MRI, brain (with and without contrast)
Facility: Sheridan County Hospital
Billing Code: 70553 (CPT)
- CPT Billing Code: 70553
- Insurance Median: $761
- Cash Discount Price: $1,185
- vs. Medicare Baseline: 2.14x 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 214% of the Medicare baseline (a markup of 114%). 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 |
|---|---|---|
| Celtic Insurance | $717 | 201% |
| Blue Cross Blue Shield | $761 | 214% |
| UnitedHealthcare | $1,126 | 316% |
Consumer Guidance & Cost Commentary
For this MRI of the brain at Sheridan County Hospital in Hoxie, KS, the cash price is $1,185, which matches the facility's median negotiated rate of $761.00 for in-network plans. While the facility is a Critical Access Hospital with government local ownership, the cash price is notably higher than the median negotiated rate, suggesting that paying out-of-pocket may not offer the lowest cost for those with active insurance. Patients should be aware that prompt-pay discounts, which can range from 20% to 50%, are often available for upfront payment and could significantly reduce the final bill if requested before check-in.
The Medicare benchmark for this service is $356.43, indicating that the cash price represents a markup of 2.1 times the federal baseline. Although the data does not provide specific state or county average comparisons for this procedure, the significant difference between the Medicare rate and the cash price highlights the importance of verifying your specific plan's allowed amount. If your insurance deductible has not been met, you may face the full negotiated rate of $761.00; however, if the insurance allowed amount exceeds the cash price, paying directly could save you money. Always request an itemized bill and ask about self-pay or prompt-pay discounts prior to scheduling to avoid unexpected charges.