Ness County Hospital

All Charges

Charge

Type

Setting

Price

MRA NECK WO/W CONTRAST

Facility

$2,911.00

Service Code	HCPCS 70549
Hospital Charge Code	7054900
Hospital Revenue Code	610
Min. Negotiated Rate	$2,387.02
Max. Negotiated Rate	$2,823.67
Rate for Payer: Cash Price	$2,183.25
Rate for Payer: Health Partners Plans Commercial	$2,765.45
Rate for Payer: UnitedHealthcare Commercial	$2,823.67
Rate for Payer: WPPA Commercial	$2,387.02

MRA NECK WO/W CONTRAST

Facility

$2,911.00

Service Code	HCPCS 70549
Hospital Charge Code	7054900
Hospital Revenue Code	610
Min. Negotiated Rate	$664.93
Max. Negotiated Rate	$2,823.67
Rate for Payer: BCBS Commercial	$664.93
Rate for Payer: Cash Price	$2,183.25
Rate for Payer: Cash Price	$2,183.25
Rate for Payer: Celtic Commercial/Exchange	$1,344.88
Rate for Payer: Health Partners Plans Commercial	$2,765.45
Rate for Payer: UnitedHealthcare Commercial	$2,823.67
Rate for Payer: WPPA Commercial	$2,445.24

MRI ABD W/O CONTRAST

Facility

$2,029.00

Service Code	HCPCS 74181
Hospital Charge Code	7418100
Hospital Revenue Code	610
Min. Negotiated Rate	$552.52
Max. Negotiated Rate	$1,968.13
Rate for Payer: BCBS Commercial	$552.52
Rate for Payer: Cash Price	$1,521.75
Rate for Payer: Cash Price	$1,521.75
Rate for Payer: Celtic Commercial/Exchange	$937.40
Rate for Payer: Health Partners Plans Commercial	$1,927.55
Rate for Payer: UnitedHealthcare Commercial	$1,968.13
Rate for Payer: WPPA Commercial	$1,704.36

MRI ABD W/O CONTRAST

Facility

$2,029.00

Service Code	HCPCS 74181
Hospital Charge Code	7418100
Hospital Revenue Code	610
Min. Negotiated Rate	$1,663.78
Max. Negotiated Rate	$1,968.13
Rate for Payer: Cash Price	$1,521.75
Rate for Payer: Health Partners Plans Commercial	$1,927.55
Rate for Payer: UnitedHealthcare Commercial	$1,968.13
Rate for Payer: WPPA Commercial	$1,663.78

MRI ABD WO/W CONTRAST

Facility

$2,978.00

Service Code	HCPCS 74183
Hospital Charge Code	7418300
Hospital Revenue Code	610
Min. Negotiated Rate	$552.52
Max. Negotiated Rate	$2,888.66
Rate for Payer: BCBS Commercial	$552.52
Rate for Payer: Cash Price	$2,233.50
Rate for Payer: Cash Price	$2,233.50
Rate for Payer: Celtic Commercial/Exchange	$1,375.84
Rate for Payer: Health Partners Plans Commercial	$2,829.10
Rate for Payer: UnitedHealthcare Commercial	$2,888.66
Rate for Payer: WPPA Commercial	$2,501.52

MRI ABD WO/W CONTRAST

Facility

$2,978.00

Service Code	HCPCS 74183
Hospital Charge Code	7418300
Hospital Revenue Code	610
Min. Negotiated Rate	$2,441.96
Max. Negotiated Rate	$2,888.66
Rate for Payer: Cash Price	$2,233.50
Rate for Payer: Health Partners Plans Commercial	$2,829.10
Rate for Payer: UnitedHealthcare Commercial	$2,888.66
Rate for Payer: WPPA Commercial	$2,441.96

MRI ANKLE LT WO

Facility

$1,929.00

Service Code	HCPCS 73721 LT
Hospital Charge Code	7111121
Hospital Revenue Code	610
Min. Negotiated Rate	$552.52
Max. Negotiated Rate	$1,871.13
Rate for Payer: BCBS Commercial	$552.52
Rate for Payer: Cash Price	$1,446.75
Rate for Payer: Cash Price	$1,446.75
Rate for Payer: Celtic Commercial/Exchange	$891.20
Rate for Payer: Health Partners Plans Commercial	$1,832.55
Rate for Payer: UnitedHealthcare Commercial	$1,871.13
Rate for Payer: WPPA Commercial	$1,620.36

MRI ANKLE LT WO

Facility

$1,929.00

Service Code	HCPCS 73721 LT
Hospital Charge Code	7111121
Hospital Revenue Code	610
Min. Negotiated Rate	$1,581.78
Max. Negotiated Rate	$1,871.13
Rate for Payer: Cash Price	$1,446.75
Rate for Payer: Health Partners Plans Commercial	$1,832.55
Rate for Payer: UnitedHealthcare Commercial	$1,871.13
Rate for Payer: WPPA Commercial	$1,581.78

MRI ANKLE RT WO

Facility

$1,929.00

Service Code	HCPCS 73721 RT
Hospital Charge Code	7111120
Hospital Revenue Code	610
Min. Negotiated Rate	$552.52
Max. Negotiated Rate	$1,871.13
Rate for Payer: BCBS Commercial	$552.52
Rate for Payer: Cash Price	$1,446.75
Rate for Payer: Cash Price	$1,446.75
Rate for Payer: Celtic Commercial/Exchange	$891.20
Rate for Payer: Health Partners Plans Commercial	$1,832.55
Rate for Payer: UnitedHealthcare Commercial	$1,871.13
Rate for Payer: WPPA Commercial	$1,620.36

MRI ANKLE RT WO

Facility

$1,929.00

Service Code	HCPCS 73721 RT
Hospital Charge Code	7111120
Hospital Revenue Code	610
Min. Negotiated Rate	$1,581.78
Max. Negotiated Rate	$1,871.13
Rate for Payer: Cash Price	$1,446.75
Rate for Payer: Health Partners Plans Commercial	$1,832.55
Rate for Payer: UnitedHealthcare Commercial	$1,871.13
Rate for Payer: WPPA Commercial	$1,581.78

MRI CHEST WO AND W CONTRAST

Facility

$1,943.00

Service Code	HCPCS 71552
Hospital Charge Code	7155200
Hospital Revenue Code	610
Min. Negotiated Rate	$1,593.26
Max. Negotiated Rate	$1,884.71
Rate for Payer: Cash Price	$1,457.25
Rate for Payer: Health Partners Plans Commercial	$1,845.85
Rate for Payer: UnitedHealthcare Commercial	$1,884.71
Rate for Payer: WPPA Commercial	$1,593.26

MRI CHEST WO AND W CONTRAST

Facility

$1,943.00

Service Code	HCPCS 71552
Hospital Charge Code	7155200
Hospital Revenue Code	610
Min. Negotiated Rate	$552.52
Max. Negotiated Rate	$1,884.71
Rate for Payer: BCBS Commercial	$552.52
Rate for Payer: Cash Price	$1,457.25
Rate for Payer: Cash Price	$1,457.25
Rate for Payer: Celtic Commercial/Exchange	$897.67
Rate for Payer: Health Partners Plans Commercial	$1,845.85
Rate for Payer: UnitedHealthcare Commercial	$1,884.71
Rate for Payer: WPPA Commercial	$1,632.12

MRI CHEST W/O CONTRAST

Facility

$1,721.00

Service Code	HCPCS 71550
Hospital Charge Code	7155000
Hospital Revenue Code	610
Min. Negotiated Rate	$1,411.22
Max. Negotiated Rate	$1,669.37
Rate for Payer: Cash Price	$1,290.75
Rate for Payer: Health Partners Plans Commercial	$1,634.95
Rate for Payer: UnitedHealthcare Commercial	$1,669.37
Rate for Payer: WPPA Commercial	$1,411.22

MRI CHEST W/O CONTRAST

Facility

$1,721.00

Service Code	HCPCS 71550
Hospital Charge Code	7155000
Hospital Revenue Code	610
Min. Negotiated Rate	$552.52
Max. Negotiated Rate	$1,669.37
Rate for Payer: BCBS Commercial	$552.52
Rate for Payer: Cash Price	$1,290.75
Rate for Payer: Cash Price	$1,290.75
Rate for Payer: Celtic Commercial/Exchange	$795.10
Rate for Payer: Health Partners Plans Commercial	$1,634.95
Rate for Payer: UnitedHealthcare Commercial	$1,669.37
Rate for Payer: WPPA Commercial	$1,445.64

MRI C-SPINE WITH CONTRAST

Facility

$2,175.00

Service Code	HCPCS 72142
Hospital Charge Code	7214200
Hospital Revenue Code	610
Min. Negotiated Rate	$552.52
Max. Negotiated Rate	$2,109.75
Rate for Payer: BCBS Commercial	$552.52
Rate for Payer: Cash Price	$1,631.25
Rate for Payer: Cash Price	$1,631.25
Rate for Payer: Celtic Commercial/Exchange	$1,004.85
Rate for Payer: Health Partners Plans Commercial	$2,066.25
Rate for Payer: UnitedHealthcare Commercial	$2,109.75
Rate for Payer: WPPA Commercial	$1,827.00

MRI C-SPINE WITH CONTRAST

Facility

$2,175.00

Service Code	HCPCS 72142
Hospital Charge Code	7214200
Hospital Revenue Code	610
Min. Negotiated Rate	$1,783.50
Max. Negotiated Rate	$2,109.75
Rate for Payer: Cash Price	$1,631.25
Rate for Payer: Health Partners Plans Commercial	$2,066.25
Rate for Payer: UnitedHealthcare Commercial	$2,109.75
Rate for Payer: WPPA Commercial	$1,783.50

MRI C-SPINE W/O CONTRAST

Facility

$2,150.00

Service Code	HCPCS 72141
Hospital Charge Code	7214100
Hospital Revenue Code	610
Min. Negotiated Rate	$1,763.00
Max. Negotiated Rate	$2,085.50
Rate for Payer: Cash Price	$1,612.50
Rate for Payer: Health Partners Plans Commercial	$2,042.50
Rate for Payer: UnitedHealthcare Commercial	$2,085.50
Rate for Payer: WPPA Commercial	$1,763.00

MRI C-SPINE W/O CONTRAST

Facility

$2,150.00

Service Code	HCPCS 72141
Hospital Charge Code	7214100
Hospital Revenue Code	610
Min. Negotiated Rate	$552.52
Max. Negotiated Rate	$2,085.50
Rate for Payer: BCBS Commercial	$552.52
Rate for Payer: Cash Price	$1,612.50
Rate for Payer: Cash Price	$1,612.50
Rate for Payer: Celtic Commercial/Exchange	$993.30
Rate for Payer: Health Partners Plans Commercial	$2,042.50
Rate for Payer: UnitedHealthcare Commercial	$2,085.50
Rate for Payer: WPPA Commercial	$1,806.00

MRI C-SPINE WO/W CONTRAST

Facility

$2,729.00

Service Code	HCPCS 72156
Hospital Charge Code	7215600
Hospital Revenue Code	610
Min. Negotiated Rate	$2,237.78
Max. Negotiated Rate	$2,647.13
Rate for Payer: Cash Price	$2,046.75
Rate for Payer: Health Partners Plans Commercial	$2,592.55
Rate for Payer: UnitedHealthcare Commercial	$2,647.13
Rate for Payer: WPPA Commercial	$2,237.78

MRI C-SPINE WO/W CONTRAST

Facility

$2,729.00

Service Code	HCPCS 72156
Hospital Charge Code	7215600
Hospital Revenue Code	610
Min. Negotiated Rate	$552.52
Max. Negotiated Rate	$2,647.13
Rate for Payer: BCBS Commercial	$552.52
Rate for Payer: Cash Price	$2,046.75
Rate for Payer: Cash Price	$2,046.75
Rate for Payer: Celtic Commercial/Exchange	$1,260.80
Rate for Payer: Health Partners Plans Commercial	$2,592.55
Rate for Payer: UnitedHealthcare Commercial	$2,647.13
Rate for Payer: WPPA Commercial	$2,292.36

MRI ELBOW LT WO

Facility

$1,794.00

Service Code	HCPCS 73221 LT
Hospital Charge Code	7111125
Hospital Revenue Code	610
Min. Negotiated Rate	$1,471.08
Max. Negotiated Rate	$1,740.18
Rate for Payer: Cash Price	$1,345.50
Rate for Payer: Health Partners Plans Commercial	$1,704.30
Rate for Payer: UnitedHealthcare Commercial	$1,740.18
Rate for Payer: WPPA Commercial	$1,471.08

MRI ELBOW LT WO

Facility

$1,794.00

Service Code	HCPCS 73221 LT
Hospital Charge Code	7111125
Hospital Revenue Code	610
Min. Negotiated Rate	$552.52
Max. Negotiated Rate	$1,740.18
Rate for Payer: BCBS Commercial	$552.52
Rate for Payer: Cash Price	$1,345.50
Rate for Payer: Cash Price	$1,345.50
Rate for Payer: Celtic Commercial/Exchange	$828.83
Rate for Payer: Health Partners Plans Commercial	$1,704.30
Rate for Payer: UnitedHealthcare Commercial	$1,740.18
Rate for Payer: WPPA Commercial	$1,506.96

MRI ELBOW RT WO

Facility

$1,794.00

Service Code	HCPCS 73221 RT
Hospital Charge Code	7111124
Hospital Revenue Code	610
Min. Negotiated Rate	$552.52
Max. Negotiated Rate	$1,740.18
Rate for Payer: BCBS Commercial	$552.52
Rate for Payer: Cash Price	$1,345.50
Rate for Payer: Cash Price	$1,345.50
Rate for Payer: Celtic Commercial/Exchange	$828.83
Rate for Payer: Health Partners Plans Commercial	$1,704.30
Rate for Payer: UnitedHealthcare Commercial	$1,740.18
Rate for Payer: WPPA Commercial	$1,506.96

MRI ELBOW RT WO

Facility

$1,794.00

Service Code	HCPCS 73221 RT
Hospital Charge Code	7111124
Hospital Revenue Code	610
Min. Negotiated Rate	$1,471.08
Max. Negotiated Rate	$1,740.18
Rate for Payer: Cash Price	$1,345.50
Rate for Payer: Health Partners Plans Commercial	$1,704.30
Rate for Payer: UnitedHealthcare Commercial	$1,740.18
Rate for Payer: WPPA Commercial	$1,471.08

MRI FOOT LT WO

Facility

$1,685.00

Service Code	HCPCS 73718 LT
Hospital Charge Code	7111123
Hospital Revenue Code	610
Min. Negotiated Rate	$552.52
Max. Negotiated Rate	$1,634.45
Rate for Payer: BCBS Commercial	$552.52
Rate for Payer: Cash Price	$1,263.75
Rate for Payer: Cash Price	$1,263.75
Rate for Payer: Celtic Commercial/Exchange	$778.47
Rate for Payer: Health Partners Plans Commercial	$1,600.75
Rate for Payer: UnitedHealthcare Commercial	$1,634.45
Rate for Payer: WPPA Commercial	$1,415.40

Know your out-of-pocket cost for care.

All Charges