CMS Price Transparency Data

Review of medical records for care

Facility: Nemaha Valley Community Hospital

Billing Code: 90889 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90889
Insurance Median: $32
Cash Discount Price: $32
vs. Medicare Baseline: N/A Medicare

The contracted insurance negotiated median rate for a Review of medical records for care at Nemaha Valley Community Hospital is $32. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $32. Compared to the federal Medicare reimbursement reference rate of N/A, this hospital’s rate is N/A the Medicare baseline. Located in 1600 Community Dr, Seneca, KS.

Cash / Self-Pay

$32

Average discount available for prompt cash payment at this facility.

Insurance Median

$32

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

N/A

Standard federal government reimbursement rate for this code.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Humana	$15	N/A
Partners Direct Health - All Plans	$18	N/A
Aetna	$30 - $329	N/A
Multiplan - All Plans	$32	N/A
Midlands Choice - All Plans	$33	N/A
Health Partners - All Plans	$33	N/A
Celtic Comm Exch - All Plans	$329	N/A

Consumer Guidance & Cost Commentary

For the CPT code 90889, "Review of medical records for care," Nemaha Valley Community Hospital in Seneca, KS, lists a gross charge of $35.00. The facility's cash median price is $32.00, while the median negotiated rate across its seven payers is also $32.00. This indicates that for most insurance plans, the allowed amount aligns closely with the cash price, meaning patients with high-deductible plans may not save money by using insurance unless their specific plan's negotiated rate exceeds the cash price. It is important to note that while the gross charge is $35.00, the actual amount billed to an insured member will be capped at the negotiated rate of $32.00, which serves as a ceiling to protect in-network members from the full chargemaster price.

Patients should verify their specific plan's allowed amount before scheduling, as in-network rates can vary significantly between carriers. For this service, Aetna shows a wide range of negotiated rates from $30.00 to $329.00 across two plans, which is an unusual variance that warrants checking the specific plan details to ensure you are not being billed the maximum allowed amount. Additionally, since the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, you may be eligible for prompt-pay discounts if you choose to pay the balance upfront. Always request a self-pay classification and a prompt-pay discount prior to check-in to avoid automatic claims submission, which could void any potential cash savings.

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $32.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 90889.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Nemaha Valley Community Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 90889.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.