MRI, brain (with and without contrast)
Facility: Girard Medical Center
Billing Code: 70553 (CPT)
- CPT Billing Code: 70553
- Insurance Median: $1,400
- Cash Discount Price: $2,400
- vs. Medicare Baseline: 3.93x 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 393% of the Medicare baseline (a markup of 293%). 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 - $1,400 | 155% |
| Humana | $1,400 | 393% |
| Medicare (plans) | $1,400 | 393% |
| Aetna | $1,400 - $7,000 | 393% |
| Ambetter / Centene | $1,400 | 393% |
| UnitedHealthcare | $1,400 - $3,800 | 393% |
| Kansas Superior Select-All Plans | $1,400 | 393% |
| Multiplan-All Plans | $3,700 | 1038% |
| Uhhis-All Plans | $3,800 | 1066% |
Consumer Guidance & Cost Commentary
For the MRI of the brain at Girard Medical Center in Girard, KS, the cash median price is $2,400, while the median negotiated rate across nine payers is $1,400. This facility, a Critical Access Hospital owned by a government hospital district, charges significantly less than the gross list price of $4,000. While Medicare sets a benchmark of $356.43 for this procedure, commercial negotiated rates here average $1,400, which is higher than the cash price. Patients with high-deductible plans or those without insurance may find the cash price of $2,400 more affordable than the insurance negotiated rate of $1,400, provided they can pay upfront to avoid potential balance billing or deductibles. It is important to note that while the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, patients should still verify their specific plan details and ask the hospital directly about "self-pay" or "prompt-pay" discounts before scheduling.
The facility's pricing structure reflects standard commercial dynamics where administrative costs and contract dynamics often result in negotiated rates exceeding cash prices. For this specific CPT code, the lowest allowed amount among payers is $553, while the highest is $7,000, with most plans clustering around the $1,400 median. Since over 80% of hospital bills contain errors, patients should request a detailed, itemized billing audit rather than accepting a summary bill, which may hide unbundled charges or services not rendered. If a patient receives a bill that appears higher than expected, they should dispute it in writing with the