CMS Price Transparency Data

MRI, brain (with and without contrast)

Facility: Pender Memorial Hospital

Billing Code: 70553 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70553
Insurance Median: $1,047
Cash Discount Price: $1,644
vs. Medicare Baseline: 2.94x Medicare

The contracted insurance negotiated median rate for a MRI, brain (with and without contrast) at Pender Memorial Hospital is $1,047. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,644. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 2.94x the Medicare baseline. Located in 507 E Fremont St, Burgaw, NC.

Cash / Self-Pay

$1,644

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,047

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$356.43

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $356.43 (100%)

Cash / Self-Pay: $1,644 (461%)

Insurance Median: $1,047 (294%)

Cash: $1,644 (461% of Medicare)

Ins. Median: $1,047 (294% of 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 294% of the Medicare baseline (a markup of 194%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Blue Cross Blue Shield	$628 - $1,348	176%
Humana	$937 - $3,142	263%
Pace Of The Southern Piedmont	$987	277%
New Hanover Health	$1,006	282%
Aetna	$1,011 - $3,106	284%
Cigna	$1,016 - $1,611	285%
Carolina Complete	$1,026	288%
Nc Department Of Public Safety	$1,026 - $1,973	288%
Amerihealth	$1,047	294%
Wellcare	$1,047	294%
Ambetter / Centene	$1,381	387%
Liberty Health	$1,401	393%
Caresource North Carolina	$1,462	410%
Plotkin Health	$2,192	615%
UnitedHealthcare	$2,667	748%
Medcost	$2,751 - $3,066	772%
Employers Choice Network	$3,544	994%
Three Rivers Provider Network	$3,544	994%

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 $1,644.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 70553.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Pender Memorial Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 70553.
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.