CMS Price Transparency Data

MRI, brain (no contrast)

Facility: Central Florida Lake Monroe Hospital

Billing Code: 70551 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70551
Insurance Median: $6,441
Cash Discount Price: $20,779
vs. Medicare Baseline: 26.42x Medicare

The contracted insurance negotiated median rate for a MRI, brain (no contrast) at Central Florida Lake Monroe Hospital is $6,441. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $20,779. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 26.42x the Medicare baseline. Located in 1401 W Seminole Blvd, Sanford, FL.

Cash / Self-Pay

$20,779

Average discount available for prompt cash payment at this facility.

Insurance Median

$6,441

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$243.77

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $243.77 (100%)

Cash / Self-Pay: $20,779 (8524%)

Insurance Median: $6,441 (2642%)

Cash: $20,779 (8524% of Medicare)

Ins. Median: $6,441 (2642% of 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 2642% of the Medicare baseline (a markup of 2542%). 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
United	$518 - $9,351	212%
Freedom Health	$1,496	614%
Optimum	$1,496	614%
Aetna	$1,580 - $6,234	648%
Corvel Corporation	$2,454	1007%
Prime Health	$2,506	1028%
Careworks (Rockport Community)	$2,583	1060%
Avmed	$3,110 - $10,390	1276%
Simply	$3,200	1313%
Molina Healthcare	$3,948 - $6,649	1620%
Sunshine State Health Plan	$5,299	2174%
Plotkin Health	$10,390	4262%
Prime Health Sheriff	$10,390	4262%
Multiplan	$15,584 - $17,662	6393%
Three Rivers Provider Network	$15,584	6393%
Ppo Next	$17,662	7245%
Novanet	$18,701	7672%

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 $20,779.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 70551.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Central Florida Lake Monroe Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 70551.
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.