CMS Price Transparency Data

MRI, brain (no contrast)

Facility: Hamilton Memorial Hospital

Billing Code: 70551 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70551
Insurance Median: $1,934
Cash Discount Price: $2,243
vs. Medicare Baseline: 7.93x Medicare

The contracted insurance negotiated median rate for a MRI, brain (no contrast) at Hamilton Memorial Hospital is $1,934. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,243. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 7.93x the Medicare baseline. Located in 611 S Marshall Avenue, McLeansboro, IL.

Cash / Self-Pay

$2,243

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,934

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: $2,243 (920%)

Insurance Median: $1,934 (793%)

Cash: $2,243 (920% of Medicare)

Ins. Median: $1,934 (793% 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 793% of the Medicare baseline (a markup of 693%). 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	$185 - $2,375	76%
Blue Cross Blue Shield	$185 - $2,401	76%
Health Alliance	$185 - $2,111	76%
Medicare (plans)	$185 - $1,055	76%
UnitedHealthcare	$185 - $1,889	76%
Wellcare	$185 - $1,055	76%
Medicaid / KanCare	$982 - $1,055	403%
Alliance Coal	$1,055	433%
Humana	$1,055	433%
Healthlink	$1,180 - $1,360	484%
Healthscope	$1,847	758%
Wellfirst (Ssmhic)	$1,847	758%
Hope Trust	$1,979	812%
Cigna	$2,071	850%
Hfn, Inc	$2,111 - $2,375	866%
Multiplan	$2,243	920%
Siho	$2,375	974%
Three Rivers Provider	$2,375	974%
Healthsmart	$2,507	1028%
Stratose	$2,507	1028%

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 $2,243.
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 Hamilton Memorial 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.