commercial	$94.92

PHENYTOIN, FREE

Facility

$75.00

Service Code	HCPCS 80186
Hospital Charge Code	8018600
Hospital Revenue Code	300
Min. Negotiated Rate	$61.50
Max. Negotiated Rate	$72.75
Rate for Payer: Cash Price	$56.25
Rate for Payer: Health Partners Plans Commercial	$71.25
Rate for Payer: UnitedHealthcare Commercial	$72.75
Rate for Payer: WPPA Commercial	$61.50

PHENYTOIN, FREE

Facility

$75.00

Service Code	HCPCS 80186
Hospital Charge Code	8018600
Hospital Revenue Code	300
Min. Negotiated Rate	$34.65
Max. Negotiated Rate	$72.75
Rate for Payer: BCBS Commercial	$54.63
Rate for Payer: Cash Price	$56.25
Rate for Payer: Cash Price	$56.25
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

PHENYTOIN TOTAL

Facility

$101.00

Service Code	HCPCS 80185
Hospital Charge Code	8018500
Hospital Revenue Code	301
Min. Negotiated Rate	$82.82
Max. Negotiated Rate	$97.97
Rate for Payer: Cash Price	$75.75
Rate for Payer: Health Partners Plans Commercial	$95.95
Rate for Payer: UnitedHealthcare Commercial	$97.97
Rate for Payer: WPPA Commercial	$82.82

PHENYTOIN TOTAL

Facility

$101.00

Service Code	HCPCS 80185
Hospital Charge Code	8018500
Hospital Revenue Code	301
Min. Negotiated Rate	$46.66
Max. Negotiated Rate	$97.97
Rate for Payer: BCBS Commercial	$54.39
Rate for Payer: Cash Price	$75.75
Rate for Payer: Cash Price	$75.75
Rate for Payer: Celtic Commercial/Exchange	$46.66
Rate for Payer: Health Partners Plans Commercial	$95.95
Rate for Payer: UnitedHealthcare Commercial	$97.97
Rate for Payer: WPPA Commercial	$84.84

PHISODERM 5 OZ

Facility

$10.00

Hospital Charge Code	2505634
Hospital Revenue Code	270
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$7.72
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

PHISODERM 5 OZ

Facility

$10.00

Hospital Charge Code	2505634
Hospital Revenue Code	270
Min. Negotiated Rate	$8.20
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$7.72
Rate for Payer: Health Partners Plans Commercial	$9.50
Rate for Payer: UnitedHealthcare Commercial	$9.70
Rate for Payer: WPPA Commercial	$8.20

PHISOHEX CLEANSER 5OZ.

Facility

$95.00

Hospital Charge Code	2501021
Hospital Revenue Code	270
Min. Negotiated Rate	$77.90
Max. Negotiated Rate	$92.15
Rate for Payer: Cash Price	$71.36
Rate for Payer: Health Partners Plans Commercial	$90.25
Rate for Payer: UnitedHealthcare Commercial	$92.15
Rate for Payer: WPPA Commercial	$77.90

PHISOHEX CLEANSER 5OZ.

Facility

$95.00

Hospital Charge Code	2501021
Hospital Revenue Code	270
Min. Negotiated Rate	$43.89
Max. Negotiated Rate	$92.15
Rate for Payer: Cash Price	$71.36
Rate for Payer: Celtic Commercial/Exchange	$43.89
Rate for Payer: Health Partners Plans Commercial	$90.25
Rate for Payer: UnitedHealthcare Commercial	$92.15
Rate for Payer: WPPA Commercial	$79.80

PHONOPHERESIS

Facility

$76.00

Service Code	HCPCS 97035 GP
Hospital Charge Code	4201039
Hospital Revenue Code	420
Min. Negotiated Rate	$62.32
Max. Negotiated Rate	$73.72
Rate for Payer: Cash Price	$57.56
Rate for Payer: Health Partners Plans Commercial	$72.20
Rate for Payer: UnitedHealthcare Commercial	$73.72
Rate for Payer: WPPA Commercial	$62.32

PHONOPHERESIS

Facility

$76.00

Service Code	HCPCS 97035 GP
Hospital Charge Code	4201039
Hospital Revenue Code	420
Min. Negotiated Rate	$29.29
Max. Negotiated Rate	$73.72
Rate for Payer: BCBS Commercial	$29.29
Rate for Payer: Cash Price	$57.56
Rate for Payer: Cash Price	$57.56
Rate for Payer: Celtic Commercial/Exchange	$35.11
Rate for Payer: Health Partners Plans Commercial	$72.20
Rate for Payer: UnitedHealthcare Commercial	$73.72
Rate for Payer: WPPA Commercial	$63.84

PHOSPHATASE, ALKALINE

Facility

$40.00

Service Code	HCPCS 84075
Hospital Charge Code	8407500
Hospital Revenue Code	301
Min. Negotiated Rate	$32.80
Max. Negotiated Rate	$38.80
Rate for Payer: Cash Price	$30.00
Rate for Payer: Health Partners Plans Commercial	$38.00
Rate for Payer: UnitedHealthcare Commercial	$38.80
Rate for Payer: WPPA Commercial	$32.80

PHOSPHATASE, ALKALINE

Facility

$40.00

Service Code	HCPCS 84075
Hospital Charge Code	8407500
Hospital Revenue Code	301
Min. Negotiated Rate	$11.11
Max. Negotiated Rate	$38.80
Rate for Payer: BCBS Commercial	$11.11
Rate for Payer: Cash Price	$30.00
Rate for Payer: Cash Price	$30.00
Rate for Payer: Celtic Commercial/Exchange	$18.48
Rate for Payer: Health Partners Plans Commercial	$38.00
Rate for Payer: UnitedHealthcare Commercial	$38.80
Rate for Payer: WPPA Commercial	$33.60

PHOSPHATASE, ALK HEAT STABLE

Facility

$59.00

Service Code	HCPCS 84078
Hospital Charge Code	8407800
Hospital Revenue Code	301
Min. Negotiated Rate	$27.26
Max. Negotiated Rate	$57.23
Rate for Payer: BCBS Commercial	$30.51
Rate for Payer: Cash Price	$44.25
Rate for Payer: Cash Price	$44.25
Rate for Payer: Celtic Commercial/Exchange	$27.26
Rate for Payer: Health Partners Plans Commercial	$56.05
Rate for Payer: UnitedHealthcare Commercial	$57.23
Rate for Payer: WPPA Commercial	$49.56

PHOSPHATASE, ALK HEAT STABLE

Facility

$59.00

Service Code	HCPCS 84078
Hospital Charge Code	8407800
Hospital Revenue Code	301
Min. Negotiated Rate	$48.38
Max. Negotiated Rate	$57.23
Rate for Payer: Cash Price	$44.25
Rate for Payer: Health Partners Plans Commercial	$56.05
Rate for Payer: UnitedHealthcare Commercial	$57.23
Rate for Payer: WPPA Commercial	$48.38

Know your out-of-pocket cost for care.

All Charges