CMS Price Transparency Data

MRI, brain (with and without contrast)

Facility: Faith Community Hospital

Billing Code: 70553 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70553
Insurance Median: $258
Cash Discount Price: $3,330
vs. Medicare Baseline: 0.72x Medicare

The contracted insurance negotiated median rate for a MRI, brain (with and without contrast) at Faith Community Hospital is $258. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,330. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 0.72x the Medicare baseline. Located in 215 Chisholm Trail, Jacksboro, TX.

Cash / Self-Pay

$3,330

Average discount available for prompt cash payment at this facility.

Insurance Median

$258

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: $3,330 (934%)

Insurance Median: $258 (72%)

Cash: $3,330 (934% of Medicare)

Ins. Median: $258 (72% 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
Humana	$224	63%
Medicare (plans)	$224	63%
Medicaid / KanCare	$292	82%
UnitedHealthcare	$381	107%

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 $3,330.
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 Faith Community 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.