CMS Price Transparency Data

MRI, brain (with and without contrast)

Facility: Dundy County Hospital

Billing Code: 70553 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70553
Insurance Median: $3,155
Cash Discount Price: $4,303
vs. Medicare Baseline: 8.85x Medicare

The contracted insurance negotiated median rate for a MRI, brain (with and without contrast) at Dundy County Hospital is $3,155. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,303. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 8.85x the Medicare baseline. Located in P O Box 626, 1313 North Cheyenne St, Benkelman, NE.

Cash / Self-Pay

$4,303

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,155

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: $4,303 (1207%)

Insurance Median: $3,155 (885%)

Cash: $4,303 (1207% of Medicare)

Ins. Median: $3,155 (885% 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 885% of the Medicare baseline (a markup of 785%). 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
Molina	$2,391	671%
UnitedHealthcare	$2,391 - $3,108	671%
Medica	$2,642	741%
Blue Cross Blue Shield	$3,108 - $4,781	872%
Total Care	$3,139	881%
Wellcare	$3,170	889%
Midlands Choice	$3,586	1006%
Multiplan	$4,685	1314%
Aetna	$6,775	1901%

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 $4,303.
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 Dundy County 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.