CMS Price Transparency Data

MRI, brain (no contrast)

Facility: St James Hospital

Billing Code: 70551 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70551
Insurance Median: $505
Cash Discount Price: $460
vs. Medicare Baseline: 2.07x Medicare

The contracted insurance negotiated median rate for a MRI, brain (no contrast) at St James Hospital is $505. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $460. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 2.07x the Medicare baseline. Located in 411 Canisteo Street, Hornell, NY.

Cash / Self-Pay

$460

Average discount available for prompt cash payment at this facility.

Insurance Median

$505

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: $460 (189%)

Insurance Median: $505 (207%)

Cash: $460 (189% of Medicare)

Ins. Median: $505 (207% 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 207% of the Medicare baseline (a markup of 107%). 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	$191 - $319	78%
Medicare (plans)	$278 - $351	114%
Blue Cross Blue Shield	$303 - $713	124%
Fidelis 5155	$303 - $505	124%
Medicaid / KanCare	$303 - $1,136	124%
UnitedHealthcare	$303 - $505	124%
Humana	$319	131%
Molina Healthcare 1723	$505 - $1,136	207%
Empire Plan 5179	$673	276%
Mvp 2900	$676 - $693	277%
Cigna	$717	294%

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 $460.
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 St James 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.