MRI, brain (with and without contrast)
Facility: Holton Community Hospital
Billing Code: 70553 (CPT)
- CPT Billing Code: 70553
- Insurance Median: $3,015
- Cash Discount Price: $2,725
- vs. Medicare Baseline: 8.46x 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 846% of the Medicare baseline (a markup of 746%). 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 | $521 | 146% |
| Aetna | $1,925 - $3,633 | 540% |
| UnitedHealthcare | $1,925 - $3,633 | 540% |
| Humana | $1,945 | 546% |
| Kansas Superior Select - All Plans | $1,964 | 551% |
| Preferred Health Freedom | $3,015 | 846% |
| Preferred Health Professionals | $3,015 | 846% |
| Preferred Health Fn Select - All Other Plans | $3,015 | 846% |
| Wppa Providers - All Plans | $3,451 | 968% |
| Medicaid / KanCare | $3,633 | 1019% |
Consumer Guidance & Cost Commentary
For the MRI of the brain at Holton Community Hospital, the facility's cash price of $2,725 is significantly lower than the gross charge of $3,633, offering a potential savings of up to $908 for patients paying out-of-pocket. While the facility's negotiated rates for commercial payers like Aetna and UnitedHealthcare range from $1,925 to $3,633, these amounts often exceed the cash price, meaning self-pay patients with high-deductible plans might save money by paying directly. It is important to note that Medicaid/KanCare rates are set at $3,633, which matches the gross charge, so commercial insurance members should verify their specific plan's negotiated amount before scheduling to ensure they are not paying more than the cash rate.
The facility's pricing is evaluated against a Medicare benchmark of $356.43, with the cash price representing a 764% markup relative to this federal baseline. Although the data does not provide specific county or state average comparisons for this procedure, the facility's status as a Critical Access Hospital in Holton, KS, suggests that its pricing structure may differ from larger regional centers. Patients should request a prompt-pay discount if paying in full upfront, which can reduce the bill by 20% to 50% by bypassing administrative processing fees. Additionally, since the facility is a voluntary non-profit, patients are encouraged to ask about self-pay or prompt-pay discounts prior to check-in to avoid unexpected balances, and should always request an itemized bill to review every charge for accuracy.