CMS Price Transparency Data

MRI, brain (with and without contrast)

Facility: Iowa Specialty Hospital - Clarion

Billing Code: 70553 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70553
Insurance Median: $908
Cash Discount Price: $2,321
vs. Medicare Baseline: 2.55x Medicare

The contracted insurance negotiated median rate for a MRI, brain (with and without contrast) at Iowa Specialty Hospital - Clarion is $908. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,321. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 2.55x the Medicare baseline. Located in 1316 South Main Street, Clarion, IA.

Cash / Self-Pay

$2,321

Average discount available for prompt cash payment at this facility.

Insurance Median

$908

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: $2,321 (651%)

Insurance Median: $908 (255%)

Cash: $2,321 (651% of Medicare)

Ins. Median: $908 (255% 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 255% of the Medicare baseline (a markup of 155%). 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
Tricare	$100 - $2,189	28%
Triwest Va - All Plans	$100 - $2,189	28%
Aetna	$112 - $6,001	31%
Healthscope Stellar-All Plans	$166 - $3,728	47%
Health Partners Ish-All Other Plans	$202 - $5,648	57%
Wellmark Hmo	$212 - $1,067	59%
Wellmark Ppo - All Other Plans	$238 - $1,173	67%
UnitedHealthcare	$289 - $6,707	81%
Auxiant Clarion Schools-All Plans	$439 - $4,589	123%
Health Partners Prestage	$506 - $5,295	142%
Cigna	$749 - $6,848	210%
Midlands Choice-All Plans	$749 - $6,848	210%

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 $2,321.
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 Iowa Specialty Hospital - Clarion 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.