Ness County Hospital

All Charges

Charge

Type

Setting

Price

MRI TMJ W/O CONTRAST

Facility

$1,721.00

Service Code	HCPCS 70336
Hospital Charge Code	7033600
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 T-SPINE W/ CONTRAST

Facility

$2,339.00

Service Code	HCPCS 72147
Hospital Charge Code	7214700
Hospital Revenue Code	610
Min. Negotiated Rate	$552.52
Max. Negotiated Rate	$2,268.83
Rate for Payer: BCBS Commercial	$552.52
Rate for Payer: Cash Price	$1,754.25
Rate for Payer: Cash Price	$1,754.25
Rate for Payer: Celtic Commercial/Exchange	$1,080.62
Rate for Payer: Health Partners Plans Commercial	$2,222.05
Rate for Payer: UnitedHealthcare Commercial	$2,268.83
Rate for Payer: WPPA Commercial	$1,964.76

MRI T-SPINE W/ CONTRAST

Facility

$2,339.00

Service Code	HCPCS 72147
Hospital Charge Code	7214700
Hospital Revenue Code	610
Min. Negotiated Rate	$1,917.98
Max. Negotiated Rate	$2,268.83
Rate for Payer: Cash Price	$1,754.25
Rate for Payer: Health Partners Plans Commercial	$2,222.05
Rate for Payer: UnitedHealthcare Commercial	$2,268.83
Rate for Payer: WPPA Commercial	$1,917.98

MRI T-SPINE W/O CONTRAST

Facility

$2,013.00

Service Code	HCPCS 72146
Hospital Charge Code	7214600
Hospital Revenue Code	610
Min. Negotiated Rate	$1,650.66
Max. Negotiated Rate	$1,952.61
Rate for Payer: Cash Price	$1,509.75
Rate for Payer: Health Partners Plans Commercial	$1,912.35
Rate for Payer: UnitedHealthcare Commercial	$1,952.61
Rate for Payer: WPPA Commercial	$1,650.66

MRI T-SPINE W/O CONTRAST

Facility

$2,013.00

Service Code	HCPCS 72146
Hospital Charge Code	7214600
Hospital Revenue Code	610
Min. Negotiated Rate	$552.52
Max. Negotiated Rate	$1,952.61
Rate for Payer: BCBS Commercial	$552.52
Rate for Payer: Cash Price	$1,509.75
Rate for Payer: Cash Price	$1,509.75
Rate for Payer: Celtic Commercial/Exchange	$930.01
Rate for Payer: Health Partners Plans Commercial	$1,912.35
Rate for Payer: UnitedHealthcare Commercial	$1,952.61
Rate for Payer: WPPA Commercial	$1,690.92

MRI T-SPINE WO/W CONTRAST

Facility

$2,703.00

Service Code	HCPCS 72157
Hospital Charge Code	7215700
Hospital Revenue Code	610
Min. Negotiated Rate	$2,216.46
Max. Negotiated Rate	$2,621.91
Rate for Payer: Cash Price	$2,027.25
Rate for Payer: Health Partners Plans Commercial	$2,567.85
Rate for Payer: UnitedHealthcare Commercial	$2,621.91
Rate for Payer: WPPA Commercial	$2,216.46

MRI T-SPINE WO/W CONTRAST

Facility

$2,703.00

Service Code	HCPCS 72157
Hospital Charge Code	7215700
Hospital Revenue Code	610
Min. Negotiated Rate	$552.52
Max. Negotiated Rate	$2,621.91
Rate for Payer: BCBS Commercial	$552.52
Rate for Payer: Cash Price	$2,027.25
Rate for Payer: Cash Price	$2,027.25
Rate for Payer: Celtic Commercial/Exchange	$1,248.79
Rate for Payer: Health Partners Plans Commercial	$2,567.85
Rate for Payer: UnitedHealthcare Commercial	$2,621.91
Rate for Payer: WPPA Commercial	$2,270.52

MRI UP EXT NOT JNT W/O CONT

Facility

$1,808.00

Service Code	HCPCS 73218
Hospital Charge Code	7322001
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 UP EXT NOT JNT W/O CONT

Facility

$1,808.00

Service Code	HCPCS 73218
Hospital Charge Code	7322001
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 UPP EXT JNT WO/W CONTRAST

Facility

$1,956.00

Service Code	HCPCS 73223
Hospital Charge Code	7322300
Hospital Revenue Code	610
Min. Negotiated Rate	$552.52
Max. Negotiated Rate	$1,897.32
Rate for Payer: BCBS Commercial	$552.52
Rate for Payer: Cash Price	$1,467.00
Rate for Payer: Cash Price	$1,467.00
Rate for Payer: Celtic Commercial/Exchange	$903.67
Rate for Payer: Health Partners Plans Commercial	$1,858.20
Rate for Payer: UnitedHealthcare Commercial	$1,897.32
Rate for Payer: WPPA Commercial	$1,643.04

MRI UPP EXT JNT WO/W CONTRAST

Facility

$1,956.00

Service Code	HCPCS 73223
Hospital Charge Code	7322300
Hospital Revenue Code	610
Min. Negotiated Rate	$1,603.92
Max. Negotiated Rate	$1,897.32
Rate for Payer: Cash Price	$1,467.00
Rate for Payer: Health Partners Plans Commercial	$1,858.20
Rate for Payer: UnitedHealthcare Commercial	$1,897.32
Rate for Payer: WPPA Commercial	$1,603.92

MRI UPP EXT NOT JOINT WO/W

Facility

$2,255.00

Service Code	HCPCS 73220
Hospital Charge Code	7322000
Hospital Revenue Code	610
Min. Negotiated Rate	$1,849.10
Max. Negotiated Rate	$2,187.35
Rate for Payer: Cash Price	$1,691.25
Rate for Payer: Health Partners Plans Commercial	$2,142.25
Rate for Payer: UnitedHealthcare Commercial	$2,187.35
Rate for Payer: WPPA Commercial	$1,849.10

MRI UPP EXT NOT JOINT WO/W

Facility

$2,255.00

Service Code	HCPCS 73220
Hospital Charge Code	7322000
Hospital Revenue Code	610
Min. Negotiated Rate	$552.52
Max. Negotiated Rate	$2,187.35
Rate for Payer: BCBS Commercial	$552.52
Rate for Payer: Cash Price	$1,691.25
Rate for Payer: Cash Price	$1,691.25
Rate for Payer: Celtic Commercial/Exchange	$1,041.81
Rate for Payer: Health Partners Plans Commercial	$2,142.25
Rate for Payer: UnitedHealthcare Commercial	$2,187.35
Rate for Payer: WPPA Commercial	$1,894.20

MRI WRIST LT WO

Facility

$1,794.00

Service Code	HCPCS 73221 LT
Hospital Charge Code	7111129
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 WRIST LT WO

Facility

$1,794.00

Service Code	HCPCS 73221 LT
Hospital Charge Code	7111129
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 WRIST RT WO

Facility

$1,794.00

Service Code	HCPCS 73221 RT
Hospital Charge Code	7111128
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 WRIST RT WO

Facility

$1,794.00

Service Code	HCPCS 73221 RT
Hospital Charge Code	7111128
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

MRSA

Facility

$44.00

Service Code	HCPCS 87081
Hospital Charge Code	8708101
Hospital Revenue Code	306
Min. Negotiated Rate	$36.08
Max. Negotiated Rate	$42.68
Rate for Payer: Cash Price	$33.00
Rate for Payer: Health Partners Plans Commercial	$41.80
Rate for Payer: UnitedHealthcare Commercial	$42.68
Rate for Payer: WPPA Commercial	$36.08

MRSA

Facility

$44.00

Service Code	HCPCS 87081
Hospital Charge Code	8708101
Hospital Revenue Code	306
Min. Negotiated Rate	$20.33
Max. Negotiated Rate	$42.68
Rate for Payer: BCBS Commercial	$23.96
Rate for Payer: Cash Price	$33.00
Rate for Payer: Cash Price	$33.00
Rate for Payer: Celtic Commercial/Exchange	$20.33
Rate for Payer: Health Partners Plans Commercial	$41.80
Rate for Payer: UnitedHealthcare Commercial	$42.68
Rate for Payer: WPPA Commercial	$36.96

M.S. CONTIN 15 MG TAB (ORAMORPH)(MORHPINE SULFATE ER)

Facility

$5.00

Service Code	NDC 68084015711
Hospital Charge Code	2511640
Hospital Revenue Code	250
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$4.20
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

M.S. CONTIN 15 MG TAB (ORAMORPH)(MORHPINE SULFATE ER)

Facility

$5.00

Service Code	NDC 68084015711
Hospital Charge Code	2511640
Hospital Revenue Code	250
Min. Negotiated Rate	$4.10
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$4.20
Rate for Payer: Health Partners Plans Commercial	$4.75
Rate for Payer: UnitedHealthcare Commercial	$4.85
Rate for Payer: WPPA Commercial	$4.10

MUCINEX 600 MG TAB (GUAIFENESIN ER)

Facility

$2.00

Service Code	NDC 00904671839
Hospital Charge Code	2514115
Hospital Revenue Code	250
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.72
Rate for Payer: Health Partners Plans Commercial	$1.90
Rate for Payer: UnitedHealthcare Commercial	$1.94
Rate for Payer: WPPA Commercial	$1.64

MUCINEX 600 MG TAB (GUAIFENESIN ER)

Facility

$2.00

Service Code	NDC 00904671839
Hospital Charge Code	2514115
Hospital Revenue Code	250
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.72
Rate for Payer: Celtic Commercial/Exchange	$0.92
Rate for Payer: Health Partners Plans Commercial	$1.90
Rate for Payer: UnitedHealthcare Commercial	$1.94
Rate for Payer: WPPA Commercial	$1.68

MUCINEX D 12-HR (GUAIFENESIN + PSEUDOEPHEDRINE ER)

Facility

$2.00

Service Code	NDC 63824005718
Hospital Charge Code	2517886
Hospital Revenue Code	250
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.72
Rate for Payer: Health Partners Plans Commercial	$1.90
Rate for Payer: UnitedHealthcare Commercial	$1.94
Rate for Payer: WPPA Commercial	$1.64

MUCINEX D 12-HR (GUAIFENESIN + PSEUDOEPHEDRINE ER)

Facility

$2.00

Service Code	NDC 63824005718
Hospital Charge Code	2517886
Hospital Revenue Code	250
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.72
Rate for Payer: Celtic Commercial/Exchange	$0.92
Rate for Payer: Health Partners Plans Commercial	$1.90
Rate for Payer: UnitedHealthcare Commercial	$1.94
Rate for Payer: WPPA Commercial	$1.68

Know your out-of-pocket cost for care.

All Charges