Ness County Hospital

All Charges

Charge

Type

Setting

Price

PROTEIN,TOTL,EXCPT REFRCT,URIN

Facility

$55.00

Service Code	HCPCS 84156
Hospital Charge Code	8415600
Hospital Revenue Code	301
Min. Negotiated Rate	$18.82
Max. Negotiated Rate	$53.35
Rate for Payer: BCBS Commercial	$18.82
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

PROTEIN,TOTL,EXCPT REFRCT,URIN

Facility

$55.00

Service Code	HCPCS 84156
Hospital Charge Code	8415600
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

PROTHROMBIN TIME

Facility

$54.00

Service Code	HCPCS 85610
Hospital Charge Code	8561000
Hospital Revenue Code	305
Min. Negotiated Rate	$44.28
Max. Negotiated Rate	$52.38
Rate for Payer: Cash Price	$40.50
Rate for Payer: Health Partners Plans Commercial	$51.30
Rate for Payer: UnitedHealthcare Commercial	$52.38
Rate for Payer: WPPA Commercial	$44.28

PROTHROMBIN TIME

Facility

$54.00

Service Code	HCPCS 85610
Hospital Charge Code	8561000
Hospital Revenue Code	305
Min. Negotiated Rate	$16.08
Max. Negotiated Rate	$52.38
Rate for Payer: BCBS Commercial	$16.08
Rate for Payer: Cash Price	$40.50
Rate for Payer: Cash Price	$40.50
Rate for Payer: Celtic Commercial/Exchange	$24.95
Rate for Payer: Health Partners Plans Commercial	$51.30
Rate for Payer: UnitedHealthcare Commercial	$52.38
Rate for Payer: WPPA Commercial	$45.36

PROTONIX 40 MG IV

Facility

$25.00

Hospital Charge Code	2519502
Hospital Revenue Code	250
Min. Negotiated Rate	$11.55
Max. Negotiated Rate	$24.25
Rate for Payer: Cash Price	$19.12
Rate for Payer: Celtic Commercial/Exchange	$11.55
Rate for Payer: Health Partners Plans Commercial	$23.75
Rate for Payer: UnitedHealthcare Commercial	$24.25
Rate for Payer: WPPA Commercial	$21.00

PROTONIX 40 MG IV

Facility

$25.00

Hospital Charge Code	2519502
Hospital Revenue Code	250
Min. Negotiated Rate	$20.50
Max. Negotiated Rate	$24.25
Rate for Payer: Cash Price	$19.12
Rate for Payer: Health Partners Plans Commercial	$23.75
Rate for Payer: UnitedHealthcare Commercial	$24.25
Rate for Payer: WPPA Commercial	$20.50

PROTONIX 40 MG TAB (PANTOPRAZOLE)

Facility

$15.00

Service Code	NDC 60687073611
Hospital Charge Code	2512598
Hospital Revenue Code	250
Min. Negotiated Rate	$6.93
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$11.74
Rate for Payer: Celtic Commercial/Exchange	$6.93
Rate for Payer: Health Partners Plans Commercial	$14.25
Rate for Payer: UnitedHealthcare Commercial	$14.55
Rate for Payer: WPPA Commercial	$12.60

PROTONIX 40 MG TAB (PANTOPRAZOLE)

Facility

$15.00

Service Code	NDC 60687073611
Hospital Charge Code	2512598
Hospital Revenue Code	250
Min. Negotiated Rate	$12.30
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$11.74
Rate for Payer: Health Partners Plans Commercial	$14.25
Rate for Payer: UnitedHealthcare Commercial	$14.55
Rate for Payer: WPPA Commercial	$12.30

PROVERA 10 MG (MEDROXYPROGESTERONE) oral tablet

Facility

$5.00

Service Code	NDC 60687010521
Hospital Charge Code	2510741
Hospital Revenue Code	250
Min. Negotiated Rate	$4.10
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$3.82
Rate for Payer: Health Partners Plans Commercial	$4.75
Rate for Payer: UnitedHealthcare Commercial	$4.85
Rate for Payer: WPPA Commercial	$4.10

PROVERA 10 MG (MEDROXYPROGESTERONE) oral tablet

Facility

$5.00

Service Code	NDC 60687010521
Hospital Charge Code	2510741
Hospital Revenue Code	250
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$3.82
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

PROZAC 10 MG CAP (FLUOXETINE)

Facility

$8.00

Service Code	NDC 68001039900
Hospital Charge Code	2513851
Hospital Revenue Code	250
Min. Negotiated Rate	$3.70
Max. Negotiated Rate	$7.76
Rate for Payer: Cash Price	$6.52
Rate for Payer: Celtic Commercial/Exchange	$3.70
Rate for Payer: Health Partners Plans Commercial	$7.60
Rate for Payer: UnitedHealthcare Commercial	$7.76
Rate for Payer: WPPA Commercial	$6.72

PROZAC 10 MG CAP (FLUOXETINE)

Facility

$8.00

Service Code	NDC 68001039900
Hospital Charge Code	2513851
Hospital Revenue Code	250
Min. Negotiated Rate	$6.56
Max. Negotiated Rate	$7.76
Rate for Payer: Cash Price	$6.52
Rate for Payer: Health Partners Plans Commercial	$7.60
Rate for Payer: UnitedHealthcare Commercial	$7.76
Rate for Payer: WPPA Commercial	$6.56

PSA-SCREENING

Facility

$159.00

Service Code	HCPCS G0103
Hospital Charge Code	8415301
Hospital Revenue Code	301
Min. Negotiated Rate	$69.98
Max. Negotiated Rate	$154.23
Rate for Payer: BCBS Commercial	$69.98
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

PSA-SCREENING

Facility

$159.00

Service Code	HCPCS G0103
Hospital Charge Code	8415301
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

PSEUDOEPHEDRINE 30 MG TAB

Facility

$1.00

Service Code	NDC 46122042862
Hospital Charge Code	2512523
Hospital Revenue Code	250
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

PSEUDOEPHEDRINE 30 MG TAB

Facility

$1.00

Service Code	NDC 46122042862
Hospital Charge Code	2512523
Hospital Revenue Code	250
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

PSYCHOSES

Facility

$13,349.88

Service Code	MSDRG 885
Min. Negotiated Rate	$13,349.88
Max. Negotiated Rate	$13,349.88
Rate for Payer: BCBS Commercial	$13,349.88

PT EVAL (AEGIS) PER 1/4 HR

Facility

$49.00

Service Code	HCPCS G0151
Hospital Charge Code	4209944
Hospital Revenue Code	421
Min. Negotiated Rate	$22.64
Max. Negotiated Rate	$47.53
Rate for Payer: Cash Price	$36.94
Rate for Payer: Celtic Commercial/Exchange	$22.64
Rate for Payer: Health Partners Plans Commercial	$46.55
Rate for Payer: UnitedHealthcare Commercial	$47.53
Rate for Payer: WPPA Commercial	$41.16

PT EVAL (AEGIS) PER 1/4 HR

Facility

$49.00

Service Code	HCPCS G0151
Hospital Charge Code	4209944
Hospital Revenue Code	421
Min. Negotiated Rate	$40.18
Max. Negotiated Rate	$47.53
Rate for Payer: Cash Price	$36.94
Rate for Payer: Health Partners Plans Commercial	$46.55
Rate for Payer: UnitedHealthcare Commercial	$47.53
Rate for Payer: WPPA Commercial	$40.18

PT EVAL HIGH COMPLEX 45 MIN

Facility

$251.00

Service Code	HCPCS 97163 GP
Hospital Charge Code	9716300
Hospital Revenue Code	424
Min. Negotiated Rate	$115.96
Max. Negotiated Rate	$243.47
Rate for Payer: BCBS Commercial	$120.60
Rate for Payer: Cash Price	$188.25
Rate for Payer: Cash Price	$188.25
Rate for Payer: Celtic Commercial/Exchange	$115.96
Rate for Payer: Health Partners Plans Commercial	$238.45
Rate for Payer: UnitedHealthcare Commercial	$243.47
Rate for Payer: WPPA Commercial	$210.84

PT EVAL HIGH COMPLEX 45 MIN

Facility

$251.00

Service Code	HCPCS 97163 GP
Hospital Charge Code	9716300
Hospital Revenue Code	424
Min. Negotiated Rate	$205.82
Max. Negotiated Rate	$243.47
Rate for Payer: Cash Price	$188.25
Rate for Payer: Health Partners Plans Commercial	$238.45
Rate for Payer: UnitedHealthcare Commercial	$243.47
Rate for Payer: WPPA Commercial	$205.82

PT EVAL LOW COMPLEX 20 MIN.

Facility

$130.00

Service Code	HCPCS 97161 GP
Hospital Charge Code	9716100
Hospital Revenue Code	424
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

PT EVAL LOW COMPLEX 20 MIN.

Facility

$130.00

Service Code	HCPCS 97161 GP
Hospital Charge Code	9716100
Hospital Revenue Code	424
Min. Negotiated Rate	$60.06
Max. Negotiated Rate	$138.69
Rate for Payer: BCBS Commercial	$138.69
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

PT EVAL MOD COMPLEX 30 MIN

Facility

$243.00

Service Code	HCPCS 97162 GP
Hospital Charge Code	9716200
Hospital Revenue Code	424
Min. Negotiated Rate	$112.27
Max. Negotiated Rate	$235.71
Rate for Payer: BCBS Commercial	$120.60
Rate for Payer: Cash Price	$182.25
Rate for Payer: Cash Price	$182.25
Rate for Payer: Celtic Commercial/Exchange	$112.27
Rate for Payer: Health Partners Plans Commercial	$230.85
Rate for Payer: UnitedHealthcare Commercial	$235.71
Rate for Payer: WPPA Commercial	$204.12

PT EVAL MOD COMPLEX 30 MIN

Facility

$243.00

Service Code	HCPCS 97162 GP
Hospital Charge Code	9716200
Hospital Revenue Code	424
Min. Negotiated Rate	$199.26
Max. Negotiated Rate	$235.71
Rate for Payer: Cash Price	$182.25
Rate for Payer: Health Partners Plans Commercial	$230.85
Rate for Payer: UnitedHealthcare Commercial	$235.71
Rate for Payer: WPPA Commercial	$199.26

Know your out-of-pocket cost for care.

All Charges