CMS Price Transparency Data

MRI, brain (with and without contrast)

Facility: HSHS St Elizabeth's Hospital

Billing Code: 70553 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 70553
  • Insurance Median: $2,862
  • Cash Discount Price: $4,812
  • vs. Medicare Baseline: 8.03x Medicare
The contracted insurance negotiated median rate for a MRI, brain (with and without contrast) at HSHS St Elizabeth's Hospital is $2,862. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,812. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 8.03x the Medicare baseline. Located in One St Elizabeth Boulevard, O Fallon, IL.
Cash / Self-Pay
$4,812

Average discount available for prompt cash payment at this facility.

Insurance Median
$2,862

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: $4,812 (1350%)
Insurance Median: $2,862 (803%)
Cash: $4,812 (1350% of Medicare)
Ins. Median: $2,862 (803% 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 803% of the Medicare baseline (a markup of 703%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash 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 $149 - $4,706 42%
Blue Cross Blue Shield $149 - $6,684 42%
Claim Doc $149 - $997 42%
Clear Spring Health Of Illinois $149 - $399 42%
Health Alliance Medical Plans $149 - $5,681 42%
Health Partners $149 - $399 42%
Hopetrust $149 - $957 42%
Humana $149 - $399 42%
Molina Healthcare $149 - $417 42%
Naphcare $149 - $864 42%
Sae Hospice $149 - $399 42%
UnitedHealthcare $149 - $6,684 42%
Meridian Health Plan $388 109%
Celtic Insurance Company $797 224%
Amish Community $1,872 525%
Cigna $2,862 - $6,684 803%
Wellfirst $4,304 1208%
First Health $4,973 1395%
Healthlink $5,314 - $6,684 1491%
Caterpillar, Inc. $5,367 1506%
Consociate Group $5,882 1650%
Choicecare $6,016 1688%
Healthcare Finest Network (Hfn) $6,016 1688%
Multiplan/Phcs $6,016 1688%
Provider Network Of America $6,016 1688%
City Of Springfield $6,684 1875%
Current Health Solutions $6,684 1875%
Healthscope $6,684 1875%
Illinois Breast And Cervical Cancer Program $6,684 1875%
Interplan $6,684 1875%
Live360 $6,684 1875%
Wexford $6,684 1875%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: One St Elizabeth Boulevard, O Fallon, IL 62269
  • CMS Rating: ★★★★☆
  • Ownership Type: Voluntary non-profit - Church
  • Hospital Type: Acute Care Hospitals