Ness County Hospital

All Charges

Charge

Type

Setting

Price

PROS SPEC ANTIGEN (PSA) FREE

Facility

$138.00

Service Code	HCPCS 84154
Hospital Charge Code	8415400
Hospital Revenue Code	301
Min. Negotiated Rate	$113.16
Max. Negotiated Rate	$133.86
Rate for Payer: Cash Price	$103.50
Rate for Payer: Health Partners Plans Commercial	$131.10
Rate for Payer: UnitedHealthcare Commercial	$133.86
Rate for Payer: WPPA Commercial	$113.16

PROS SPEC ANTIGEN (PSA) FREE

Facility

$138.00

Service Code	HCPCS 84154
Hospital Charge Code	8415400
Hospital Revenue Code	301
Min. Negotiated Rate	$52.90
Max. Negotiated Rate	$133.86
Rate for Payer: BCBS Commercial	$52.90
Rate for Payer: Cash Price	$103.50
Rate for Payer: Cash Price	$103.50
Rate for Payer: Celtic Commercial/Exchange	$63.76
Rate for Payer: Health Partners Plans Commercial	$131.10
Rate for Payer: UnitedHealthcare Commercial	$133.86
Rate for Payer: WPPA Commercial	$115.92

PROSTATECTOMY WITH CC

Facility

$13,895.33

Service Code	MSDRG 666
Min. Negotiated Rate	$13,895.33
Max. Negotiated Rate	$13,895.33
Rate for Payer: BCBS Commercial	$13,895.33

PROSTATECTOMY WITH MCC

Facility

$25,060.19

Service Code	MSDRG 665
Min. Negotiated Rate	$25,060.19
Max. Negotiated Rate	$25,060.19
Rate for Payer: BCBS Commercial	$25,060.19

PROSTATECTOMY WITHOUT CC/MCC

Facility

$8,646.43

Service Code	MSDRG 667
Min. Negotiated Rate	$8,646.43
Max. Negotiated Rate	$8,646.43
Rate for Payer: BCBS Commercial	$8,646.43

PROSTATE SPEC ANTIGEN PSA TOTL

Facility

$159.00

Service Code	HCPCS 84153
Hospital Charge Code	8415300
Hospital Revenue Code	301
Min. Negotiated Rate	$67.95
Max. Negotiated Rate	$154.23
Rate for Payer: BCBS Commercial	$67.95
Rate for Payer: Cash Price	$119.25
Rate for Payer: Cash Price	$119.25
Rate for Payer: Celtic Commercial/Exchange	$73.46
Rate for Payer: Health Partners Plans Commercial	$151.05
Rate for Payer: UnitedHealthcare Commercial	$154.23
Rate for Payer: WPPA Commercial	$133.56

PROSTATE SPEC ANTIGEN PSA TOTL

Facility

$159.00

Service Code	HCPCS 84153
Hospital Charge Code	8415300
Hospital Revenue Code	301
Min. Negotiated Rate	$130.38
Max. Negotiated Rate	$154.23
Rate for Payer: Cash Price	$119.25
Rate for Payer: Health Partners Plans Commercial	$151.05
Rate for Payer: UnitedHealthcare Commercial	$154.23
Rate for Payer: WPPA Commercial	$130.38

PROSTHETIC TRNNG 1ST ENC 15 M

Facility

$130.00

Service Code	HCPCS 97761 GO
Hospital Charge Code	9776100
Hospital Revenue Code	430
Min. Negotiated Rate	$106.60
Max. Negotiated Rate	$126.10
Rate for Payer: Cash Price	$97.50
Rate for Payer: Health Partners Plans Commercial	$123.50
Rate for Payer: UnitedHealthcare Commercial	$126.10
Rate for Payer: WPPA Commercial	$106.60

PROSTHETIC TRNNG 1ST ENC 15 M

Facility

$130.00

Service Code	HCPCS 97761 GO
Hospital Charge Code	9776100
Hospital Revenue Code	430
Min. Negotiated Rate	$50.50
Max. Negotiated Rate	$126.10
Rate for Payer: BCBS Commercial	$50.50
Rate for Payer: Cash Price	$97.50
Rate for Payer: Cash Price	$97.50
Rate for Payer: Celtic Commercial/Exchange	$60.06
Rate for Payer: Health Partners Plans Commercial	$123.50
Rate for Payer: UnitedHealthcare Commercial	$126.10
Rate for Payer: WPPA Commercial	$109.20

PROTAMINE SULFATE 250 MG/25 ML INJ. VIAL

Facility

$132.00

Service Code	NDC 63323022935
Hospital Charge Code	2506020
Hospital Revenue Code	250
Min. Negotiated Rate	$60.98
Max. Negotiated Rate	$128.04
Rate for Payer: Cash Price	$99.52
Rate for Payer: Celtic Commercial/Exchange	$60.98
Rate for Payer: Health Partners Plans Commercial	$125.40
Rate for Payer: UnitedHealthcare Commercial	$128.04
Rate for Payer: WPPA Commercial	$110.88

PROTAMINE SULFATE 250 MG/25 ML INJ. VIAL

Facility

$132.00

Service Code	NDC 63323022935
Hospital Charge Code	2506020
Hospital Revenue Code	250
Min. Negotiated Rate	$108.24
Max. Negotiated Rate	$128.04
Rate for Payer: Cash Price	$99.52
Rate for Payer: Health Partners Plans Commercial	$125.40
Rate for Payer: UnitedHealthcare Commercial	$128.04
Rate for Payer: WPPA Commercial	$108.24

PROTEIN C ACTIVITY & ANTIGEN

Facility

$212.00

Hospital Charge Code	8888952
Hospital Revenue Code	305
Min. Negotiated Rate	$173.84
Max. Negotiated Rate	$205.64
Rate for Payer: Cash Price	$159.00
Rate for Payer: Health Partners Plans Commercial	$201.40
Rate for Payer: UnitedHealthcare Commercial	$205.64
Rate for Payer: WPPA Commercial	$173.84

PROTEIN C ACTIVITY & ANTIGEN

Facility

$212.00

Hospital Charge Code	8888952
Hospital Revenue Code	305
Min. Negotiated Rate	$97.94
Max. Negotiated Rate	$205.64
Rate for Payer: Cash Price	$159.00
Rate for Payer: Celtic Commercial/Exchange	$97.94
Rate for Payer: Health Partners Plans Commercial	$201.40
Rate for Payer: UnitedHealthcare Commercial	$205.64
Rate for Payer: WPPA Commercial	$178.08

PROTEIN ELECTRO FRACT & QUANT

Facility

$119.00

Service Code	HCPCS 84165
Hospital Charge Code	8416500
Hospital Revenue Code	301
Min. Negotiated Rate	$40.29
Max. Negotiated Rate	$115.43
Rate for Payer: BCBS Commercial	$40.29
Rate for Payer: Cash Price	$89.25
Rate for Payer: Cash Price	$89.25
Rate for Payer: Celtic Commercial/Exchange	$54.98
Rate for Payer: Health Partners Plans Commercial	$113.05
Rate for Payer: UnitedHealthcare Commercial	$115.43
Rate for Payer: WPPA Commercial	$99.96

PROTEIN ELECTRO FRACT & QUANT

Facility

$119.00

Service Code	HCPCS 84165
Hospital Charge Code	8416500
Hospital Revenue Code	301
Min. Negotiated Rate	$97.58
Max. Negotiated Rate	$115.43
Rate for Payer: Cash Price	$89.25
Rate for Payer: Health Partners Plans Commercial	$113.05
Rate for Payer: UnitedHealthcare Commercial	$115.43
Rate for Payer: WPPA Commercial	$97.58

PROTEIN ELECTRO-OTHER

Facility

$120.00

Service Code	HCPCS 84166
Hospital Charge Code	8416600
Hospital Revenue Code	301
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

PROTEIN ELECTRO-OTHER

Facility

$120.00

Service Code	HCPCS 84166
Hospital Charge Code	8416600
Hospital Revenue Code	301
Min. Negotiated Rate	$38.52
Max. Negotiated Rate	$116.40
Rate for Payer: BCBS Commercial	$38.52
Rate for Payer: Cash Price	$90.00
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

PROTEIN S ACTIVITY W/REFLEX TO

Facility

$252.00

Service Code	HCPCS 85306
Hospital Charge Code	8530601
Hospital Revenue Code	305
Min. Negotiated Rate	$108.26
Max. Negotiated Rate	$244.44
Rate for Payer: BCBS Commercial	$108.26
Rate for Payer: Cash Price	$189.00
Rate for Payer: Cash Price	$189.00
Rate for Payer: Celtic Commercial/Exchange	$116.42
Rate for Payer: Health Partners Plans Commercial	$239.40
Rate for Payer: UnitedHealthcare Commercial	$244.44
Rate for Payer: WPPA Commercial	$211.68

PROTEIN S ACTIVITY W/REFLEX TO

Facility

$252.00

Service Code	HCPCS 85306
Hospital Charge Code	8530601
Hospital Revenue Code	305
Min. Negotiated Rate	$206.64
Max. Negotiated Rate	$244.44
Rate for Payer: Cash Price	$189.00
Rate for Payer: Health Partners Plans Commercial	$239.40
Rate for Payer: UnitedHealthcare Commercial	$244.44
Rate for Payer: WPPA Commercial	$206.64

PROTEIN S ANTIGEN, TOTAL&FREE

Facility

$304.00

Hospital Charge Code	8888954
Hospital Revenue Code	305
Min. Negotiated Rate	$249.28
Max. Negotiated Rate	$294.88
Rate for Payer: Cash Price	$228.00
Rate for Payer: Health Partners Plans Commercial	$288.80
Rate for Payer: UnitedHealthcare Commercial	$294.88
Rate for Payer: WPPA Commercial	$249.28

PROTEIN S ANTIGEN, TOTAL&FREE

Facility

$304.00

Hospital Charge Code	8888954
Hospital Revenue Code	305
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$294.88
Rate for Payer: Cash Price	$228.00
Rate for Payer: Celtic Commercial/Exchange	$140.45
Rate for Payer: Health Partners Plans Commercial	$288.80
Rate for Payer: UnitedHealthcare Commercial	$294.88
Rate for Payer: WPPA Commercial	$255.36

PROTEIN,TOTAL,EXCPT REFRAC-OTH

Facility

$44.00

Service Code	HCPCS 84157
Hospital Charge Code	8415700
Hospital Revenue Code	301
Min. Negotiated Rate	$36.08
Max. Negotiated Rate	$42.68
Rate for Payer: Cash Price	$33.00
Rate for Payer: Health Partners Plans Commercial	$41.80
Rate for Payer: UnitedHealthcare Commercial	$42.68
Rate for Payer: WPPA Commercial	$36.08

PROTEIN,TOTAL,EXCPT REFRAC-OTH

Facility

$44.00

Service Code	HCPCS 84157
Hospital Charge Code	8415700
Hospital Revenue Code	301
Min. Negotiated Rate	$18.82
Max. Negotiated Rate	$42.68
Rate for Payer: BCBS Commercial	$18.82
Rate for Payer: Cash Price	$33.00
Rate for Payer: Cash Price	$33.00
Rate for Payer: Celtic Commercial/Exchange	$20.33
Rate for Payer: Health Partners Plans Commercial	$41.80
Rate for Payer: UnitedHealthcare Commercial	$42.68
Rate for Payer: WPPA Commercial	$36.96

PROTEIN,TOTL,EXCPT REFRAC SERM

Facility

$58.00

Service Code	HCPCS 84155
Hospital Charge Code	8415500
Hospital Revenue Code	301
Min. Negotiated Rate	$47.56
Max. Negotiated Rate	$56.26
Rate for Payer: Cash Price	$43.50
Rate for Payer: Health Partners Plans Commercial	$55.10
Rate for Payer: UnitedHealthcare Commercial	$56.26
Rate for Payer: WPPA Commercial	$47.56

PROTEIN,TOTL,EXCPT REFRAC SERM

Facility

$58.00

Service Code	HCPCS 84155
Hospital Charge Code	8415500
Hospital Revenue Code	301
Min. Negotiated Rate	$8.64
Max. Negotiated Rate	$56.26
Rate for Payer: BCBS Commercial	$8.64
Rate for Payer: Cash Price	$43.50
Rate for Payer: Cash Price	$43.50
Rate for Payer: Celtic Commercial/Exchange	$26.80
Rate for Payer: Health Partners Plans Commercial	$55.10
Rate for Payer: UnitedHealthcare Commercial	$56.26
Rate for Payer: WPPA Commercial	$48.72

Know your out-of-pocket cost for care.

All Charges