MRI, brain (with and without contrast)
Facility: Ashland Health Center
Billing Code: 70553 (CPT)
- CPT Billing Code: 70553
- Insurance Median: $847
- Cash Discount Price: $678
- vs. Medicare Baseline: 2.38x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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 238% of the Medicare baseline (a markup of 138%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Blue Cross Blue Shield | $284 | 80% |
| Compalliance-All Plans | $678 | 190% |
| Health Partners Of Kansas-All Plans | $720 | 202% |
| Multiplan-All Plans | $830 | 233% |
| Medicaid / KanCare | $847 | 238% |
| UnitedHealthcare | $847 | 238% |
| Medica Mcare - All Plans | $847 | 238% |
| Healthy Blue Mcr Adv - All Other Plans | $847 | 238% |
| Medicare (plans) | $847 | 238% |
| Health Choice-All Plans | $847 | 238% |
| Aetna | $847 | 238% |
| Providers Care (Wppa)-All Plans | $1,270 | 356% |
Consumer Guidance & Cost Commentary
For CPT code 70553, MRI of the brain (with and without contrast), the facility's negotiated rate is $847.00, which matches the gross charge and the median paid amount across all payers. This rate is identical to the cash median of $678.00 and the median negotiated rate, indicating that no additional administrative fees are added for insurance billing in this specific transaction. While the facility is a Critical Access Hospital in Ashland, KS, the data does not provide a specific county or state average for comparison. However, the Medicare benchmark for this service is $356.43, meaning the negotiated rate represents a markup of 2.4 times the Medicare amount.
Patients should be aware that paying cash upfront could result in a lower out-of-pocket cost of $678.00 compared to the $847.00 billed by insurance, though the current data shows these figures are already aligned at the facility level. If a patient has a high-deductible plan, they might still benefit from requesting a prompt-pay discount, which typically ranges from 20% to 50% off the billed amount for upfront payment. It is crucial to ask the billing department about self-pay or prompt-pay rates before scheduling the appointment and to sign a waiver preventing automatic claims submission to ensure the cash discount applies. Additionally, since the No Surprises Act prohibits balance billing for emergency care and non-emergency services at in-network facilities, patients should not pay surprise bills immediately; instead, they should request a formal itemized audit to verify all charges before settling the account.