MRI, brain (no contrast)
Facility: Susan B Allen Memorial Hospital
Billing Code: 70551 (CPT)
- CPT Billing Code: 70551
- Insurance Median: $554
- Cash Discount Price: $1,254
- vs. Medicare Baseline: 2.27x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Understanding this gauge: We use the federal Medicare rate of $243.77 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 227% of the Medicare baseline (a markup of 127%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
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 | $350 | 144% |
| Providrs Care | $757 | 311% |
Consumer Guidance & Cost Commentary
For this MRI of the brain at Susan B Allen Memorial Hospital in El Dorado, KS, the cash price is $1,254, which is lower than the facility's negotiated rates of $554 and the maximum allowed amounts of $350 to $757 for UnitedHealthcare and Providrs Care. While commercial insurance contracts often result in higher out-of-pocket costs due to administrative overhead and deductible requirements, paying cash directly can sometimes be the most economical option for patients with high-deductible plans. The facility offers a voluntary non-profit status and is located in a rural area, so patients should explicitly ask for "self-pay" or "prompt-pay" discounts before scheduling to ensure they are not billed the full chargemaster rate.
This service is priced at 2.3 times the Medicare benchmark of $243.77, indicating a significant markup above the federal cost baseline. Since Medicare rates represent a scientifically validated measure of the true cost of care, comparing the facility's gross charge of $1,929 to this benchmark reveals that the commercial negotiated rates are substantially higher than the baseline. Consumers should be aware that balance billing is generally prohibited for emergency services at in-network facilities under the No Surprises Act, but it is crucial to verify network status and request an itemized bill to avoid unexpected charges for out-of-network ancillary services like lab work or emergency physician fees.