CMS Price Transparency Data

MRI, brain (with and without contrast)

Facility: Fayette County Hospital

Billing Code: 70553 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70553
Insurance Median: $802
Cash Discount Price: $3,973
vs. Medicare Baseline: 2.25x Medicare

The contracted insurance negotiated median rate for a MRI, brain (with and without contrast) at Fayette County Hospital is $802. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,973. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 2.25x the Medicare baseline. Located in 650 W Taylor St, Vandalia, IL.

Cash / Self-Pay

$3,973

Average discount available for prompt cash payment at this facility.

Insurance Median

$802

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: $3,973 (1115%)

Insurance Median: $802 (225%)

Cash: $3,973 (1115% of Medicare)

Ins. Median: $802 (225% 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 225% of the Medicare baseline (a markup of 125%). 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 Mcare	$105 - $2,342	29%
Healthlink Mcr Adv	$105 - $2,342	29%
Cigna	$122 - $5,490	34%
Aetna	$134 - $5,051	38%
Coventry/Ghp-All Plans	$142 - $4,758	40%
Multiplan - All Plans	$195 - $6,222	55%
Health Alliance - All Other Plans	$211 - $6,046	59%
Blue Cross Blue Shield	$214 - $6,149	60%
Illinicare - All Plans	$297 - $802	83%
Medicaid / KanCare	$297 - $802	83%
Meridian-All Plans	$297 - $802	83%
UnitedHealthcare	$519 - $6,076	146%
Healthlink Hmo	$538 - $5,124	151%
Healthlink Ppo - All Other Plans	$538 - $5,856	151%
Humana	$2,342	657%

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 $3,973.
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 Fayette County 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.