Ness County Hospital

All Charges

Charge

Type

Setting

Price

KEFZOL 1 GM INJ. (ANCEF/CEFAZOLIN)

Facility

$19.00

Service Code	NDC 00143926225
Hospital Charge Code	2503803
Hospital Revenue Code	250
Min. Negotiated Rate	$8.78
Max. Negotiated Rate	$18.43
Rate for Payer: Cash Price	$14.62
Rate for Payer: Celtic Commercial/Exchange	$8.78
Rate for Payer: Health Partners Plans Commercial	$18.05
Rate for Payer: UnitedHealthcare Commercial	$18.43
Rate for Payer: WPPA Commercial	$15.96

KEFZOL 1 GM INJ. (ANCEF/CEFAZOLIN)

Facility

$19.00

Service Code	NDC 00143926225
Hospital Charge Code	2503803
Hospital Revenue Code	250
Min. Negotiated Rate	$15.58
Max. Negotiated Rate	$18.43
Rate for Payer: Cash Price	$14.62
Rate for Payer: Health Partners Plans Commercial	$18.05
Rate for Payer: UnitedHealthcare Commercial	$18.43
Rate for Payer: WPPA Commercial	$15.58

Kefzol 2 GM (cefazolin) IV piggyback

Facility

$57.00

Service Code	NDC 00264310511
Hospital Charge Code	2518207
Hospital Revenue Code	250
Min. Negotiated Rate	$46.74
Max. Negotiated Rate	$55.29
Rate for Payer: Cash Price	$43.00
Rate for Payer: Health Partners Plans Commercial	$54.15
Rate for Payer: UnitedHealthcare Commercial	$55.29
Rate for Payer: WPPA Commercial	$46.74

Kefzol 2 GM (cefazolin) IV piggyback

Facility

$57.00

Service Code	NDC 00264310511
Hospital Charge Code	2518207
Hospital Revenue Code	250
Min. Negotiated Rate	$26.33
Max. Negotiated Rate	$55.29
Rate for Payer: Cash Price	$43.00
Rate for Payer: Celtic Commercial/Exchange	$26.33
Rate for Payer: Health Partners Plans Commercial	$54.15
Rate for Payer: UnitedHealthcare Commercial	$55.29
Rate for Payer: WPPA Commercial	$47.88

KENALOG 0.1 % CREAM (TRIAMCINOLONE ACETONIDE)

Facility

$31.00

Service Code	NDC 45802006435
Hospital Charge Code	2503811
Hospital Revenue Code	250
Min. Negotiated Rate	$14.32
Max. Negotiated Rate	$30.07
Rate for Payer: Cash Price	$23.40
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

KENALOG 0.1 % CREAM (TRIAMCINOLONE ACETONIDE)

Facility

$31.00

Service Code	NDC 45802006435
Hospital Charge Code	2503811
Hospital Revenue Code	250
Min. Negotiated Rate	$25.42
Max. Negotiated Rate	$30.07
Rate for Payer: Cash Price	$23.40
Rate for Payer: Health Partners Plans Commercial	$29.45
Rate for Payer: UnitedHealthcare Commercial	$30.07
Rate for Payer: WPPA Commercial	$25.42

KENALOG 40 MG/ML INJ. (TRIAMCINOLONE ACETATE)

Facility

$51.00

Service Code	NDC 00703024101
Hospital Charge Code	2513034
Hospital Revenue Code	250
Min. Negotiated Rate	$41.82
Max. Negotiated Rate	$49.47
Rate for Payer: Cash Price	$38.25
Rate for Payer: Health Partners Plans Commercial	$48.45
Rate for Payer: UnitedHealthcare Commercial	$49.47
Rate for Payer: WPPA Commercial	$41.82

KENALOG 40 MG/ML INJ. (TRIAMCINOLONE ACETATE)

Facility

$51.00

Service Code	NDC 00703024101
Hospital Charge Code	2513034
Hospital Revenue Code	250
Min. Negotiated Rate	$23.56
Max. Negotiated Rate	$49.47
Rate for Payer: Cash Price	$38.25
Rate for Payer: Celtic Commercial/Exchange	$23.56
Rate for Payer: Health Partners Plans Commercial	$48.45
Rate for Payer: UnitedHealthcare Commercial	$49.47
Rate for Payer: WPPA Commercial	$42.84

KENALOG IN ORABASE 0.1% - 5 GM tube(triamcinolone acetonide dental paste)

Facility

$249.00

Service Code	NDC 64980032005
Hospital Charge Code	2514032
Hospital Revenue Code	250
Min. Negotiated Rate	$204.18
Max. Negotiated Rate	$241.53
Rate for Payer: Cash Price	$186.82
Rate for Payer: Health Partners Plans Commercial	$236.55
Rate for Payer: UnitedHealthcare Commercial	$241.53
Rate for Payer: WPPA Commercial	$204.18

KENALOG IN ORABASE 0.1% - 5 GM tube(triamcinolone acetonide dental paste)

Facility

$249.00

Service Code	NDC 64980032005
Hospital Charge Code	2514032
Hospital Revenue Code	250
Min. Negotiated Rate	$115.04
Max. Negotiated Rate	$241.53
Rate for Payer: Cash Price	$186.82
Rate for Payer: Celtic Commercial/Exchange	$115.04
Rate for Payer: Health Partners Plans Commercial	$236.55
Rate for Payer: UnitedHealthcare Commercial	$241.53
Rate for Payer: WPPA Commercial	$209.16

KEPPRA 250 MG TAB (LEVETIRACETAM)

Facility

$1.00

Service Code	NDC 68084085911
Hospital Charge Code	2519080
Hospital Revenue Code	250
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$1.35
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

KEPPRA 250 MG TAB (LEVETIRACETAM)

Facility

$1.00

Service Code	NDC 68084085911
Hospital Charge Code	2519080
Hospital Revenue Code	250
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$1.35
Rate for Payer: Health Partners Plans Commercial	$0.95
Rate for Payer: UnitedHealthcare Commercial	$0.97
Rate for Payer: WPPA Commercial	$0.82

KEPPRA 500 MG/5 ML INJ. (LEVETIRACETAM)

Facility

$45.00

Service Code	NDC 55150017705
Hospital Charge Code	2519460
Hospital Revenue Code	250
Min. Negotiated Rate	$36.90
Max. Negotiated Rate	$43.65
Rate for Payer: Cash Price	$33.75
Rate for Payer: Health Partners Plans Commercial	$42.75
Rate for Payer: UnitedHealthcare Commercial	$43.65
Rate for Payer: WPPA Commercial	$36.90

KEPPRA 500 MG/5 ML INJ. (LEVETIRACETAM)

Facility

$45.00

Service Code	NDC 55150017705
Hospital Charge Code	2519460
Hospital Revenue Code	250
Min. Negotiated Rate	$20.79
Max. Negotiated Rate	$43.65
Rate for Payer: Cash Price	$33.75
Rate for Payer: Celtic Commercial/Exchange	$20.79
Rate for Payer: Health Partners Plans Commercial	$42.75
Rate for Payer: UnitedHealthcare Commercial	$43.65
Rate for Payer: WPPA Commercial	$37.80

KEPPRA 500 MG PREMIX (LEVETIRACETAM) IV

Facility

$122.00

Service Code	NDC 43598075552
Hospital Charge Code	2519478
Hospital Revenue Code	250
Min. Negotiated Rate	$100.04
Max. Negotiated Rate	$118.34
Rate for Payer: Cash Price	$91.80
Rate for Payer: Health Partners Plans Commercial	$115.90
Rate for Payer: UnitedHealthcare Commercial	$118.34
Rate for Payer: WPPA Commercial	$100.04

KEPPRA 500 MG PREMIX (LEVETIRACETAM) IV

Facility

$122.00

Service Code	NDC 43598075552
Hospital Charge Code	2519478
Hospital Revenue Code	250
Min. Negotiated Rate	$56.36
Max. Negotiated Rate	$118.34
Rate for Payer: Cash Price	$91.80
Rate for Payer: Celtic Commercial/Exchange	$56.36
Rate for Payer: Health Partners Plans Commercial	$115.90
Rate for Payer: UnitedHealthcare Commercial	$118.34
Rate for Payer: WPPA Commercial	$102.48

KERLIX 4 1/2

Facility

$9.00

Hospital Charge Code	2720944LTC
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

KERLIX 4 1/2

Facility

$9.00

Hospital Charge Code	2720944LTC
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

KETAMINE 500MG/10ML INJ

Facility

$22.00

Service Code	NDC 00143950810
Hospital Charge Code	2514768
Hospital Revenue Code	250
Min. Negotiated Rate	$18.04
Max. Negotiated Rate	$21.34
Rate for Payer: Cash Price	$16.88
Rate for Payer: Health Partners Plans Commercial	$20.90
Rate for Payer: UnitedHealthcare Commercial	$21.34
Rate for Payer: WPPA Commercial	$18.04

KETAMINE 500MG/10ML INJ

Facility

$22.00

Service Code	NDC 00143950810
Hospital Charge Code	2514768
Hospital Revenue Code	250
Min. Negotiated Rate	$10.16
Max. Negotiated Rate	$21.34
Rate for Payer: Cash Price	$16.88
Rate for Payer: Celtic Commercial/Exchange	$10.16
Rate for Payer: Health Partners Plans Commercial	$20.90
Rate for Payer: UnitedHealthcare Commercial	$21.34
Rate for Payer: WPPA Commercial	$18.48

KETAMINE/NORKETAMINE SCREEN

Facility

$271.00

Service Code	HCPCS 80357
Hospital Charge Code	8035700
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

KETAMINE/NORKETAMINE SCREEN

Facility

$271.00

Service Code	HCPCS 80357
Hospital Charge Code	8035700
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

KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC

Facility

$18,564.23

Service Code	MSDRG 657
Min. Negotiated Rate	$18,564.23
Max. Negotiated Rate	$18,564.23
Rate for Payer: BCBS Commercial	$18,564.23

KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC

Facility

$29,208.14

Service Code	MSDRG 656
Min. Negotiated Rate	$29,208.14
Max. Negotiated Rate	$29,208.14
Rate for Payer: BCBS Commercial	$29,208.14

KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC

Facility

$15,413.12

Service Code	MSDRG 658
Min. Negotiated Rate	$15,413.12
Max. Negotiated Rate	$15,413.12
Rate for Payer: BCBS Commercial	$15,413.12

Know your out-of-pocket cost for care.

All Charges