CMS Price Transparency Data

MRI, brain (with and without contrast)

Facility: Hermann Area District Hospital

Billing Code: 70553 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70553
Insurance Median: $1,525
Cash Discount Price: $2,080
vs. Medicare Baseline: 4.28x Medicare

The contracted insurance negotiated median rate for a MRI, brain (with and without contrast) at Hermann Area District Hospital is $1,525. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,080. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 4.28x the Medicare baseline. Located in 509 W 18Th St, Hermann, MO.

Cash / Self-Pay

$2,080

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,525

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: $2,080 (584%)

Insurance Median: $1,525 (428%)

Cash: $2,080 (584% of Medicare)

Ins. Median: $1,525 (428% 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 428% of the Medicare baseline (a markup of 328%). 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
Healthy Blue Mcaid - All Plans	$386	108%
Ambetter / Centene	$401 - $2,441	113%
Blue Cross Blue Shield	$416 - $2,323	117%
UnitedHealthcare	$416 - $1,456	117%
Care Partners Mcaid- All Plans	$562	158%
Healthlink Hmo	$927	260%
Healthlink Ppo - All Other Plans	$1,030	289%
Tricare	$1,373	385%
Choicecare Mcr Adv- All Plans	$1,456	408%
American Hlth Mcr Adv- All Plans	$1,525	428%
Humana	$1,525	428%
Aetna	$1,556 - $3,294	437%
Wellcare Mcr Adv - All Plans	$1,556	437%
Cigna	$1,890	530%
Harmony Hp Mcaid- All Plans	$2,011	564%
Healthcare Usa Mcaid- All Plans	$2,254	632%
Multiplan/Phcs - All Plans	$2,600	729%
Coventry - All Plans	$2,947	827%
Comp Results - All Plans	$3,120	875%
Three Rivers - All Plans	$3,120	875%

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 $2,080.
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 Hermann Area District 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.