MRI, brain (with and without contrast)
Facility: Decatur Health
Billing Code: 70553 (CPT)
- CPT Billing Code: 70553
- Insurance Median: $1,120
- Cash Discount Price: $1,321
- vs. Medicare Baseline: 3.14x 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 314% of the Medicare baseline (a markup of 214%). 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 | $678 | 190% |
| Wppa/Providrs Care- All Plans | $880 | 247% |
| UnitedHealthcare | $895 - $1,120 | 251% |
| Humana | $904 | 254% |
| Aetna | $1,321 - $1,467 | 371% |
| Midlands Choice- All Plans | $1,321 | 371% |
| Medicaid / KanCare | $1,482 | 416% |
Consumer Guidance & Cost Commentary
For this MRI of the brain at Decatur Health in Oberlin, Kansas, the cash price is $1,321, which matches the facility's negotiated rate for Medicaid and is lower than the median negotiated rate of $1,120 found across other payers. While the gross charge listed is $1,467, patients with high-deductible plans may find paying cash directly more affordable than relying on insurance, as commercial negotiated rates often exceed cash prices due to administrative overhead. To secure the lowest possible cost, patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront fee reductions can bypass the standard insurance billing cycle and save significant amounts on the final bill.
When evaluating this cost, it is important to compare rates against the Medicare benchmark rather than the hospital's full list price, as the latter is inflated to make discounts appear larger. The Medicare amount for this procedure is $356.43, providing a clear baseline for fair pricing; commercial rates typically range from 200% to 300% of this figure, though fair pricing is often defined as 120% to 150%. Additionally, if a patient receives care from an out-of-network provider at this facility, they could face balance billing for the difference between the allowed amount and the full charge, a practice that is now largely prohibited for emergency and non-emergency services under the No Surprises Act. Consumers should always request a detailed, itemized bill to verify that no unbundled codes or services not rendered are included, ensuring the final invoice accurately reflects the care provided.