CMS Price Transparency Data

MRI, brain (with and without contrast)

Facility: Lee County Community Hospital

Billing Code: 70553 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70553
Insurance Median: $746
Cash Discount Price: $656
vs. Medicare Baseline: 2.09x Medicare

The contracted insurance negotiated median rate for a MRI, brain (with and without contrast) at Lee County Community Hospital is $746. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $656. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 2.09x the Medicare baseline. Located in 127 Health Care Drive, Pennington Gap, VA.

Cash / Self-Pay

$656

Average discount available for prompt cash payment at this facility.

Insurance Median

$746

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: $656 (184%)

Insurance Median: $746 (209%)

Cash: $656 (184% of Medicare)

Ins. Median: $746 (209% 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 209% of the Medicare baseline (a markup of 109%). 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
UnitedHealthcare	$481 - $2,853	135%
Aetna	$628 - $2,853	176%
Ambetter / Centene	$628	176%
Amerigroup	$628 - $2,853	176%
Managed Medicaire	$628	176%
Medicare (plans)	$628	176%
Mountain Empire Pace	$628	176%
Sentara Health	$628 - $736	176%
United Mine Workers Of America	$628	176%
Humana	$638	179%
Blue Cross Blue Shield	$646 - $2,853	181%
Molina Healthcare	$653 - $762	183%
Cigna	$659 - $2,853	185%
Devoted Health Plan	$659	185%
Nhc Advantage	$659	185%
Optima Health	$733	206%
Seven Corners, Inc.	$1,506	423%
First Health Coventry	$2,853	800%
Medcost	$2,853	800%

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 $656.
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 Lee County Community 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.