CMS Price Transparency Data

MRI, brain (with and without contrast)

Facility: Sycamore Shoals Hospital

Billing Code: 70553 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70553
Insurance Median: $577
Cash Discount Price: $669
vs. Medicare Baseline: 1.62x Medicare

The contracted insurance negotiated median rate for a MRI, brain (with and without contrast) at Sycamore Shoals Hospital is $577. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $669. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 1.62x the Medicare baseline. Located in 1501 West Elk Avenue, Elizabethton, TN.

Cash / Self-Pay

$669

Average discount available for prompt cash payment at this facility.

Insurance Median

$577

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: $669 (188%)

Insurance Median: $577 (162%)

Cash: $669 (188% of Medicare)

Ins. Median: $577 (162% 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.

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
Aetna	$317 - $2,844	89%
Amerigroup	$317 - $421	89%
Humana	$317	89%
Managed Medicaire	$317	89%
Medicare (plans)	$317	89%
Sentara Health	$317 - $1,240	89%
United Mine Workers Of America	$317	89%
UnitedHealthcare	$317 - $4,346	89%
Blue Cross Blue Shield	$326 - $1,510	91%
Molina Healthcare	$329 - $577	92%
Cigna	$332 - $1,025	93%
Devoted Health Plan	$332	93%
Nhc Advantage	$332	93%
Wellcare	$336 - $4,457	94%
Optima Health	$555	156%
Ambetter / Centene	$690	194%
Medcost	$1,560	438%
First Health Coventry	$3,343	938%
Seven Corners, Inc.	$4,457	1250%

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 $669.
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 Sycamore Shoals 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.