MRI of the Brain With and Without Contrast
CPT 70553 is the "gold standard" brain MRI, used for tumor evaluation, multiple sclerosis, stroke follow-up, and unexplained neurological symptoms. Medicare pays $316.97 for this scan, but providers charge an average of $1,911.21 (a 6.0x markup). This is one of the most expensive routine imaging studies. Freestanding MRI centers often charge $500 to $1,200, compared to $2,000 to $4,000 at hospitals.
CPT 70553 at a Glance
- Average provider charge: $1,911.21
- Medicare rate: $316.97
- Typical markup: 6.0x over Medicare
- Freestanding center range: $500 to $1,200
- Setting: Same rate office and facility
- Common uses: Tumors, MS, stroke follow-up
- Beneficiaries (2023): 299,254
- Components: Technical (TC) + Professional (26)
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How the Medicare Rate Is Calculated
Medicare prices every procedure using Relative Value Units (RVUs) across three components, then multiplies by a national conversion factor of $33.4009 (2026). For imaging codes like 70553, the non-facility and facility Practice Expense RVUs are identical, so Medicare pays the same rate regardless of setting. However, hospitals add their own facility fee on top.
| Component | What It Covers | RVU |
|---|---|---|
| Work RVU | Radiologist time, skill, and judgment | 2.23 |
| Practice Expense RVU | MRI equipment, technologist, contrast material | 7.10 |
| Malpractice RVU | Professional liability insurance | 0.16 |
| Total RVU | 9.49 | |
| x $33.4009 | 2026 conversion factor | $316.97 |
Medicare Rate by State
Medicare adjusts the national rate using Geographic Practice Cost Indices (GPCIs). The same brain MRI pays differently depending on your location.
Medicare Rate by State (2026)
Medicare adjusts payments by location using Geographic Practice Cost Indices (GPCIs). Select your state to see the adjusted rate.
Sample State Rates
| State | Medicare Pays | Avg. Charge | Markup |
|---|---|---|---|
| Texas (Austin) | $329.66 | $1,911.21 | 5.8x |
| California (Los Angeles) | $359.75 | $1,911.21 | 5.3x |
| New York (Manhattan) | $359.06 | $1,911.21 | 5.3x |
| Florida (Fort Lauderdale) | $323.45 | $1,911.21 | 5.9x |
| Ohio | $296.99 | $1,911.21 | 6.4x |
| Mississippi | $283.67 | $1,911.21 | 6.7x |
| Arkansas | $281.42 | $1,911.21 | 6.8x |
| Alaska | $367.47 | $1,911.21 | 5.2x |
Rates shown use 2026 GPCIs and the $33.4009 conversion factor. For imaging codes, the Medicare physician fee is the same in office and facility settings. The average provider charge of $1,911.21 is the 2023 national average from CMS utilization data.
What Insured Patients Actually Pay for a Brain MRI
Your insurer has a negotiated rate with the MRI facility, typically 150% to 300% of the Medicare rate. For a brain MRI with and without contrast, that negotiated rate is usually $475 to $950. What you owe depends on your plan:
| Your Situation | What You Likely Pay | How It Works |
|---|---|---|
| Copay plan (deductible met) | $100 to $300 | Flat copay for advanced imaging |
| Coinsurance plan (deductible met) | $95 to $190 | 20% of the negotiated rate ($475 to $950) |
| High-deductible plan (deductible NOT met) | $475 to $950 | Full negotiated rate until deductible is met |
| Medicare Part B | $63.39 | 20% of $316.97 after annual deductible |
Should You Use Insurance or Pay Cash?
If you have a high-deductible plan and have not met your deductible, you are paying the full negotiated rate for imaging. For a brain MRI, this is typically $475 to $950 through insurance. Freestanding MRI centers often offer cash-pay rates of $500 to $1,200 for this scan.
When Cash-Pay Wins
- The freestanding MRI center's cash rate is close to or below your insurer's negotiated rate
- You are unlikely to meet your deductible this year
- The cash-pay center has shorter wait times (MRI scheduling can take weeks)
- Your insurance denied prior authorization and you need the scan
When Using Insurance Wins
- You are close to meeting your annual deductible
- Your plan has a flat copay for advanced imaging ($100 to $300)
- You expect significant medical expenses later this year
- You need the results integrated with your medical records for treatment planning
Common Billing Problems with Brain MRIs
Hospital vs. freestanding center price gap
The same brain MRI that costs $500 to $1,200 at a freestanding MRI center can cost $2,000 to $4,000 at a hospital outpatient department. The hospital adds a facility fee on top of the scan and radiologist charges. If your doctor orders a brain MRI, ask where it will be performed and request a freestanding center if one is available in your area.
Contrast material charged separately
Some facilities bill the contrast material (gadolinium) as a separate line item on top of the MRI code. This should be included in the global fee for CPT 70553. If you see a separate charge for contrast material in addition to the 70553 code, question it with the billing department.
Wrong MRI code billed
CPT 70551 is MRI brain without contrast. CPT 70552 is MRI brain with contrast only. CPT 70553 is with and without contrast (both sequences). Each has a different price. Verify the code matches what was actually performed. If you only received one contrast sequence, you should not be billed for 70553.
Open MRI vs. closed MRI pricing
Open MRI facilities sometimes charge less, but image quality may vary. The CPT code is the same regardless of the MRI type. If you choose an open MRI for comfort reasons, confirm the image quality will be sufficient for your doctor's diagnostic needs. A repeat scan due to inadequate image quality would double your cost.
Related Imaging Codes
| Code | Description | Medicare Rate |
|---|---|---|
| 70551 | MRI brain without contrast | ~$200 |
| 70552 | MRI brain with contrast only | ~$270 |
| 70553 | MRI brain with and without contrast | $316.97 |
| 70450 | CT head without contrast | $106.55 |
Frequently Asked Questions
How much does a brain MRI cost without insurance?
Without insurance, a brain MRI with and without contrast (CPT 70553) costs $500 to $4,000 depending on the facility. The national average provider charge is $1,911.21. Freestanding MRI centers typically charge $500 to $1,200, while hospitals charge $2,000 to $4,000 or more. Medicare pays $316.97 for this scan.
Do I need a brain MRI with contrast or without?
A brain MRI without contrast (CPT 70551, approximately $200 Medicare rate) is sufficient for many conditions. The with-and-without contrast version (70553) is typically needed for tumor evaluation, infection, or when your doctor needs to see how blood vessels and tissues enhance with contrast. Ask your doctor whether the non-contrast version would be adequate for your situation, as it costs significantly less.
Why is my brain MRI bill so high?
The average provider charge for CPT 70553 is $1,911.21, which is 6.0 times the Medicare rate. Hospital MRI departments add facility fees that can double or triple the cost. Additionally, the contrast material itself adds cost. Freestanding MRI centers are typically 50 to 70% cheaper than hospital outpatient departments for the same scan.
Does insurance require prior authorization for a brain MRI?
Most insurance plans require prior authorization for brain MRIs. Your ordering physician typically handles this, but delays can occur. If authorization is denied, your doctor can appeal with clinical documentation. Without authorization, you may be responsible for the full cost. Medicare Part B covers 80% after your deductible, leaving approximately $63 in coinsurance.
Need Help Lowering a Medical Bill?
CareRoute Bill Defense is a done-for-you bill reduction service. We analyze the codes on your imaging bill, identify overcharges and coding errors, and apply reduction strategies on your behalf. If your brain MRI bill seems too high, we can help.
Learn about Bill Defense