Ness County Hospital

All Charges

Charge

Type

Setting

Price

PHOSPHATASE, ALK ISOENZYMES

Facility

$97.00

Service Code	HCPCS 84080
Hospital Charge Code	8408000
Hospital Revenue Code	301
Min. Negotiated Rate	$44.81
Max. Negotiated Rate	$94.09
Rate for Payer: BCBS Commercial	$54.81
Rate for Payer: Cash Price	$72.75
Rate for Payer: Cash Price	$72.75
Rate for Payer: Celtic Commercial/Exchange	$44.81
Rate for Payer: Health Partners Plans Commercial	$92.15
Rate for Payer: UnitedHealthcare Commercial	$94.09
Rate for Payer: WPPA Commercial	$81.48

PHOSPHATASE, ALK ISOENZYMES

Facility

$97.00

Service Code	HCPCS 84080
Hospital Charge Code	8408000
Hospital Revenue Code	301
Min. Negotiated Rate	$79.54
Max. Negotiated Rate	$94.09
Rate for Payer: Cash Price	$72.75
Rate for Payer: Health Partners Plans Commercial	$92.15
Rate for Payer: UnitedHealthcare Commercial	$94.09
Rate for Payer: WPPA Commercial	$79.54

PHOSPHORUS INORGANIC(PHOSPHATE

Facility

$55.00

Service Code	HCPCS 84100
Hospital Charge Code	8410000
Hospital Revenue Code	301
Min. Negotiated Rate	$45.10
Max. Negotiated Rate	$53.35
Rate for Payer: Cash Price	$41.25
Rate for Payer: Health Partners Plans Commercial	$52.25
Rate for Payer: UnitedHealthcare Commercial	$53.35
Rate for Payer: WPPA Commercial	$45.10

PHOSPHORUS INORGANIC(PHOSPHATE

Facility

$55.00

Service Code	HCPCS 84100
Hospital Charge Code	8410000
Hospital Revenue Code	301
Min. Negotiated Rate	$10.18
Max. Negotiated Rate	$53.35
Rate for Payer: BCBS Commercial	$10.18
Rate for Payer: Cash Price	$41.25
Rate for Payer: Cash Price	$41.25
Rate for Payer: Celtic Commercial/Exchange	$25.41
Rate for Payer: Health Partners Plans Commercial	$52.25
Rate for Payer: UnitedHealthcare Commercial	$53.35
Rate for Payer: WPPA Commercial	$46.20

PHOSPHORUS INORGANIC,URINE

Facility

$28.00

Service Code	HCPCS 84105
Hospital Charge Code	8410500
Hospital Revenue Code	300
Min. Negotiated Rate	$22.96
Max. Negotiated Rate	$27.16
Rate for Payer: Cash Price	$21.00
Rate for Payer: Health Partners Plans Commercial	$26.60
Rate for Payer: UnitedHealthcare Commercial	$27.16
Rate for Payer: WPPA Commercial	$22.96

PHOSPHORUS INORGANIC,URINE

Facility

$28.00

Service Code	HCPCS 84105
Hospital Charge Code	8410500
Hospital Revenue Code	300
Min. Negotiated Rate	$12.94
Max. Negotiated Rate	$27.16
Rate for Payer: BCBS Commercial	$17.72
Rate for Payer: Cash Price	$21.00
Rate for Payer: Cash Price	$21.00
Rate for Payer: Celtic Commercial/Exchange	$12.94
Rate for Payer: Health Partners Plans Commercial	$26.60
Rate for Payer: UnitedHealthcare Commercial	$27.16
Rate for Payer: WPPA Commercial	$23.52

PHYS-2.5 CM LAC REPAIR

Facility

$383.00

Service Code	HCPCS 12041
Hospital Charge Code	1204101
Hospital Revenue Code	981
Min. Negotiated Rate	$176.95
Max. Negotiated Rate	$532.27
Rate for Payer: BCBS Commercial	$532.27
Rate for Payer: Cash Price	$287.25
Rate for Payer: Cash Price	$287.25
Rate for Payer: Celtic Commercial/Exchange	$176.95
Rate for Payer: Health Partners Plans Commercial	$363.85
Rate for Payer: UnitedHealthcare Commercial	$371.51
Rate for Payer: WPPA Commercial	$321.72

PHYS-2.5 CM LAC REPAIR

Facility

$383.00

Service Code	HCPCS 12041
Hospital Charge Code	1204101
Hospital Revenue Code	981
Min. Negotiated Rate	$314.06
Max. Negotiated Rate	$371.51
Rate for Payer: Cash Price	$287.25
Rate for Payer: Health Partners Plans Commercial	$363.85
Rate for Payer: UnitedHealthcare Commercial	$371.51
Rate for Payer: WPPA Commercial	$314.06

PHYS-5.1/7.5CM SIMPLE REPAIR

Facility

$185.00

Service Code	HCPCS 12014
Hospital Charge Code	1201401
Hospital Revenue Code	981
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

PHYS-5.1/7.5CM SIMPLE REPAIR

Facility

$185.00

Service Code	HCPCS 12014
Hospital Charge Code	1201401
Hospital Revenue Code	981
Min. Negotiated Rate	$85.47
Max. Negotiated Rate	$475.71
Rate for Payer: BCBS Commercial	$475.71
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

PHYSICAL THER EVAL (AEGIS)

Facility

$197.00

Service Code	HCPCS G0151
Hospital Charge Code	4209911
Hospital Revenue Code	421
Min. Negotiated Rate	$161.54
Max. Negotiated Rate	$191.09
Rate for Payer: Cash Price	$147.75
Rate for Payer: Health Partners Plans Commercial	$187.15
Rate for Payer: UnitedHealthcare Commercial	$191.09
Rate for Payer: WPPA Commercial	$161.54

PHYSICAL THER EVAL (AEGIS)

Facility

$197.00

Service Code	HCPCS G0151
Hospital Charge Code	4209911
Hospital Revenue Code	421
Min. Negotiated Rate	$91.01
Max. Negotiated Rate	$191.09
Rate for Payer: Cash Price	$147.75
Rate for Payer: Celtic Commercial/Exchange	$91.01
Rate for Payer: Health Partners Plans Commercial	$187.15
Rate for Payer: UnitedHealthcare Commercial	$191.09
Rate for Payer: WPPA Commercial	$165.48

PHYS PERFORM TEST/MEASURE. 15"

Facility

$65.00

Service Code	HCPCS 97750 GP
Hospital Charge Code	4200938
Hospital Revenue Code	424
Min. Negotiated Rate	$53.30
Max. Negotiated Rate	$63.05
Rate for Payer: Cash Price	$48.75
Rate for Payer: Health Partners Plans Commercial	$61.75
Rate for Payer: UnitedHealthcare Commercial	$63.05
Rate for Payer: WPPA Commercial	$53.30

PHYS PERFORM TEST/MEASURE. 15"

Facility

$65.00

Service Code	HCPCS 97750 GP
Hospital Charge Code	4200938
Hospital Revenue Code	424
Min. Negotiated Rate	$30.03
Max. Negotiated Rate	$63.05
Rate for Payer: BCBS Commercial	$53.53
Rate for Payer: Cash Price	$48.75
Rate for Payer: Cash Price	$48.75
Rate for Payer: Celtic Commercial/Exchange	$30.03
Rate for Payer: Health Partners Plans Commercial	$61.75
Rate for Payer: UnitedHealthcare Commercial	$63.05
Rate for Payer: WPPA Commercial	$54.60

PHYS THER TX BY ASSIST (AEGIS)

Facility

$194.00

Service Code	HCPCS G0157
Hospital Charge Code	4209933
Hospital Revenue Code	421
Min. Negotiated Rate	$159.08
Max. Negotiated Rate	$188.18
Rate for Payer: Cash Price	$145.50
Rate for Payer: Health Partners Plans Commercial	$184.30
Rate for Payer: UnitedHealthcare Commercial	$188.18
Rate for Payer: WPPA Commercial	$159.08

PHYS THER TX BY ASSIST (AEGIS)

Facility

$194.00

Service Code	HCPCS G0157
Hospital Charge Code	4209933
Hospital Revenue Code	421
Min. Negotiated Rate	$89.63
Max. Negotiated Rate	$188.18
Rate for Payer: Cash Price	$145.50
Rate for Payer: Celtic Commercial/Exchange	$89.63
Rate for Payer: Health Partners Plans Commercial	$184.30
Rate for Payer: UnitedHealthcare Commercial	$188.18
Rate for Payer: WPPA Commercial	$162.96

PHYS THER TX BY PT (AEGIS)

Facility

$185.00

Service Code	HCPCS G0151
Hospital Charge Code	4209922
Hospital Revenue Code	421
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

PHYS THER TX BY PT (AEGIS)

Facility

$185.00

Service Code	HCPCS G0151
Hospital Charge Code	4209922
Hospital Revenue Code	421
Min. Negotiated Rate	$85.47
Max. Negotiated Rate	$179.45
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

PICC INTRODUCER

Facility

$110.00

Hospital Charge Code	2706412
Hospital Revenue Code	270
Min. Negotiated Rate	$50.82
Max. Negotiated Rate	$106.70
Rate for Payer: Cash Price	$82.69
Rate for Payer: Celtic Commercial/Exchange	$50.82
Rate for Payer: Health Partners Plans Commercial	$104.50
Rate for Payer: UnitedHealthcare Commercial	$106.70
Rate for Payer: WPPA Commercial	$92.40

PICC INTRODUCER

Facility

$110.00

Hospital Charge Code	2706412
Hospital Revenue Code	270
Min. Negotiated Rate	$90.20
Max. Negotiated Rate	$106.70
Rate for Payer: Cash Price	$82.69
Rate for Payer: Health Partners Plans Commercial	$104.50
Rate for Payer: UnitedHealthcare Commercial	$106.70
Rate for Payer: WPPA Commercial	$90.20

PICC LINE BLOOD DRAW

Facility

$162.00

Service Code	HCPCS 36592
Hospital Charge Code	3659200
Hospital Revenue Code	761
Min. Negotiated Rate	$74.84
Max. Negotiated Rate	$157.14
Rate for Payer: BCBS Commercial	$144.89
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

PICC LINE BLOOD DRAW

Facility

$162.00

Service Code	HCPCS 36592
Hospital Charge Code	3659200
Hospital Revenue Code	761
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

PICC LINE INSERTION KIT

Facility

$483.00

Hospital Charge Code	2706363
Hospital Revenue Code	270
Min. Negotiated Rate	$223.15
Max. Negotiated Rate	$468.51
Rate for Payer: Cash Price	$362.62
Rate for Payer: Celtic Commercial/Exchange	$223.15
Rate for Payer: Health Partners Plans Commercial	$458.85
Rate for Payer: UnitedHealthcare Commercial	$468.51
Rate for Payer: WPPA Commercial	$405.72

PICC LINE INSERTION KIT

Facility

$483.00

Hospital Charge Code	2706363
Hospital Revenue Code	270
Min. Negotiated Rate	$396.06
Max. Negotiated Rate	$468.51
Rate for Payer: Cash Price	$362.62
Rate for Payer: Health Partners Plans Commercial	$458.85
Rate for Payer: UnitedHealthcare Commercial	$468.51
Rate for Payer: WPPA Commercial	$396.06

PICC PEELAWAY INTRODUCER

Facility

$50.00

Hospital Charge Code	2580629
Hospital Revenue Code	270
Min. Negotiated Rate	$41.00
Max. Negotiated Rate	$48.50
Rate for Payer: Cash Price	$38.10
Rate for Payer: Health Partners Plans Commercial	$47.50
Rate for Payer: UnitedHealthcare Commercial	$48.50
Rate for Payer: WPPA Commercial	$41.00

Know your out-of-pocket cost for care.

All Charges