Ness County Hospital

All Charges

Charge

Type

Setting

Price

PREVACID 15 MG CAP (LANSOPRAZOLE)

Facility

$18.00

Service Code	NDC 60687011111
Hospital Charge Code	2514644
Hospital Revenue Code	250
Min. Negotiated Rate	$8.32
Max. Negotiated Rate	$17.46
Rate for Payer: Cash Price	$14.06
Rate for Payer: Celtic Commercial/Exchange	$8.32
Rate for Payer: Health Partners Plans Commercial	$17.10
Rate for Payer: UnitedHealthcare Commercial	$17.46
Rate for Payer: WPPA Commercial	$15.12

PREVALON HEEL PROTECTOR

Facility

$120.00

Hospital Charge Code	2725050
Hospital Revenue Code	272
Min. Negotiated Rate	$55.44
Max. Negotiated Rate	$116.40
Rate for Payer: Cash Price	$90.00
Rate for Payer: Celtic Commercial/Exchange	$55.44
Rate for Payer: Health Partners Plans Commercial	$114.00
Rate for Payer: UnitedHealthcare Commercial	$116.40
Rate for Payer: WPPA Commercial	$100.80

PREVALON HEEL PROTECTOR

Facility

$120.00

Hospital Charge Code	2725050
Hospital Revenue Code	272
Min. Negotiated Rate	$98.40
Max. Negotiated Rate	$116.40
Rate for Payer: Cash Price	$90.00
Rate for Payer: Health Partners Plans Commercial	$114.00
Rate for Payer: UnitedHealthcare Commercial	$116.40
Rate for Payer: WPPA Commercial	$98.40

Prevnar 20 (PF) (pneumoc 20-val conj-dip cr(PF)) IM syringe

Facility

$913.00

Service Code	NDC 00005200010
Hospital Charge Code	2506376
Hospital Revenue Code	250
Min. Negotiated Rate	$748.66
Max. Negotiated Rate	$885.61
Rate for Payer: Cash Price	$685.39
Rate for Payer: Health Partners Plans Commercial	$867.35
Rate for Payer: UnitedHealthcare Commercial	$885.61
Rate for Payer: WPPA Commercial	$748.66

Prevnar 20 (PF) (pneumoc 20-val conj-dip cr(PF)) IM syringe

Facility

$913.00

Service Code	NDC 00005200010
Hospital Charge Code	2506376
Hospital Revenue Code	250
Min. Negotiated Rate	$421.81
Max. Negotiated Rate	$885.61
Rate for Payer: Cash Price	$685.39
Rate for Payer: Celtic Commercial/Exchange	$421.81
Rate for Payer: Health Partners Plans Commercial	$867.35
Rate for Payer: UnitedHealthcare Commercial	$885.61
Rate for Payer: WPPA Commercial	$766.92

PRILOSEC 20 MG CAP (OMEPRAZOLE DR)

Facility

$13.00

Service Code	NDC 00904691761
Hospital Charge Code	2511087
Hospital Revenue Code	250
Min. Negotiated Rate	$10.66
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$10.39
Rate for Payer: Health Partners Plans Commercial	$12.35
Rate for Payer: UnitedHealthcare Commercial	$12.61
Rate for Payer: WPPA Commercial	$10.66

PRILOSEC 20 MG CAP (OMEPRAZOLE DR)

Facility

$13.00

Service Code	NDC 00904691761
Hospital Charge Code	2511087
Hospital Revenue Code	250
Min. Negotiated Rate	$6.01
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$10.39
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

PRIMAPORE 2X3

Facility

$1.00

Hospital Charge Code	2725701
Hospital Revenue Code	270
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

PRIMAPORE 2X3

Facility

$1.00

Hospital Charge Code	2725701
Hospital Revenue Code	270
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

PRIMAPORE 2X3 LTC

Facility

$9.00

Hospital Charge Code	2725701LTC
Hospital Revenue Code	272
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$6.75
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

PRIMAPORE 2X3 LTC

Facility

$9.00

Hospital Charge Code	2725701LTC
Hospital Revenue Code	272
Min. Negotiated Rate	$7.38
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$6.75
Rate for Payer: Health Partners Plans Commercial	$8.55
Rate for Payer: UnitedHealthcare Commercial	$8.73
Rate for Payer: WPPA Commercial	$7.38

Primaxin 250 mg IV (imipenem/cilastatin)

Facility

$62.00

Service Code	NDC 63323034925
Hospital Charge Code	2517688
Hospital Revenue Code	250
Min. Negotiated Rate	$50.84
Max. Negotiated Rate	$60.14
Rate for Payer: Cash Price	$46.84
Rate for Payer: Health Partners Plans Commercial	$58.90
Rate for Payer: UnitedHealthcare Commercial	$60.14
Rate for Payer: WPPA Commercial	$50.84

Primaxin 250 mg IV (imipenem/cilastatin)

Facility

$62.00

Service Code	NDC 63323034925
Hospital Charge Code	2517688
Hospital Revenue Code	250
Min. Negotiated Rate	$28.64
Max. Negotiated Rate	$60.14
Rate for Payer: Cash Price	$46.84
Rate for Payer: Celtic Commercial/Exchange	$28.64
Rate for Payer: Health Partners Plans Commercial	$58.90
Rate for Payer: UnitedHealthcare Commercial	$60.14
Rate for Payer: WPPA Commercial	$52.08

Primaxin 500 mg vial (imipenem-cilastatin)

Facility

$292.00

Service Code	NDC 63323032221
Hospital Charge Code	2514701
Hospital Revenue Code	250
Min. Negotiated Rate	$239.44
Max. Negotiated Rate	$283.24
Rate for Payer: Cash Price	$219.49
Rate for Payer: Health Partners Plans Commercial	$277.40
Rate for Payer: UnitedHealthcare Commercial	$283.24
Rate for Payer: WPPA Commercial	$239.44

Primaxin 500 mg vial (imipenem-cilastatin)

Facility

$292.00

Service Code	NDC 63323032221
Hospital Charge Code	2514701
Hospital Revenue Code	250
Min. Negotiated Rate	$134.90
Max. Negotiated Rate	$283.24
Rate for Payer: Cash Price	$219.49
Rate for Payer: Celtic Commercial/Exchange	$134.90
Rate for Payer: Health Partners Plans Commercial	$277.40
Rate for Payer: UnitedHealthcare Commercial	$283.24
Rate for Payer: WPPA Commercial	$245.28

PRINIVIL 10 MG TAB (ZESTRIL or LISINOPRIL)

Facility

$3.00

Service Code	NDC 60687032511
Hospital Charge Code	2510691
Hospital Revenue Code	250
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.29
Rate for Payer: Health Partners Plans Commercial	$2.85
Rate for Payer: UnitedHealthcare Commercial	$2.91
Rate for Payer: WPPA Commercial	$2.46

PRINIVIL 10 MG TAB (ZESTRIL or LISINOPRIL)

Facility

$3.00

Service Code	NDC 60687032511
Hospital Charge Code	2510691
Hospital Revenue Code	250
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$2.29
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

PROCAINAMIDE

Facility

$97.00

Service Code	HCPCS 80190
Hospital Charge Code	8019000
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

PROCAINAMIDE

Facility

$97.00

Service Code	HCPCS 80190
Hospital Charge Code	8019000
Hospital Revenue Code	301
Min. Negotiated Rate	$44.81
Max. Negotiated Rate	$94.09
Rate for Payer: BCBS Commercial	$57.72
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

Procainamide 1GM/ 10 ml vial (pronestyl)

Facility

$325.00

Service Code	NDC 00409190201
Hospital Charge Code	2505972
Hospital Revenue Code	250
Min. Negotiated Rate	$150.15
Max. Negotiated Rate	$315.25
Rate for Payer: Cash Price	$244.35
Rate for Payer: Celtic Commercial/Exchange	$150.15
Rate for Payer: Health Partners Plans Commercial	$308.75
Rate for Payer: UnitedHealthcare Commercial	$315.25
Rate for Payer: WPPA Commercial	$273.00

Procainamide 1GM/ 10 ml vial (pronestyl)

Facility

$325.00

Service Code	NDC 00409190201
Hospital Charge Code	2505972
Hospital Revenue Code	250
Min. Negotiated Rate	$266.50
Max. Negotiated Rate	$315.25
Rate for Payer: Cash Price	$244.35
Rate for Payer: Health Partners Plans Commercial	$308.75
Rate for Payer: UnitedHealthcare Commercial	$315.25
Rate for Payer: WPPA Commercial	$266.50

PROCALCITONIN

Facility

$302.00

Service Code	HCPCS 84145
Hospital Charge Code	8414500
Hospital Revenue Code	301
Min. Negotiated Rate	$91.94
Max. Negotiated Rate	$292.94
Rate for Payer: BCBS Commercial	$91.94
Rate for Payer: Cash Price	$226.50
Rate for Payer: Cash Price	$226.50
Rate for Payer: Celtic Commercial/Exchange	$139.52
Rate for Payer: Health Partners Plans Commercial	$286.90
Rate for Payer: UnitedHealthcare Commercial	$292.94
Rate for Payer: WPPA Commercial	$253.68

PROCALCITONIN

Facility

$302.00

Service Code	HCPCS 84145
Hospital Charge Code	8414500
Hospital Revenue Code	301
Min. Negotiated Rate	$247.64
Max. Negotiated Rate	$292.94
Rate for Payer: Cash Price	$226.50
Rate for Payer: Health Partners Plans Commercial	$286.90
Rate for Payer: UnitedHealthcare Commercial	$292.94
Rate for Payer: WPPA Commercial	$247.64

PROCARDIA 10 MG CAP (NIFEDIPINE)

Facility

$5.00

Service Code	NDC 00904722961
Hospital Charge Code	2505915
Hospital Revenue Code	250
Min. Negotiated Rate	$4.10
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$4.43
Rate for Payer: Health Partners Plans Commercial	$4.75
Rate for Payer: UnitedHealthcare Commercial	$4.85
Rate for Payer: WPPA Commercial	$4.10

PROCARDIA 10 MG CAP (NIFEDIPINE)

Facility

$5.00

Service Code	NDC 00904722961
Hospital Charge Code	2505915
Hospital Revenue Code	250
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$4.43
Rate for Payer: Celtic Commercial/Exchange	$2.31
Rate for Payer: Health Partners Plans Commercial	$4.75
Rate for Payer: UnitedHealthcare Commercial	$4.85
Rate for Payer: WPPA Commercial	$4.20

Know your out-of-pocket cost for care.

All Charges