MRI, brain (with and without contrast)
Facility: Ellsworth County Medical Center
Billing Code: 70553 (CPT)
- CPT Billing Code: 70553
- Insurance Median: $1,028
- Cash Discount Price: $1,143
- vs. Medicare Baseline: 2.88x 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 288% of the Medicare baseline (a markup of 188%). 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 | $495 - $521 | 139% |
| Va Ccn-All Plans | $537 | 151% |
| Humana | $537 - $1,085 | 151% |
| Triwest -All Plans | $537 | 151% |
| Healthy Blue Mcr Adv | $537 | 151% |
| UnitedHealthcare | $743 - $1,142 | 208% |
| Aetna | $1,028 | 288% |
| First Health - All Plans | $1,028 | 288% |
| Cigna | $1,085 | 304% |
| Coventry Mcaid-All Plans | $1,142 | 320% |
| Medicaid / KanCare | $1,142 | 320% |
| Healthy Blue Mcaid- All Other Plans | $1,142 | 320% |
| Providers Care-Wppa-All Plans | $1,714 | 481% |
Consumer Guidance & Cost Commentary
For the MRI of the brain (with and without contrast) at Ellsworth County Medical Center in Ellsworth, Kansas, the cash price is $1,143.00, which matches the facility's cash median. This cash rate is significantly higher than the Medicare benchmark of $356.43, indicating a markup of 2.9 times the federal baseline. While the facility is a Critical Access Hospital with a proprietary ownership structure, patients should be aware that commercial insurance negotiated rates often exceed cash prices due to administrative overhead and contract dynamics. For instance, UnitedHealthcare's negotiated rate ranges from $743 to $1,142, while Humana's range spans $537 to $1,085. In cases where a patient has a high deductible or limited insurance coverage, paying the cash price of $1,143.00 upfront may be more cost-effective than relying on insurance, which could result in higher out-of-pocket costs if the deductible is not met.
To minimize potential costs, patients should proactively inquire about "self-pay" or "prompt-pay" discounts before scheduling their appointment, as these incentives can reduce the bill by 20% to 50% by bypassing expensive claims processing. It is also important to request a full itemized billing audit rather than accepting a summary bill, as over 80% of hospital bills contain errors such as unbundled codes or charges for services not rendered. Although the facility's location in Ellsworth, KS (zip 67439) does not provide specific county or state average data in this report, understanding that commercial rates often average 200% to 30