CMS Price Transparency Data

MRI, brain (with and without contrast)

Facility: Adena Pike Medical Center

Billing Code: 70553 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70553
Insurance Median: $2,165
Cash Discount Price: $1,495
vs. Medicare Baseline: 6.07x Medicare

The contracted insurance negotiated median rate for a MRI, brain (with and without contrast) at Adena Pike Medical Center is $2,165. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,495. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 6.07x the Medicare baseline. Located in 100 Dawn Lane, Waverly, OH.

Cash / Self-Pay

$1,495

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,165

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: $1,495 (419%)

Insurance Median: $2,165 (607%)

Cash: $1,495 (419% of Medicare)

Ins. Median: $2,165 (607% 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 607% of the Medicare baseline (a markup of 507%). 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	$718 - $2,434	201%
Blue Cross Blue Shield	$718 - $2,581	201%
Buckeye Community Health Plan	$718	201%
Humana	$718 - $2,841	201%
Medical Mutual Of Ohio	$718 - $1,900	201%
Medigold	$718	201%
Molina	$718	201%
Care Source	$732	205%
Gateway Health	$987	277%
Molina Marketplace	$1,177	330%
Care Source Just4Me	$1,292	362%
Sidecar Health	$1,974	554%
First Health	$2,000 - $2,344	561%
Ohio Ppo Connect	$2,093	587%
The Health Plan	$2,093	587%
Cigna	$2,165	607%
Medical Mutual Of Ohio Supermed	$2,254	632%
Ohio Health Choice	$2,380	668%
UnitedHealthcare	$2,572	722%
Integrated Health Plan	$2,811	789%
Healthsmart	$2,841	797%
Multiplan/Private Healthcare Systems	$2,841	797%
Three Rivers Network	$2,841	797%

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 $1,495.
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 Adena Pike Medical Center 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.