Ness County Hospital

All Charges

Charge

Type

Setting

Price

MRI FOOT LT WO

Facility

$1,685.00

Service Code	HCPCS 73718 LT
Hospital Charge Code	7111123
Hospital Revenue Code	610
Min. Negotiated Rate	$1,381.70
Max. Negotiated Rate	$1,634.45
Rate for Payer: Cash Price	$1,263.75
Rate for Payer: Health Partners Plans Commercial	$1,600.75
Rate for Payer: UnitedHealthcare Commercial	$1,634.45
Rate for Payer: WPPA Commercial	$1,381.70

MRI FOOT RT WO

Facility

$1,807.00

Service Code	HCPCS 73718 RT
Hospital Charge Code	7111122
Hospital Revenue Code	610
Min. Negotiated Rate	$552.52
Max. Negotiated Rate	$1,752.79
Rate for Payer: BCBS Commercial	$552.52
Rate for Payer: Cash Price	$1,355.25
Rate for Payer: Cash Price	$1,355.25
Rate for Payer: Celtic Commercial/Exchange	$834.83
Rate for Payer: Health Partners Plans Commercial	$1,716.65
Rate for Payer: UnitedHealthcare Commercial	$1,752.79
Rate for Payer: WPPA Commercial	$1,517.88

MRI FOOT RT WO

Facility

$1,807.00

Service Code	HCPCS 73718 RT
Hospital Charge Code	7111122
Hospital Revenue Code	610
Min. Negotiated Rate	$1,481.74
Max. Negotiated Rate	$1,752.79
Rate for Payer: Cash Price	$1,355.25
Rate for Payer: Health Partners Plans Commercial	$1,716.65
Rate for Payer: UnitedHealthcare Commercial	$1,752.79
Rate for Payer: WPPA Commercial	$1,481.74

MRI GADOLINIUM 20 ML

Facility

$253.00

Service Code	HCPCS A9579
Hospital Charge Code	7322888
Hospital Revenue Code	636
Min. Negotiated Rate	$9.50
Max. Negotiated Rate	$245.41
Rate for Payer: BCBS Commercial	$9.50
Rate for Payer: Cash Price	$189.75
Rate for Payer: Cash Price	$189.75
Rate for Payer: Celtic Commercial/Exchange	$116.89
Rate for Payer: Health Partners Plans Commercial	$240.35
Rate for Payer: UnitedHealthcare Commercial	$245.41
Rate for Payer: WPPA Commercial	$212.52

MRI GADOLINIUM 20 ML

Facility

$253.00

Service Code	HCPCS A9579
Hospital Charge Code	7322888
Hospital Revenue Code	636
Min. Negotiated Rate	$207.46
Max. Negotiated Rate	$245.41
Rate for Payer: Cash Price	$189.75
Rate for Payer: Health Partners Plans Commercial	$240.35
Rate for Payer: UnitedHealthcare Commercial	$245.41
Rate for Payer: WPPA Commercial	$207.46

MRI HAND LT WO

Facility

$1,808.00

Service Code	HCPCS 73218 LT
Hospital Charge Code	7111131
Hospital Revenue Code	610
Min. Negotiated Rate	$552.52
Max. Negotiated Rate	$1,753.76
Rate for Payer: BCBS Commercial	$552.52
Rate for Payer: Cash Price	$1,356.00
Rate for Payer: Cash Price	$1,356.00
Rate for Payer: Celtic Commercial/Exchange	$835.30
Rate for Payer: Health Partners Plans Commercial	$1,717.60
Rate for Payer: UnitedHealthcare Commercial	$1,753.76
Rate for Payer: WPPA Commercial	$1,518.72

MRI HAND LT WO

Facility

$1,808.00

Service Code	HCPCS 73218 LT
Hospital Charge Code	7111131
Hospital Revenue Code	610
Min. Negotiated Rate	$1,482.56
Max. Negotiated Rate	$1,753.76
Rate for Payer: Cash Price	$1,356.00
Rate for Payer: Health Partners Plans Commercial	$1,717.60
Rate for Payer: UnitedHealthcare Commercial	$1,753.76
Rate for Payer: WPPA Commercial	$1,482.56

MRI HAND RT WO

Facility

$1,808.00

Service Code	HCPCS 73218 RT
Hospital Charge Code	7111130
Hospital Revenue Code	610
Min. Negotiated Rate	$1,482.56
Max. Negotiated Rate	$1,753.76
Rate for Payer: Cash Price	$1,356.00
Rate for Payer: Health Partners Plans Commercial	$1,717.60
Rate for Payer: UnitedHealthcare Commercial	$1,753.76
Rate for Payer: WPPA Commercial	$1,482.56

MRI HAND RT WO

Facility

$1,808.00

Service Code	HCPCS 73218 RT
Hospital Charge Code	7111130
Hospital Revenue Code	610
Min. Negotiated Rate	$552.52
Max. Negotiated Rate	$1,753.76
Rate for Payer: BCBS Commercial	$552.52
Rate for Payer: Cash Price	$1,356.00
Rate for Payer: Cash Price	$1,356.00
Rate for Payer: Celtic Commercial/Exchange	$835.30
Rate for Payer: Health Partners Plans Commercial	$1,717.60
Rate for Payer: UnitedHealthcare Commercial	$1,753.76
Rate for Payer: WPPA Commercial	$1,518.72

MRI HEAD WITH CONTRAST

Facility

$2,373.00

Service Code	HCPCS 70552
Hospital Charge Code	7055200
Hospital Revenue Code	610
Min. Negotiated Rate	$1,945.86
Max. Negotiated Rate	$2,301.81
Rate for Payer: Cash Price	$1,779.75
Rate for Payer: Health Partners Plans Commercial	$2,254.35
Rate for Payer: UnitedHealthcare Commercial	$2,301.81
Rate for Payer: WPPA Commercial	$1,945.86

MRI HEAD WITH CONTRAST

Facility

$2,373.00

Service Code	HCPCS 70552
Hospital Charge Code	7055200
Hospital Revenue Code	610
Min. Negotiated Rate	$552.52
Max. Negotiated Rate	$2,301.81
Rate for Payer: BCBS Commercial	$552.52
Rate for Payer: Cash Price	$1,779.75
Rate for Payer: Cash Price	$1,779.75
Rate for Payer: Celtic Commercial/Exchange	$1,096.33
Rate for Payer: Health Partners Plans Commercial	$2,254.35
Rate for Payer: UnitedHealthcare Commercial	$2,301.81
Rate for Payer: WPPA Commercial	$1,993.32

MRI HEAD W/O CONTRAST

Facility

$2,229.00

Service Code	HCPCS 70551
Hospital Charge Code	7055100
Hospital Revenue Code	610
Min. Negotiated Rate	$552.52
Max. Negotiated Rate	$2,162.13
Rate for Payer: BCBS Commercial	$552.52
Rate for Payer: Cash Price	$1,671.75
Rate for Payer: Cash Price	$1,671.75
Rate for Payer: Celtic Commercial/Exchange	$1,029.80
Rate for Payer: Health Partners Plans Commercial	$2,117.55
Rate for Payer: UnitedHealthcare Commercial	$2,162.13
Rate for Payer: WPPA Commercial	$1,872.36

MRI HEAD W/O CONTRAST

Facility

$2,229.00

Service Code	HCPCS 70551
Hospital Charge Code	7055100
Hospital Revenue Code	610
Min. Negotiated Rate	$1,827.78
Max. Negotiated Rate	$2,162.13
Rate for Payer: Cash Price	$1,671.75
Rate for Payer: Health Partners Plans Commercial	$2,117.55
Rate for Payer: UnitedHealthcare Commercial	$2,162.13
Rate for Payer: WPPA Commercial	$1,827.78

MRI HEAD WO/W CONTRAST

Facility

$2,702.00

Service Code	HCPCS 70553
Hospital Charge Code	7055300
Hospital Revenue Code	610
Min. Negotiated Rate	$552.52
Max. Negotiated Rate	$2,620.94
Rate for Payer: BCBS Commercial	$552.52
Rate for Payer: Cash Price	$2,026.50
Rate for Payer: Cash Price	$2,026.50
Rate for Payer: Celtic Commercial/Exchange	$1,248.32
Rate for Payer: Health Partners Plans Commercial	$2,566.90
Rate for Payer: UnitedHealthcare Commercial	$2,620.94
Rate for Payer: WPPA Commercial	$2,269.68

MRI HEAD WO/W CONTRAST

Facility

$2,702.00

Service Code	HCPCS 70553
Hospital Charge Code	7055300
Hospital Revenue Code	610
Min. Negotiated Rate	$2,215.64
Max. Negotiated Rate	$2,620.94
Rate for Payer: Cash Price	$2,026.50
Rate for Payer: Health Partners Plans Commercial	$2,566.90
Rate for Payer: UnitedHealthcare Commercial	$2,620.94
Rate for Payer: WPPA Commercial	$2,215.64

MRI HIP LT WO

Facility

$1,949.00

Service Code	HCPCS 73721 LT
Hospital Charge Code	7111117
Hospital Revenue Code	610
Min. Negotiated Rate	$552.52
Max. Negotiated Rate	$1,890.53
Rate for Payer: BCBS Commercial	$552.52
Rate for Payer: Cash Price	$1,461.75
Rate for Payer: Cash Price	$1,461.75
Rate for Payer: Celtic Commercial/Exchange	$900.44
Rate for Payer: Health Partners Plans Commercial	$1,851.55
Rate for Payer: UnitedHealthcare Commercial	$1,890.53
Rate for Payer: WPPA Commercial	$1,637.16

MRI HIP LT WO

Facility

$1,949.00

Service Code	HCPCS 73721 LT
Hospital Charge Code	7111117
Hospital Revenue Code	610
Min. Negotiated Rate	$1,598.18
Max. Negotiated Rate	$1,890.53
Rate for Payer: Cash Price	$1,461.75
Rate for Payer: Health Partners Plans Commercial	$1,851.55
Rate for Payer: UnitedHealthcare Commercial	$1,890.53
Rate for Payer: WPPA Commercial	$1,598.18

MRI HIP RT WO

Facility

$1,949.00

Service Code	HCPCS 73721 RT
Hospital Charge Code	7111116
Hospital Revenue Code	610
Min. Negotiated Rate	$552.52
Max. Negotiated Rate	$1,890.53
Rate for Payer: BCBS Commercial	$552.52
Rate for Payer: Cash Price	$1,461.75
Rate for Payer: Cash Price	$1,461.75
Rate for Payer: Celtic Commercial/Exchange	$900.44
Rate for Payer: Health Partners Plans Commercial	$1,851.55
Rate for Payer: UnitedHealthcare Commercial	$1,890.53
Rate for Payer: WPPA Commercial	$1,637.16

MRI HIP RT WO

Facility

$1,949.00

Service Code	HCPCS 73721 RT
Hospital Charge Code	7111116
Hospital Revenue Code	610
Min. Negotiated Rate	$1,598.18
Max. Negotiated Rate	$1,890.53
Rate for Payer: Cash Price	$1,461.75
Rate for Payer: Health Partners Plans Commercial	$1,851.55
Rate for Payer: UnitedHealthcare Commercial	$1,890.53
Rate for Payer: WPPA Commercial	$1,598.18

MRI KNEE LT WO

Facility

$1,949.00

Service Code	HCPCS 73721 LT
Hospital Charge Code	7111119
Hospital Revenue Code	610
Min. Negotiated Rate	$552.52
Max. Negotiated Rate	$1,890.53
Rate for Payer: BCBS Commercial	$552.52
Rate for Payer: Cash Price	$1,461.75
Rate for Payer: Cash Price	$1,461.75
Rate for Payer: Celtic Commercial/Exchange	$900.44
Rate for Payer: Health Partners Plans Commercial	$1,851.55
Rate for Payer: UnitedHealthcare Commercial	$1,890.53
Rate for Payer: WPPA Commercial	$1,637.16

MRI KNEE LT WO

Facility

$1,949.00

Service Code	HCPCS 73721 LT
Hospital Charge Code	7111119
Hospital Revenue Code	610
Min. Negotiated Rate	$1,598.18
Max. Negotiated Rate	$1,890.53
Rate for Payer: Cash Price	$1,461.75
Rate for Payer: Health Partners Plans Commercial	$1,851.55
Rate for Payer: UnitedHealthcare Commercial	$1,890.53
Rate for Payer: WPPA Commercial	$1,598.18

MRI KNEE RT WO

Facility

$1,949.00

Service Code	HCPCS 73721 RT
Hospital Charge Code	7111118
Hospital Revenue Code	610
Min. Negotiated Rate	$552.52
Max. Negotiated Rate	$1,890.53
Rate for Payer: BCBS Commercial	$552.52
Rate for Payer: Cash Price	$1,461.75
Rate for Payer: Cash Price	$1,461.75
Rate for Payer: Celtic Commercial/Exchange	$900.44
Rate for Payer: Health Partners Plans Commercial	$1,851.55
Rate for Payer: UnitedHealthcare Commercial	$1,890.53
Rate for Payer: WPPA Commercial	$1,637.16

MRI KNEE RT WO

Facility

$1,949.00

Service Code	HCPCS 73721 RT
Hospital Charge Code	7111118
Hospital Revenue Code	610
Min. Negotiated Rate	$1,598.18
Max. Negotiated Rate	$1,890.53
Rate for Payer: Cash Price	$1,461.75
Rate for Payer: Health Partners Plans Commercial	$1,851.55
Rate for Payer: UnitedHealthcare Commercial	$1,890.53
Rate for Payer: WPPA Commercial	$1,598.18

MRI LE NOT JOINT W/O CONTRAST

Facility

$1,807.00

Service Code	HCPCS 73718
Hospital Charge Code	7372001
Hospital Revenue Code	610
Min. Negotiated Rate	$1,481.74
Max. Negotiated Rate	$1,752.79
Rate for Payer: Cash Price	$1,355.25
Rate for Payer: Health Partners Plans Commercial	$1,716.65
Rate for Payer: UnitedHealthcare Commercial	$1,752.79
Rate for Payer: WPPA Commercial	$1,481.74

MRI LE NOT JOINT W/O CONTRAST

Facility

$1,807.00

Service Code	HCPCS 73718
Hospital Charge Code	7372001
Hospital Revenue Code	610
Min. Negotiated Rate	$552.52
Max. Negotiated Rate	$1,752.79
Rate for Payer: BCBS Commercial	$552.52
Rate for Payer: Cash Price	$1,355.25
Rate for Payer: Cash Price	$1,355.25
Rate for Payer: Celtic Commercial/Exchange	$834.83
Rate for Payer: Health Partners Plans Commercial	$1,716.65
Rate for Payer: UnitedHealthcare Commercial	$1,752.79
Rate for Payer: WPPA Commercial	$1,517.88

Know your out-of-pocket cost for care.

All Charges