CMS Price Transparency Data

MRI, brain (with and without contrast)

Facility: Stoughton Hospital

Billing Code: 70553 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70553
Insurance Median: $2,810
Cash Discount Price: $3,513
vs. Medicare Baseline: 7.88x Medicare

The contracted insurance negotiated median rate for a MRI, brain (with and without contrast) at Stoughton Hospital is $2,810. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,513. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 7.88x the Medicare baseline. Located in 900 Ridge St, Stoughton, WI.

Cash / Self-Pay

$3,513

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,810

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: $3,513 (986%)

Insurance Median: $2,810 (788%)

Cash: $3,513 (986% of Medicare)

Ins. Median: $2,810 (788% 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 788% of the Medicare baseline (a markup of 688%). 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
Medicaid / KanCare	$482	135%
Tricare	$1,520	426%
Healthnet Mcr Adv - All Plans	$1,699	477%
Dean Health Insurance Med Adv	$1,788	502%
Humana	$1,788 - $5,748	502%
Quartz Mcr Adv	$1,788	502%
Security Health/First Health - All Plans	$1,788	502%
Aetna	$1,916 - $5,429	538%
Dean Health Insurance Comm - All Other Plans	$2,088	586%
Dean Health Insurance Epo	$2,088	586%
UnitedHealthcare	$2,810 - $5,110	788%
Quartz Health Solutions - All Other Lans	$4,747	1332%
Geha - All Plans	$4,790	1344%
Cigna	$5,110	1434%
Wisconsin Ppo Ppa Direct - All Plans	$5,110	1434%
Blue Cross Blue Shield	$5,557	1559%
Wps - All Plans	$5,748	1613%
Alliance - All Plans	$25,548	7168%

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 $3,513.
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 Stoughton 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.