CMS Price Transparency Data

MRI, brain (with and without contrast)

Facility: Good Samaritan Medical Center LLC

Billing Code: 70553 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70553
Insurance Median: $1,777
Cash Discount Price: Unavailable
vs. Medicare Baseline: 4.99x Medicare

The contracted insurance negotiated median rate for a MRI, brain (with and without contrast) at Good Samaritan Medical Center LLC is $1,777. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 4.99x the Medicare baseline. Located in 200 Exempla Cir, Lafayette, CO.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,777

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%)

Insurance Median: $1,777 (499%)

Ins. Median: $1,777 (499% 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 499% of the Medicare baseline (a markup of 399%). 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
Aarp	$355	100%
UnitedHealthcare	$355 - $2,583	100%
Kaiser Snp	$359	101%
Select Health	$359	101%
Aetna	$744 - $3,994	209%
Geha	$810 - $2,583	227%
Preferred One	$810 - $1,777	227%
Kaiser Perm Hmo	$824 - $1,876	231%
Denv Hlth Med Plan	$933	262%
Kaiser Self Funded	$1,024 - $1,876	287%
Kaiser Perm Ppo/Pos	$1,039 - $1,933	292%
Allegiance	$1,113	312%
Cigna	$1,113 - $4,453	312%
Blue Cross Blue Shield	$1,171 - $3,748	329%
Humana	$1,870	525%
Cofinity	$3,209	900%
First Health Network	$3,209	900%
Private Hlthcare Sys	$3,340	937%
Multiplan Inc	$3,785	1062%

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 $X.
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 Good Samaritan Medical Center LLC 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.