CMS Price Transparency Data

MRI, brain (with and without contrast)

Facility: Ellenville Regional Hospital

Billing Code: 70553 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70553
Insurance Median: $1,124
Cash Discount Price: $1,544
vs. Medicare Baseline: 3.15x Medicare

The contracted insurance negotiated median rate for a MRI, brain (with and without contrast) at Ellenville Regional Hospital is $1,124. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,544. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 3.15x the Medicare baseline. Located in 10 Healthy Way, Ellenville, NY.

Cash / Self-Pay

$1,544

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,124

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%)

Cash / Self-Pay: $1,544 (433%)

Insurance Median: $1,124 (315%)

Cash: $1,544 (433% of Medicare)

Ins. Median: $1,124 (315% 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 315% of the Medicare baseline (a markup of 215%). 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
UnitedHealthcare	$51 - $2,328	14%
Emblemhealth	$115 - $3,023	32%
Cdphp	$125 - $1,398	35%
Blue Cross Blue Shield	$135 - $1,512	38%
Fidelis	$135 - $1,512	38%
Hamaspik Choice	$135 - $1,512	38%
Humana	$135 - $1,512	38%
Mvp Health Care Of Ny	$142 - $1,587	40%
Aetna	$155 - $1,750	43%
Local 1199Seiu	$155 - $1,750	43%
Wellcare	$185 - $2,078	52%
Galaxy Health	$219 - $2,456	61%
Oxford Health Plans	$2,328	653%

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 $1,544.
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 Ellenville Regional Hospital 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.