MRI, brain (with and without contrast)
Facility: Nmc Health
Billing Code: 70553 (CPT)
- CPT Billing Code: 70553
- Insurance Median: $3,088
- Cash Discount Price: $3,759
- vs. Medicare Baseline: 8.66x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Understanding this gauge: We use the federal Medicare rate of $356.43 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 866% of the Medicare baseline (a markup of 766%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Bluestem Pace | $354 | 99% |
| Blue Cross Blue Shield | $553 | 155% |
| Medicaid / KanCare | $566 | 159% |
| Leading Age | $566 | 159% |
| Aetna | $1,278 | 359% |
| Wppa | $2,954 | 829% |
| Occunet | $3,222 | 904% |
| Medincrease Health Plan | $3,491 | 979% |
| Samaritan Ministries International | $3,491 | 979% |
| Prime Health Services | $4,028 | 1130% |
| UnitedHealthcare | $4,833 | 1356% |
| Cigna | $5,102 | 1431% |
Consumer Guidance & Cost Commentary
For this MRI of the brain procedure at Nmc Health in Newton, Kansas, the facility's cash price of $3,759 is notably lower than the gross charge of $5,370, offering potential savings for patients with high-deductible plans or those without insurance. While the facility's negotiated rates with major payers like UnitedHealthcare and Cigna range from $4,833 to $5,102, these amounts often exceed the cash price due to the administrative costs and claim processing fees inherent in insurance billing. Patients should verify their specific plan's deductible status before scheduling, as paying out-of-pocket may result in a lower total cost if the insurance negotiated rate is higher than the cash price. Additionally, it is advisable to ask the hospital directly about "self-pay" or "prompt-pay" discounts, which can further reduce the final bill by bypassing the standard insurance billing cycle.
The facility's pricing aligns closely with the state average, with the cash rate of $3,759 being 8.7% higher than the Medicare benchmark of $356.43, which serves as the objective baseline for evaluating hospital markups. Although the data does not provide a specific county average for comparison, the facility's ownership as a voluntary non-profit suggests a commitment to community pricing rather than pure profit maximization. To avoid unexpected costs, consumers should request a full itemized bill before payment to ensure no unbundled codes or services not rendered are included, as over 80% of hospital bills contain errors. If a balance bill arises from an out-of-network ancillary service, patients can dispute the charge under the No Surprises Act, which prohibits providers from billing