CMS Price Transparency Data

MRI, brain (with and without contrast)

Facility: Hamilton Memorial Hospital

Billing Code: 70553 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70553
Insurance Median: $1,521
Cash Discount Price: $1,764
vs. Medicare Baseline: 4.27x Medicare

The contracted insurance negotiated median rate for a MRI, brain (with and without contrast) at Hamilton Memorial Hospital is $1,521. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,764. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 4.27x the Medicare baseline. Located in 611 S Marshall Avenue, McLeansboro, IL.

Cash / Self-Pay

$1,764

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,521

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: $1,764 (495%)

Insurance Median: $1,521 (427%)

Cash: $1,764 (495% of Medicare)

Ins. Median: $1,521 (427% 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 427% of the Medicare baseline (a markup of 327%). 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	$299 - $1,867	84%
Blue Cross Blue Shield	$299 - $1,888	84%
Health Alliance	$299 - $1,660	84%
Medicare (plans)	$299 - $830	84%
UnitedHealthcare	$299 - $1,486	84%
Wellcare	$299 - $830	84%
Medicaid / KanCare	$772 - $830	217%
Alliance Coal	$830	233%
Humana	$830	233%
Healthlink	$1,180 - $1,360	331%
Healthscope	$1,452	407%
Wellfirst (Ssmhic)	$1,452	407%
Hope Trust	$1,556	437%
Cigna	$1,629	457%
Hfn, Inc	$1,660 - $1,867	466%
Multiplan	$1,764	495%
Siho	$1,867	524%
Three Rivers Provider	$1,867	524%
Healthsmart	$1,971	553%
Stratose	$1,971	553%

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 $1,764.
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 Hamilton Memorial 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.