MRI, brain (with and without contrast)
Facility: Hospital District #6 Patterson Health Center
Billing Code: 70553 (CPT)
- CPT Billing Code: 70553
- Insurance Median: $810
- Cash Discount Price: $720
- vs. Medicare Baseline: 2.27x 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 227% of the Medicare baseline (a markup of 127%). 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% |
| UnitedHealthcare | $810 - $900 | 227% |
| Providers Care (Wppa)-All Plans | $1,575 | 442% |
Consumer Guidance & Cost Commentary
For the MRI of the brain (with and without contrast) at Hospital District #6 Patterson Health Center in Anthony, KS, the facility's cash median price is $720.00, which is lower than the negotiated rates of $810.00 paid by UnitedHealthcare and Providers Care (Wppa). While the cash price is the lowest option listed, patients with high-deductible plans should consider that paying the full cash price upfront may result in immediate savings compared to having insurance cover the higher negotiated rate, especially if their deductible has not yet been met. It is important to note that this facility is a Critical Access Hospital owned by the Government, and patients should explicitly ask about "self-pay" or "prompt-pay" discounts before scheduling to ensure they are not billed the full chargemaster rate if they choose to pay out-of-pocket.
The Medicare benchmark for this service is $356.43, which serves as a baseline for evaluating the facility's pricing markup. The facility's cash rate of $720.00 is approximately 2.3 times the Medicare amount, reflecting the typical administrative and operational costs associated with commercial billing. If a patient receives care from an out-of-network provider at this facility, they could face balance billing for the difference between the provider's full charge and the insurance allowed amount, though the No Surprises Act protects against such surprise bills for emergency and non-emergency services at in-network facilities. To avoid unexpected costs, patients should request a detailed, itemized bill rather than accepting a summary invoice, as over 80% of hospital bills contain errors such as unbundled codes or charges for services not rendered.