CMS Price Transparency Data

MRI, brain (with and without contrast)

Facility: Nationwide Children's Hospital

Billing Code: 70553 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70553
Insurance Median: $1,461
Cash Discount Price: $3,483
vs. Medicare Baseline: 4.10x Medicare

The contracted insurance negotiated median rate for a MRI, brain (with and without contrast) at Nationwide Children's Hospital is $1,461. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,483. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 4.10x the Medicare baseline. Located in 700 Children's Drive, Columbus, OH.

Cash / Self-Pay

$3,483

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,461

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: $3,483 (977%)

Insurance Median: $1,461 (410%)

Cash: $3,483 (977% of Medicare)

Ins. Median: $1,461 (410% 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 410% of the Medicare baseline (a markup of 310%). 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
Aetna	$126 - $3,676	35%
Caresource	$154 - $593	43%
Humana	$249 - $3,676	70%
UnitedHealthcare	$305 - $3,676	86%
Ohio Ppo Connect	$308 - $3,599	86%
Osu	$308 - $3,599	86%
Blue Cross Blue Shield	$346 - $3,638	97%
Tricare	$381	107%
Mmo	$392 - $3,638	110%
Cigna	$408 - $3,638	114%
Front Path Health Coalition	$408 - $3,638	114%
Ohc	$408 - $3,599	114%
Ohg	$408 - $3,483	114%
The Health Plan	$408 - $3,715	114%
Amerihealth	$593	166%
Bchp	$593	166%
Molina	$593	166%
Ahpo	$3,638	1021%
Unicare	$3,676	1031%
Emerald Health	$3,793	1064%
First Health	$3,793	1064%
Phcs	$3,793	1064%

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 $3,483.
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 Nationwide Children's 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.