MRI, brain (with and without contrast)
Facility: Nemaha Valley Community Hospital
Billing Code: 70553 (CPT)
- CPT Billing Code: 70553
- Insurance Median: $1,286
- Cash Discount Price: $2,305
- vs. Medicare Baseline: 3.61x 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 361% of the Medicare baseline (a markup of 261%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $553 | 155% |
| Humana | $1,127 | 316% |
| Va Ccn - All Plans | $1,127 | 316% |
| Aetna | $1,138 - $2,177 | 319% |
| Celtic Comm Exch - All Plans | $1,240 | 348% |
| Partners Direct Health - All Plans | $1,332 | 374% |
| Multiplan - All Plans | $2,305 | 647% |
| Health Partners - All Plans | $2,434 | 683% |
| Midlands Choice - All Plans | $2,434 | 683% |
Consumer Guidance & Cost Commentary
For the MRI, brain (with and without contrast) procedure at Nemaha Valley Community Hospital in Seneca, KS, the cash median price is $2,305, which is significantly lower than the facility's negotiated rates of $1,286 to $2,434 across various payers. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, patients should be aware that commercial insurance contracts often result in higher out-of-pocket costs than self-pay options. Specifically, the cash price of $2,305 is lower than the negotiated rates for several major payers, including Multiplan, Health Partners, and Midlands Choice, all of which list rates at $2,305 or higher. This demonstrates that for patients with high-deductible plans or those without insurance, paying the cash price directly can be more economical than relying on insurance reimbursement, which may still require the patient to cover the difference between the negotiated rate and the cash price if their deductible has not been met.
To ensure you are receiving the most accurate pricing, it is crucial to request an itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. While the Medicare amount for this service is $356.43, commercial rates are often marked up significantly above this federal baseline; however, the cash price of $2,305 remains the most transparent and predictable figure for consumers. Patients should also inquire about prompt-pay discounts, which can reduce the total cost by 20% to 50% if paid in full upfront, effectively bypassing the administrative overhead associated with insurance claims processing.