CMS Price Transparency Data

MRI, brain (with and without contrast)

Facility: Adventist Health Sierra Vista

Billing Code: 70553 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70553
Insurance Median: $6,077
Cash Discount Price: $1,490
vs. Medicare Baseline: 17.05x Medicare

The contracted insurance negotiated median rate for a MRI, brain (with and without contrast) at Adventist Health Sierra Vista is $6,077. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,490. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 17.05x the Medicare baseline. Located in 1010 Murray St, San Luis Obispo, CA.

Cash / Self-Pay

$1,490

Average discount available for prompt cash payment at this facility.

Insurance Median

$6,077

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: $1,490 (418%)

Insurance Median: $6,077 (1705%)

Cash: $1,490 (418% of Medicare)

Ins. Median: $6,077 (1705% 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 1705% of the Medicare baseline (a markup of 1605%). 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	$448	126%
Cencal Mcr Adv - All Other Plans	$448	126%
Tricare	$448	126%
UnitedHealthcare	$448 - $5,697	126%
Cfmg-Ca Forensic Med Grp Op/Profee Only-All Plans	$582	163%
Ah Employee Health Plan - All Plans	$806	226%
Hpn-Heritage Prov Ntwrk-All Plans	$5,500	1543%
Nbd-Ntwrks By Design Exclus-All Other Plans	$6,458	1812%
Blue Shield Epn	$6,492	1821%
Nbd-Ntwrks By Design Non-Exclus	$7,859	2205%
Blue Shield Hmo/Pos	$8,082	2267%
Blue Shield Epo/Ppo-All Other Plans	$8,910	2500%
Medi-Cal	$16,561	4646%
Cencal Mcal	$18,880	5297%
Blue Shield Promise Mcal	$19,906	5585%
Ccah-Centrl Ca Allince Mcal-All Plans	$21,529	6040%
Coalinga-All Plans	$21,529	6040%

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 $1,490.
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 Adventist Health Sierra Vista 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.