CMS Price Transparency Data

MRI, brain (with and without contrast)

Facility: Elmhurst Hospital Center

Billing Code: 70553 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70553
Insurance Median: $796
Cash Discount Price: Unavailable
vs. Medicare Baseline: 2.23x Medicare

The contracted insurance negotiated median rate for a MRI, brain (with and without contrast) at Elmhurst Hospital Center is $796. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 2.23x the Medicare baseline. Located in 79-01 Broadway, Elmhurst, NY.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$796

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$356.43

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $356.43 (100%)

Insurance Median: $796 (223%)

Ins. Median: $796 (223% of 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 223% of the Medicare baseline (a markup of 123%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Healthfirst	$93 - $1,790	26%
Aetna	$111 - $1,131	31%
Amidacare	$117 - $796	33%
Emblem	$117 - $1,074	33%
Wellcare	$126 - $396	35%
Metroplus	$149 - $1,790	42%
Fidelis	$168 - $1,790	47%
Oscar	$175 - $1,702	49%
Blue Cross Blue Shield	$423 - $1,790	119%
Vaccn	$423	119%
Vnsny	$423 - $1,141	119%
Centers Plan For Healthy Living	$440	123%
Senior Whole Health	$445 - $796	125%
United	$500 - $1,074	140%
Centerlight	$671	188%
Oxford	$671 - $808	188%
Carelon	$796 - $873	223%
United Behavioral Health	$796 - $875	223%
Affinity	$811 - $1,790	228%
Carelon (Amida Care)	$811	228%
Elderplan	$845 - $873	237%
Magnacare	$1,007	283%
Multiplan	$1,074	301%
Local 1199	$1,141	320%
Villagecare Max	$1,141	320%
Cigna	$1,285	361%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $X.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 70553.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Elmhurst Hospital Center is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 70553.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.