MRI, brain (no contrast)
Facility: Decatur Health
Billing Code: 70551 (CPT)
- CPT Billing Code: 70551
- Insurance Median: $827
- Cash Discount Price: $976
- vs. Medicare Baseline: 3.39x 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 $243.77 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 339% of the Medicare baseline (a markup of 239%). 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 |
|---|---|---|
| Wppa/Providrs Care- All Plans | $651 | 267% |
| UnitedHealthcare | $662 - $827 | 272% |
| Humana | $668 | 274% |
| Blue Cross Blue Shield | $678 | 278% |
| Aetna | $976 - $1,084 | 400% |
| Midlands Choice- All Plans | $976 | 400% |
| Medicaid / KanCare | $1,095 | 449% |
Consumer Guidance & Cost Commentary
For this MRI of the brain without contrast at Decatur Health in Oberlin, Kansas, the cash price is $976, which aligns with the median negotiated rate of $827 for in-network payers like Aetna and Midlands Choice. While the facility's gross charge is $1,084, patients should note that commercial rates often exceed cash prices due to administrative overhead and contract structures. If you have a high-deductible plan, paying the cash price of $976 upfront could be more cost-effective than relying on insurance, especially since the median amount paid by insurers is $748, suggesting that many patients may owe more than the cash rate after deductibles are met. Additionally, you should explicitly ask the billing department about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if settled in full before or shortly after the service.
The Medicare benchmark for this procedure is $243.77, which serves as the objective baseline for evaluating pricing markup. The facility's cash rate of $976 represents a significant increase over the Medicare amount, reflecting the standard commercial pricing model where rates average 200% to 300% of Medicare. It is important to compare your specific negotiated rate against the Medicare benchmark rather than the hospital's gross charge, as the latter is inflated and does not reflect the true cost of care. For context, the state of Kansas and the specific county average for this service are not provided in the available data, so the Medicare rate remains the primary reference point for assessing whether the facility's pricing is reasonable relative to federal cost standards.