CMS Price Transparency Data

MRI, brain (with and without contrast)

Facility: Alice Peck Day Memorial Hospital

Billing Code: 70553 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70553
Insurance Median: $4,906
Cash Discount Price: $3,820
vs. Medicare Baseline: 13.76x Medicare

The contracted insurance negotiated median rate for a MRI, brain (with and without contrast) at Alice Peck Day Memorial Hospital is $4,906. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,820. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 13.76x the Medicare baseline. Located in 10 Alice Peck Day Drive, Lebanon, NH.

Cash / Self-Pay

$3,820

Average discount available for prompt cash payment at this facility.

Insurance Median

$4,906

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: $3,820 (1072%)

Insurance Median: $4,906 (1376%)

Cash: $3,820 (1072% of Medicare)

Ins. Median: $4,906 (1376% 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 1376% of the Medicare baseline (a markup of 1276%). 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
Ambetter / Centene	$60	17%
Nh Healthy Families	$62	17%
Cigna	$1,687 - $5,797	473%
Klais	$1,687	473%
Commercial Generic	$1,790	502%
Connecticut General	$1,790	502%
Blue Cross Blue Shield	$1,803 - $6,307	506%
Wellpoint	$1,803	506%
Medicaid / KanCare	$3,253	913%
Harvard Pilgrim	$4,408 - $6,144	1237%
UnitedHealthcare	$5,103	1432%
Tufts	$5,197	1458%
Aetna	$6,378	1789%
Mvp	$6,449	1809%
Coventry Health	$6,733	1889%
Coventry Health Wc	$6,733	1889%
Humana	$7,370	2068%

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 $3,820.
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 Alice Peck Day 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.