CMS Price Transparency Data

MRI, brain (with and without contrast)

Facility: Carle Health Pekin Hospital

Billing Code: 70553 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70553
Insurance Median: $2,129
Cash Discount Price: $8,516
vs. Medicare Baseline: 5.97x Medicare

The contracted insurance negotiated median rate for a MRI, brain (with and without contrast) at Carle Health Pekin Hospital is $2,129. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $8,516. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 5.97x the Medicare baseline. Located in 600 South 13Th Street, Pekin, IL.

Cash / Self-Pay

$8,516

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,129

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: $8,516 (2389%)

Insurance Median: $2,129 (597%)

Cash: $8,516 (2389% of Medicare)

Ins. Median: $2,129 (597% 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 597% of the Medicare baseline (a markup of 497%). 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
Aetna	$130 - $2,129	36%
Blue Cross Blue Shield	$374 - $3,364	105%
Humana	$374 - $393	105%
Molina	$374 - $2,555	105%
UnitedHealthcare	$374 - $1,122	105%
Wellcare	$374	105%
Meridian	$434	122%
Cigna	$1,366	383%
Healthlink	$2,682 - $2,998	752%
Multiplan/Phcs	$4,258	1195%

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 $8,516.
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 Carle Health Pekin 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.