MRI, brain (with and without contrast)
Facility: Smith County Memorial Hospital
Billing Code: 70553 (CPT)
- CPT Billing Code: 70553
- Insurance Median: $964
- Cash Discount Price: $1,025
- vs. Medicare Baseline: 2.70x 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 270% of the Medicare baseline (a markup of 170%). 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 | $521 | 146% |
| Medicaid / KanCare | $718 - $1,025 | 201% |
| Multiplan-All Plans | $922 | 259% |
| Wppa-All Plans | $964 | 270% |
| Health Partners Of Ks Ppo-All Plans | $974 | 273% |
| Midlands Choice-All Plans | $974 | 273% |
| UnitedHealthcare | $974 | 273% |
Consumer Guidance & Cost Commentary
For the CPT code 70553, MRI of the brain (with and without contrast), Smith County Memorial Hospital in Smith Center, KS, lists a cash median price of $1,025.00, which matches the facility's gross charge. This cash rate is significantly higher than the Medicare benchmark of $356.43, reflecting a markup of 2.7 times the federal baseline. While the facility is a Critical Access Hospital owned by the local government, patients should be aware that commercial insurance negotiated rates for this service range from $521 to $1,025 depending on the payer. Notably, Medicaid/KanCare plans have a negotiated range of $718 to $1,025, while other payers like Multiplan and UnitedHealthcare have fixed negotiated rates of $922 and $974, respectively. Because the cash price ($1,025) is identical to the highest negotiated rate, patients with high-deductible plans who have not yet met their out-of-pocket maximum may find paying cash directly more cost-effective than using insurance, provided they secure a prompt-pay discount before the claim is submitted.
To minimize costs, patients should explicitly request a self-pay or prompt-pay discount prior to scheduling, as hospitals often offer fee reductions of 20% to 50% for upfront payment to bypass administrative billing cycles. It is crucial to avoid accepting summary bills that only show broad category totals; instead, demand a full itemized CPT-coded statement to identify any errors, unbundled charges, or services not rendered, which can account for over 80% of billing inaccuracies. Since the facility is