CMS Price Transparency Data

MRI, brain (with and without contrast)

Facility: Margaretville Memorial Hospital

Billing Code: 70553 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70553
Insurance Median: $1,987
Cash Discount Price: $4,517
vs. Medicare Baseline: 5.57x Medicare

The contracted insurance negotiated median rate for a MRI, brain (with and without contrast) at Margaretville Memorial Hospital is $1,987. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,517. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 5.57x the Medicare baseline. Located in 42084 State Highway 28, Margaretville, NY.

Cash / Self-Pay

$4,517

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,987

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: $4,517 (1267%)

Insurance Median: $1,987 (557%)

Cash: $4,517 (1267% of Medicare)

Ins. Median: $1,987 (557% 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 557% of the Medicare baseline (a markup of 457%). 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
Oxford	$611	171%
UnitedHealthcare	$611 - $1,987	171%
Aetna	$665 - $4,517	187%
Mvp	$919	258%
Emblem	$956 - $1,124	268%
Mvp Exchange	$1,629	457%
Mvp Hmo/Ppo	$1,917	538%
Medicare (plans)	$1,987 - $2,981	557%
Hamaspik (McR)	$1,987	557%
Blue Cross Blue Shield	$1,987 - $3,800	557%
Mvp Gold (McR)	$1,987	557%
Affinity By Molina McR	$2,087	586%
Cdphp	$2,186	613%
Emblem Ghi/Hip Ppo/Cbp	$2,801	786%
Emblem Select Care (Exchange)	$3,072	862%
Magnacare Standard	$3,162	887%
Oxford Exchange	$3,162	887%
Todays Options	$3,279	920%
Emblem Ghi/Hip Hmo/Epo/Pos	$3,614	1014%
Magnacare Preferred	$3,614	1014%
Multiplan	$3,704	1039%
First Health	$4,065	1140%
Self-Pay	$4,098	1150%

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 $4,517.
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 Margaretville Memorial 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.