Ness County Hospital

All Charges

Charge

Type

Setting

Price

PROF-TELEHEALTH CLINIC 40 MIN

Facility

$227.00

Service Code	HCPCS 99215 GT
Hospital Charge Code	9921521
Hospital Revenue Code	983
Min. Negotiated Rate	$186.14
Max. Negotiated Rate	$220.19
Rate for Payer: Cash Price	$170.25
Rate for Payer: Health Partners Plans Commercial	$215.65
Rate for Payer: UnitedHealthcare Commercial	$220.19
Rate for Payer: WPPA Commercial	$186.14

PROF-TELEHEALTH CLINIC 45-59 MIN

Facility

$303.00

Service Code	HCPCS 99204 GT
Hospital Charge Code	9920400
Hospital Revenue Code	983
Min. Negotiated Rate	$248.46
Max. Negotiated Rate	$293.91
Rate for Payer: Cash Price	$227.25
Rate for Payer: Health Partners Plans Commercial	$287.85
Rate for Payer: UnitedHealthcare Commercial	$293.91
Rate for Payer: WPPA Commercial	$248.46

PROF-TELEHEALTH CLINIC 45-59 MIN

Facility

$303.00

Service Code	HCPCS 99204 GT
Hospital Charge Code	9920400
Hospital Revenue Code	983
Min. Negotiated Rate	$101.00
Max. Negotiated Rate	$293.91
Rate for Payer: BCBS Commercial	$101.00
Rate for Payer: Cash Price	$227.25
Rate for Payer: Cash Price	$227.25
Rate for Payer: Celtic Commercial/Exchange	$139.99
Rate for Payer: Health Partners Plans Commercial	$287.85
Rate for Payer: UnitedHealthcare Commercial	$293.91
Rate for Payer: WPPA Commercial	$254.52

PROF-TELEHEALTH CLINIC 60-74 MIN

Facility

$344.00

Service Code	HCPCS 99205 GT
Hospital Charge Code	9920500
Hospital Revenue Code	983
Min. Negotiated Rate	$282.08
Max. Negotiated Rate	$333.68
Rate for Payer: Cash Price	$258.00
Rate for Payer: Health Partners Plans Commercial	$326.80
Rate for Payer: UnitedHealthcare Commercial	$333.68
Rate for Payer: WPPA Commercial	$282.08

PROF-TELEHEALTH CLINIC 60-74 MIN

Facility

$344.00

Service Code	HCPCS 99205 GT
Hospital Charge Code	9920500
Hospital Revenue Code	983
Min. Negotiated Rate	$158.93
Max. Negotiated Rate	$333.68
Rate for Payer: BCBS Commercial	$168.67
Rate for Payer: Cash Price	$258.00
Rate for Payer: Cash Price	$258.00
Rate for Payer: Celtic Commercial/Exchange	$158.93
Rate for Payer: Health Partners Plans Commercial	$326.80
Rate for Payer: UnitedHealthcare Commercial	$333.68
Rate for Payer: WPPA Commercial	$288.96

PROF-TELEHEALTH CLINIC ADDTL 15 MIN

Facility

$31.00

Service Code	HCPCS 99417 GT
Hospital Charge Code	9941700
Hospital Revenue Code	983
Min. Negotiated Rate	$25.42
Max. Negotiated Rate	$30.07
Rate for Payer: Cash Price	$23.25
Rate for Payer: Health Partners Plans Commercial	$29.45
Rate for Payer: UnitedHealthcare Commercial	$30.07
Rate for Payer: WPPA Commercial	$25.42

PROF-TELEHEALTH CLINIC ADDTL 15 MIN

Facility

$31.00

Service Code	HCPCS 99417 GT
Hospital Charge Code	9941700
Hospital Revenue Code	983
Min. Negotiated Rate	$14.32
Max. Negotiated Rate	$43.88
Rate for Payer: BCBS Commercial	$43.88
Rate for Payer: Cash Price	$23.25
Rate for Payer: Cash Price	$23.25
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

PROF-TELEHEALTH CLINIC EST 10 MIN

Facility

$110.00

Service Code	HCPCS 99212 GT
Hospital Charge Code	9921221
Hospital Revenue Code	983
Min. Negotiated Rate	$50.82
Max. Negotiated Rate	$106.70
Rate for Payer: BCBS Commercial	$85.38
Rate for Payer: Cash Price	$82.50
Rate for Payer: Cash Price	$82.50
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

PROF-TELEHEALTH CLINIC EST 10 MIN

Facility

$110.00

Service Code	HCPCS 99212 GT
Hospital Charge Code	9921221
Hospital Revenue Code	983
Min. Negotiated Rate	$90.20
Max. Negotiated Rate	$106.70
Rate for Payer: Cash Price	$82.50
Rate for Payer: Health Partners Plans Commercial	$104.50
Rate for Payer: UnitedHealthcare Commercial	$106.70
Rate for Payer: WPPA Commercial	$90.20

PROF-TELEHEALTH CLINIC EST 20 MIN

Facility

$142.00

Service Code	HCPCS 99213 GT
Hospital Charge Code	9921321
Hospital Revenue Code	983
Min. Negotiated Rate	$116.44
Max. Negotiated Rate	$137.74
Rate for Payer: Cash Price	$106.50
Rate for Payer: Health Partners Plans Commercial	$134.90
Rate for Payer: UnitedHealthcare Commercial	$137.74
Rate for Payer: WPPA Commercial	$116.44

PROF-TELEHEALTH CLINIC EST 20 MIN

Facility

$142.00

Service Code	HCPCS 99213 GT
Hospital Charge Code	9921321
Hospital Revenue Code	983
Min. Negotiated Rate	$65.60
Max. Negotiated Rate	$137.74
Rate for Payer: BCBS Commercial	$133.49
Rate for Payer: Cash Price	$106.50
Rate for Payer: Cash Price	$106.50
Rate for Payer: Celtic Commercial/Exchange	$65.60
Rate for Payer: Health Partners Plans Commercial	$134.90
Rate for Payer: UnitedHealthcare Commercial	$137.74
Rate for Payer: WPPA Commercial	$119.28

PROF WC Dress/debride of burns, w/o anes. large

Facility

$200.00

Service Code	HCPCS 16030
Hospital Charge Code	16030WC
Hospital Revenue Code	983
Min. Negotiated Rate	$164.00
Max. Negotiated Rate	$194.00
Rate for Payer: Cash Price	$150.00
Rate for Payer: Health Partners Plans Commercial	$190.00
Rate for Payer: UnitedHealthcare Commercial	$194.00
Rate for Payer: WPPA Commercial	$164.00

PROF WC Dress/debride of burns, w/o anes. large

Facility

$200.00

Service Code	HCPCS 16030
Hospital Charge Code	16030WC
Hospital Revenue Code	983
Min. Negotiated Rate	$92.40
Max. Negotiated Rate	$371.68
Rate for Payer: BCBS Commercial	$371.68
Rate for Payer: Cash Price	$150.00
Rate for Payer: Cash Price	$150.00
Rate for Payer: Celtic Commercial/Exchange	$92.40
Rate for Payer: Health Partners Plans Commercial	$190.00
Rate for Payer: UnitedHealthcare Commercial	$194.00
Rate for Payer: WPPA Commercial	$168.00

Prof. WC VISIT LEVEL 3

Facility

$200.00

Service Code	HCPCS 99203 GF
Hospital Charge Code	99203WC
Hospital Revenue Code	983
Min. Negotiated Rate	$92.40
Max. Negotiated Rate	$194.00
Rate for Payer: BCBS Commercial	$101.00
Rate for Payer: Cash Price	$150.00
Rate for Payer: Cash Price	$150.00
Rate for Payer: Celtic Commercial/Exchange	$92.40
Rate for Payer: Health Partners Plans Commercial	$190.00
Rate for Payer: UnitedHealthcare Commercial	$194.00
Rate for Payer: WPPA Commercial	$168.00

Prof. WC VISIT LEVEL 3

Facility

$200.00

Service Code	HCPCS 99203 GF
Hospital Charge Code	99203WC
Hospital Revenue Code	983
Min. Negotiated Rate	$164.00
Max. Negotiated Rate	$194.00
Rate for Payer: Cash Price	$150.00
Rate for Payer: Health Partners Plans Commercial	$190.00
Rate for Payer: UnitedHealthcare Commercial	$194.00
Rate for Payer: WPPA Commercial	$164.00

PROGESTERONE

Facility

$147.00

Service Code	HCPCS 84144
Hospital Charge Code	8414400
Hospital Revenue Code	301
Min. Negotiated Rate	$120.54
Max. Negotiated Rate	$142.59
Rate for Payer: Cash Price	$110.25
Rate for Payer: Health Partners Plans Commercial	$139.65
Rate for Payer: UnitedHealthcare Commercial	$142.59
Rate for Payer: WPPA Commercial	$120.54

PROGESTERONE

Facility

$147.00

Service Code	HCPCS 84144
Hospital Charge Code	8414400
Hospital Revenue Code	301
Min. Negotiated Rate	$67.91
Max. Negotiated Rate	$142.59
Rate for Payer: BCBS Commercial	$71.72
Rate for Payer: Cash Price	$110.25
Rate for Payer: Cash Price	$110.25
Rate for Payer: Celtic Commercial/Exchange	$67.91
Rate for Payer: Health Partners Plans Commercial	$139.65
Rate for Payer: UnitedHealthcare Commercial	$142.59
Rate for Payer: WPPA Commercial	$123.48

PROLACTIN

Facility

$177.00

Service Code	HCPCS 84146
Hospital Charge Code	8414600
Hospital Revenue Code	301
Min. Negotiated Rate	$145.14
Max. Negotiated Rate	$171.69
Rate for Payer: Cash Price	$132.75
Rate for Payer: Health Partners Plans Commercial	$168.15
Rate for Payer: UnitedHealthcare Commercial	$171.69
Rate for Payer: WPPA Commercial	$145.14

PROLACTIN

Facility

$177.00

Service Code	HCPCS 84146
Hospital Charge Code	8414600
Hospital Revenue Code	301
Min. Negotiated Rate	$79.41
Max. Negotiated Rate	$171.69
Rate for Payer: BCBS Commercial	$79.41
Rate for Payer: Cash Price	$132.75
Rate for Payer: Cash Price	$132.75
Rate for Payer: Celtic Commercial/Exchange	$81.77
Rate for Payer: Health Partners Plans Commercial	$168.15
Rate for Payer: UnitedHealthcare Commercial	$171.69
Rate for Payer: WPPA Commercial	$148.68

Prolia (denosumab) SubQ Syringe 60mg/ml

Facility

$5,317.00

Service Code	NDC 55513071001
Hospital Charge Code	2503547
Hospital Revenue Code	250
Min. Negotiated Rate	$4,359.94
Max. Negotiated Rate	$5,157.49
Rate for Payer: Cash Price	$3,988.35
Rate for Payer: Health Partners Plans Commercial	$5,051.15
Rate for Payer: UnitedHealthcare Commercial	$5,157.49
Rate for Payer: WPPA Commercial	$4,359.94

Prolia (denosumab) SubQ Syringe 60mg/ml

Facility

$5,317.00

Service Code	NDC 55513071001
Hospital Charge Code	2503547
Hospital Revenue Code	250
Min. Negotiated Rate	$2,456.45
Max. Negotiated Rate	$5,157.49
Rate for Payer: Cash Price	$3,988.35
Rate for Payer: Celtic Commercial/Exchange	$2,456.45
Rate for Payer: Health Partners Plans Commercial	$5,051.15
Rate for Payer: UnitedHealthcare Commercial	$5,157.49
Rate for Payer: WPPA Commercial	$4,466.28

PROPOXYPHENE SCREEN

Facility

$271.00

Service Code	HCPCS 80367
Hospital Charge Code	8036700
Hospital Revenue Code	300
Min. Negotiated Rate	$222.22
Max. Negotiated Rate	$262.87
Rate for Payer: Cash Price	$203.25
Rate for Payer: Health Partners Plans Commercial	$257.45
Rate for Payer: UnitedHealthcare Commercial	$262.87
Rate for Payer: WPPA Commercial	$222.22

PROPOXYPHENE SCREEN

Facility

$271.00

Service Code	HCPCS 80367
Hospital Charge Code	8036700
Hospital Revenue Code	300
Min. Negotiated Rate	$23.88
Max. Negotiated Rate	$262.87
Rate for Payer: BCBS Commercial	$23.88
Rate for Payer: Cash Price	$203.25
Rate for Payer: Cash Price	$203.25
Rate for Payer: Celtic Commercial/Exchange	$125.20
Rate for Payer: Health Partners Plans Commercial	$257.45
Rate for Payer: UnitedHealthcare Commercial	$262.87
Rate for Payer: WPPA Commercial	$227.64

PROSCAR 5 MG TAB (FINASTERIDE)

Facility

$10.00

Service Code	NDC 60687042811
Hospital Charge Code	2514131
Hospital Revenue Code	250
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$7.50
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

PROSCAR 5 MG TAB (FINASTERIDE)

Facility

$10.00

Service Code	NDC 60687042811
Hospital Charge Code	2514131
Hospital Revenue Code	250
Min. Negotiated Rate	$8.20
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$7.50
Rate for Payer: Health Partners Plans Commercial	$9.50
Rate for Payer: UnitedHealthcare Commercial	$9.70
Rate for Payer: WPPA Commercial	$8.20

Know your out-of-pocket cost for care.

All Charges