Ness County Hospital

All Charges

Charge

Type

Setting

Price

MRI LOWER EXT JOINT WO/W

Facility

$2,579.00

Service Code	HCPCS 73723
Hospital Charge Code	7372300
Hospital Revenue Code	610
Min. Negotiated Rate	$552.52
Max. Negotiated Rate	$2,501.63
Rate for Payer: BCBS Commercial	$552.52
Rate for Payer: Cash Price	$1,934.25
Rate for Payer: Cash Price	$1,934.25
Rate for Payer: Celtic Commercial/Exchange	$1,191.50
Rate for Payer: Health Partners Plans Commercial	$2,450.05
Rate for Payer: UnitedHealthcare Commercial	$2,501.63
Rate for Payer: WPPA Commercial	$2,166.36

MRI LOWER EXT JOINT WO/W

Facility

$2,579.00

Service Code	HCPCS 73723
Hospital Charge Code	7372300
Hospital Revenue Code	610
Min. Negotiated Rate	$2,114.78
Max. Negotiated Rate	$2,501.63
Rate for Payer: Cash Price	$1,934.25
Rate for Payer: Health Partners Plans Commercial	$2,450.05
Rate for Payer: UnitedHealthcare Commercial	$2,501.63
Rate for Payer: WPPA Commercial	$2,114.78

MRI LOWER EXT NOT JOINT WO/W

Facility

$2,581.00

Service Code	HCPCS 73720
Hospital Charge Code	7372000
Hospital Revenue Code	610
Min. Negotiated Rate	$2,116.42
Max. Negotiated Rate	$2,503.57
Rate for Payer: Cash Price	$1,935.75
Rate for Payer: Health Partners Plans Commercial	$2,451.95
Rate for Payer: UnitedHealthcare Commercial	$2,503.57
Rate for Payer: WPPA Commercial	$2,116.42

MRI LOWER EXT NOT JOINT WO/W

Facility

$2,581.00

Service Code	HCPCS 73720
Hospital Charge Code	7372000
Hospital Revenue Code	610
Min. Negotiated Rate	$552.52
Max. Negotiated Rate	$2,503.57
Rate for Payer: BCBS Commercial	$552.52
Rate for Payer: Cash Price	$1,935.75
Rate for Payer: Cash Price	$1,935.75
Rate for Payer: Celtic Commercial/Exchange	$1,192.42
Rate for Payer: Health Partners Plans Commercial	$2,451.95
Rate for Payer: UnitedHealthcare Commercial	$2,503.57
Rate for Payer: WPPA Commercial	$2,168.04

MRI L-SPINE WITH CONTRAST

Facility

$2,163.00

Service Code	HCPCS 72149
Hospital Charge Code	7214900
Hospital Revenue Code	610
Min. Negotiated Rate	$1,773.66
Max. Negotiated Rate	$2,098.11
Rate for Payer: Cash Price	$1,622.25
Rate for Payer: Health Partners Plans Commercial	$2,054.85
Rate for Payer: UnitedHealthcare Commercial	$2,098.11
Rate for Payer: WPPA Commercial	$1,773.66

MRI L-SPINE WITH CONTRAST

Facility

$2,163.00

Service Code	HCPCS 72149
Hospital Charge Code	7214900
Hospital Revenue Code	610
Min. Negotiated Rate	$552.52
Max. Negotiated Rate	$2,098.11
Rate for Payer: BCBS Commercial	$552.52
Rate for Payer: Cash Price	$1,622.25
Rate for Payer: Cash Price	$1,622.25
Rate for Payer: Celtic Commercial/Exchange	$999.31
Rate for Payer: Health Partners Plans Commercial	$2,054.85
Rate for Payer: UnitedHealthcare Commercial	$2,098.11
Rate for Payer: WPPA Commercial	$1,816.92

MRI L-SPINE W/O CONTRAST

Facility

$2,163.00

Service Code	HCPCS 72148
Hospital Charge Code	7214800
Hospital Revenue Code	610
Min. Negotiated Rate	$1,773.66
Max. Negotiated Rate	$2,098.11
Rate for Payer: Cash Price	$1,622.25
Rate for Payer: Health Partners Plans Commercial	$2,054.85
Rate for Payer: UnitedHealthcare Commercial	$2,098.11
Rate for Payer: WPPA Commercial	$1,773.66

MRI L-SPINE W/O CONTRAST

Facility

$2,163.00

Service Code	HCPCS 72148
Hospital Charge Code	7214800
Hospital Revenue Code	610
Min. Negotiated Rate	$552.52
Max. Negotiated Rate	$2,098.11
Rate for Payer: BCBS Commercial	$552.52
Rate for Payer: Cash Price	$1,622.25
Rate for Payer: Cash Price	$1,622.25
Rate for Payer: Celtic Commercial/Exchange	$999.31
Rate for Payer: Health Partners Plans Commercial	$2,054.85
Rate for Payer: UnitedHealthcare Commercial	$2,098.11
Rate for Payer: WPPA Commercial	$1,816.92

MRI L-SPINE WO/W CONTRAST

Facility

$2,705.00

Service Code	HCPCS 72158
Hospital Charge Code	7215800
Hospital Revenue Code	610
Min. Negotiated Rate	$2,218.10
Max. Negotiated Rate	$2,623.85
Rate for Payer: Cash Price	$2,028.75
Rate for Payer: Health Partners Plans Commercial	$2,569.75
Rate for Payer: UnitedHealthcare Commercial	$2,623.85
Rate for Payer: WPPA Commercial	$2,218.10

MRI L-SPINE WO/W CONTRAST

Facility

$2,705.00

Service Code	HCPCS 72158
Hospital Charge Code	7215800
Hospital Revenue Code	610
Min. Negotiated Rate	$552.52
Max. Negotiated Rate	$2,623.85
Rate for Payer: BCBS Commercial	$552.52
Rate for Payer: Cash Price	$2,028.75
Rate for Payer: Cash Price	$2,028.75
Rate for Payer: Celtic Commercial/Exchange	$1,249.71
Rate for Payer: Health Partners Plans Commercial	$2,569.75
Rate for Payer: UnitedHealthcare Commercial	$2,623.85
Rate for Payer: WPPA Commercial	$2,272.20

MRI ORB FACE NECK WO/W

Facility

$1,943.00

Service Code	HCPCS 70543
Hospital Charge Code	7054300
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 ORB FACE NECK WO/W

Facility

$1,943.00

Service Code	HCPCS 70543
Hospital Charge Code	7054300
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 ORB NECK FACE W/O CONTRAST

Facility

$1,721.00

Service Code	HCPCS 70540
Hospital Charge Code	7054000
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 ORB NECK FACE W/O CONTRAST

Facility

$1,721.00

Service Code	HCPCS 70540
Hospital Charge Code	7054000
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 PELVIS W/ CONTRAST

Facility

$2,341.00

Service Code	HCPCS 72198
Hospital Charge Code	7609500
Hospital Revenue Code	610
Min. Negotiated Rate	$1,919.62
Max. Negotiated Rate	$2,270.77
Rate for Payer: Cash Price	$1,755.75
Rate for Payer: Health Partners Plans Commercial	$2,223.95
Rate for Payer: UnitedHealthcare Commercial	$2,270.77
Rate for Payer: WPPA Commercial	$1,919.62

MRI PELVIS W/ CONTRAST

Facility

$2,341.00

Service Code	HCPCS 72198
Hospital Charge Code	7609500
Hospital Revenue Code	610
Min. Negotiated Rate	$664.93
Max. Negotiated Rate	$2,270.77
Rate for Payer: BCBS Commercial	$664.93
Rate for Payer: Cash Price	$1,755.75
Rate for Payer: Cash Price	$1,755.75
Rate for Payer: Celtic Commercial/Exchange	$1,081.54
Rate for Payer: Health Partners Plans Commercial	$2,223.95
Rate for Payer: UnitedHealthcare Commercial	$2,270.77
Rate for Payer: WPPA Commercial	$1,966.44

MRI PELVIS W/O

Facility

$1,996.00

Service Code	HCPCS 72195
Hospital Charge Code	7216900
Hospital Revenue Code	610
Min. Negotiated Rate	$1,636.72
Max. Negotiated Rate	$1,936.12
Rate for Payer: Cash Price	$1,497.00
Rate for Payer: Health Partners Plans Commercial	$1,896.20
Rate for Payer: UnitedHealthcare Commercial	$1,936.12
Rate for Payer: WPPA Commercial	$1,636.72

MRI PELVIS W/O

Facility

$1,996.00

Service Code	HCPCS 72195
Hospital Charge Code	7216900
Hospital Revenue Code	610
Min. Negotiated Rate	$552.52
Max. Negotiated Rate	$1,936.12
Rate for Payer: BCBS Commercial	$552.52
Rate for Payer: Cash Price	$1,497.00
Rate for Payer: Cash Price	$1,497.00
Rate for Payer: Celtic Commercial/Exchange	$922.15
Rate for Payer: Health Partners Plans Commercial	$1,896.20
Rate for Payer: UnitedHealthcare Commercial	$1,936.12
Rate for Payer: WPPA Commercial	$1,676.64

MRI PELVIS WO/W CONTRAST

Facility

$2,894.00

Service Code	HCPCS 72197
Hospital Charge Code	7216901
Hospital Revenue Code	610
Min. Negotiated Rate	$2,373.08
Max. Negotiated Rate	$2,807.18
Rate for Payer: Cash Price	$2,170.50
Rate for Payer: Health Partners Plans Commercial	$2,749.30
Rate for Payer: UnitedHealthcare Commercial	$2,807.18
Rate for Payer: WPPA Commercial	$2,373.08

MRI PELVIS WO/W CONTRAST

Facility

$2,894.00

Service Code	HCPCS 72197
Hospital Charge Code	7216901
Hospital Revenue Code	610
Min. Negotiated Rate	$552.52
Max. Negotiated Rate	$2,807.18
Rate for Payer: BCBS Commercial	$552.52
Rate for Payer: Cash Price	$2,170.50
Rate for Payer: Cash Price	$2,170.50
Rate for Payer: Celtic Commercial/Exchange	$1,337.03
Rate for Payer: Health Partners Plans Commercial	$2,749.30
Rate for Payer: UnitedHealthcare Commercial	$2,807.18
Rate for Payer: WPPA Commercial	$2,430.96

MRI SHOULDER LT WO

Facility

$1,929.00

Service Code	HCPCS 73221 LT
Hospital Charge Code	7111127
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 SHOULDER LT WO

Facility

$1,929.00

Service Code	HCPCS 73221 LT
Hospital Charge Code	7111127
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 SHOULDER RT WO

Facility

$1,929.00

Service Code	HCPCS 73221 RT
Hospital Charge Code	7111126
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 SHOULDER RT WO

Facility

$1,929.00

Service Code	HCPCS 73221 RT
Hospital Charge Code	7111126
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 TMJ W/O CONTRAST

Facility

$1,721.00

Service Code	HCPCS 70336
Hospital Charge Code	7033600
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

Know your out-of-pocket cost for care.

All Charges