MRI, brain (with and without contrast)
Facility: William Newton Hospital
Billing Code: 70553 (CPT)
- CPT Billing Code: 70553
- Insurance Median: $1,474
- Cash Discount Price: $4,094
- vs. Medicare Baseline: 4.14x 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 414% of the Medicare baseline (a markup of 314%). 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 | $525 - $1,474 | 147% |
| Triwest- All Plans | $1,430 | 401% |
| Ambetter / Centene | $1,474 - $4,094 | 414% |
| UnitedHealthcare | $1,474 - $3,685 | 414% |
| Providrs Care Nexus | $2,506 | 703% |
| Providrs Care - All Other Plans | $2,866 | 804% |
Consumer Guidance & Cost Commentary
For the MRI of the brain with and without contrast at William Newton Hospital in Winfield, KS, the cash price is $4,094, which matches the facility's median negotiated rate and the cash median. This charge is significantly higher than the Medicare benchmark of $356.43, reflecting a markup of 4.1 times the federal rate. While commercial payers like Blue Cross Blue Shield and Triwest have negotiated rates ranging from $525 to $1,474, these amounts are still well below the cash price, illustrating that insurance contracts often cap payments lower than what a self-pay patient might expect. Patients should be aware that while cash payment can sometimes be cheaper for those with high-deductible plans if the insurance allowed amount exceeds the cash price, in this specific case, the cash rate is the highest figure available.
To ensure you are not overcharged, it is crucial to request an itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. Since the facility is a Critical Access Hospital with government-local ownership, you may be eligible for prompt-pay discounts if you pay in full upfront, which can reduce the total cost by 20% to 50% by bypassing administrative claim processing fees. Additionally, under the No Surprises Act, you are protected from balance billing for emergency care or non-emergency services from out-of-network providers at this in-network facility, so you should not feel pressured to pay unexpected differences immediately. Always verify your specific plan's deductible status and ask the hospital directly about self-pay or prompt-pay options before scheduling your appointment.