MRI, brain (with and without contrast)
Facility: Phillips County Hospital
Billing Code: 70553 (CPT)
- CPT Billing Code: 70553
- Insurance Median: $820
- Cash Discount Price: $770
- vs. Medicare Baseline: 2.30x 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 230% of the Medicare baseline (a markup of 130%). 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 | $553 - $734 | 155% |
| UnitedHealthcare | $725 - $906 | 203% |
| Health Partners-All Plans | $906 | 254% |
| Medicaid / KanCare | $906 | 254% |
Consumer Guidance & Cost Commentary
For the CPT code 70553, representing an MRI of the brain with and without contrast, Phillips County Hospital in Phillipsburg, KS, lists a cash median price of $770.00, which is lower than the facility's negotiated rates of $820.00. While the facility is a Critical Access Hospital owned by the local government, patients should be aware that cash payments can sometimes be more cost-effective than using insurance, particularly if the patient's plan has a high deductible or if the insurance negotiated rate exceeds the cash price. It is important to verify the specific allowed amount with your insurer before scheduling, as commercial rates vary significantly even within the same network.
The data indicates that the facility's gross charge of $906.00 is the maximum amount billed to UnitedHealthcare plans, while Blue Cross Blue Shield plans see a range between $553 and $734. Although the provided data does not explicitly list state or county average benchmarks for comparison, the presence of a Medicare amount of $356.43 serves as a baseline for evaluating the facility's pricing markup. Patients should request an itemized bill to ensure no errors exist, as over 80% of hospital bills contain mistakes such as unbundled codes or services not rendered. Additionally, if you are an out-of-network patient, the No Surprises Act may protect you from balance billing for emergency care or non-emergency services at in-network facilities, so you should dispute any unexpected bills immediately rather than paying them out of fear of credit damage.