CMS Price Transparency Data

MRI, brain (no contrast)

Facility: Mc Donough District Hospital

Billing Code: 70551 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70551
Insurance Median: $566
Cash Discount Price: $1,405
vs. Medicare Baseline: 2.32x Medicare

The contracted insurance negotiated median rate for a MRI, brain (no contrast) at Mc Donough District Hospital is $566. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,405. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 2.32x the Medicare baseline. Located in 525 East Grant Street, Macomb, IL.

Cash / Self-Pay

$1,405

Average discount available for prompt cash payment at this facility.

Insurance Median

$566

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: $1,405 (576%)

Insurance Median: $566 (232%)

Cash: $1,405 (576% of Medicare)

Ins. Median: $566 (232% 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 232% of the Medicare baseline (a markup of 132%). 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
Health Alliance	$40 - $3,575	16%
Hfn	$63 - $3,615	26%
UnitedHealthcare	$63 - $3,615	26%
Aetna	$67 - $4,017	27%
Humana	$67 - $3,615	27%
Medicaid / KanCare	$67 - $4,017	27%
Medicare (plans)	$67 - $270	27%
Meridian	$67 - $270	27%
Molina	$67 - $4,017	27%
Mutual Medical	$67 - $4,017	27%
Veteran Affairs	$67 - $270	27%
Tricare	$252	103%
Blue Cross Blue Shield	$303 - $4,017	124%
Springfield Health	$546 - $3,294	224%
Consociate	$566 - $3,414	232%
Trilogy	$566 - $3,414	232%
Blue Choice	$599 - $3,615	246%
Current Health	$599 - $3,615	246%
Healthlink	$599 - $3,776	246%
Preferred Plan	$633 - $3,816	260%

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 $1,405.
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 Mc Donough District 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.