CMS Price Transparency Data
MRI, brain (with and without contrast)
Facility: Saint Alphonsus Medical Center Ontario
Billing Code: 70553 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 70553
- Insurance Median: $1,157
- Cash Discount Price: $2,508
- vs. Medicare Baseline: 3.25x Medicare
The contracted insurance negotiated median rate for a MRI, brain (with and without contrast) at Saint Alphonsus Medical Center Ontario is $1,157. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,508. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 3.25x the Medicare baseline. Located in 351 Sw 9Th Street, Ontario, OR.
Cash / Self-Pay
$2,508
Average discount available for prompt cash payment at this facility.
Insurance Median
$1,157
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: $2,508 (704%)
Insurance Median: $1,157 (325%)
Cash: $2,508 (704% of Medicare)
Ins. Median: $1,157 (325% 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 325% of the Medicare baseline (a markup of 225%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Medicaid / KanCare | $250 - $1,157 | 70% |
| Blue Cross Blue Shield | $407 - $3,279 | 114% |
| Medicare (plans) | $407 - $436 | 114% |
| UnitedHealthcare | $407 - $3,704 | 114% |
| Aetna | $419 - $3,654 | 118% |
| American Health Advantage Of Idaho | $423 | 119% |
| Moda Health | $807 - $3,742 | 226% |
| Healthcare Management Admin | $1,092 | 306% |
| Blue Benefit Administrators Of Massachusetts | $1,093 | 307% |
| Blue Care Network | $1,093 | 307% |
| Blue Distinction Transplant | $1,093 | 307% |
| Blue Shield - Ca | $1,093 | 307% |
| Blue Shield - Id (Regence) | $1,093 | 307% |
| Blue Shield - Ny Highmark Northeastern | $1,093 | 307% |
| Blue Shield - Ny Highmark Western | $1,093 | 307% |
| Blue Shield - Pa (Highmark) | $1,093 | 307% |
| Blue Shield - Wa (Regence) | $1,093 | 307% |
| Webtpa | $1,096 - $3,472 | 307% |
| Selecthealth | $1,152 - $3,472 | 323% |
| Ada County Jail Inmate Ins | $1,157 | 325% |
| Ambetter / Centene | $1,157 | 325% |
| Amish Mennonite | $1,157 | 325% |
| Bcccp-Michigan | $1,157 | 325% |
| Bccp | $1,157 | 325% |
| Bmc Healthnet | $1,157 | 325% |
| Breast Grant-Connecticut | $1,157 | 325% |
| California Health And Wellness | $1,157 | 325% |
| Cardinal Innovations Lme | $1,157 | 325% |
| Care Oregon Ohp | $1,157 | 325% |
| Cencal Health Plan | $1,157 | 325% |
| Cenpatico | $1,157 | 325% |
| Centurion Of Idaho | $1,157 | 325% |
| Chhuny | $1,157 | 325% |
| Childrens Comm Health Plan | $1,157 | 325% |
| Childrens Medical Services Title 19 | $1,157 | 325% |
| Cigna | $1,157 - $3,627 | 325% |
| Community Benefit Health | $1,157 | 325% |
| Community Care Behavorial Health | $1,157 | 325% |
| Community Health Choice | $1,157 | 325% |
| Covid19 Hrsa Uninsured Testing And Treatment Fund | $1,157 | 325% |
| Dean Wi Badgercare | $1,157 | 325% |
| Delaware First Health | $1,157 | 325% |
| Delta Dental Nj | $1,157 | 325% |
| Dph Tb Program | $1,157 | 325% |
| Dscc | $1,157 | 325% |
| Eastpointe Lme | $1,157 | 325% |
| Family Health Network | $1,157 | 325% |
| Freedom First Healthcare | $1,157 | 325% |
| Ghc Scw Wi Badgercare | $1,157 | 325% |
| Harbor Health | $1,157 | 325% |
| Health Safety Net | $1,157 | 325% |
| Healthy Blue Ne | $1,157 | 325% |
| Hennepin Health | $1,157 | 325% |
| Humana | $1,157 - $3,395 | 325% |
| Id County Ada | $1,157 | 325% |
| Id County Canyon | $1,157 | 325% |
| Id County Cat Fund | $1,157 | 325% |
| Id County Payette | $1,157 | 325% |
| Idaho Womens Health Check | $1,157 | 325% |
| Indiana Breast Cervical Cancer | $1,157 | 325% |
| Inland Empire Health Plan | $1,157 | 325% |
| Intercommunity Health Ohp | $1,157 | 325% |
| Iowa Total Care | $1,157 | 325% |
| Jai Medical System | $1,157 | 325% |
| Kern Family Health Plan | $1,157 | 325% |
| Keystone First | $1,157 | 325% |
| Keystone First Chip | $1,157 | 325% |
| La Care Health Plan | $1,157 | 325% |
| Lakeland Care Inc | $1,157 | 325% |
| Managed Health Services - Indiana | $1,157 | 325% |
| Maryland Breast & Cervical Program | $1,157 | 325% |
| Maryland Healthy Smiles - Scion Dental | $1,157 | 325% |
| Maryland Physicians Care | $1,157 | 325% |
| Massachusetts Behavioral Health Partnership | $1,157 | 325% |
| Mdwise | $1,157 | 325% |
| Medi-Cal | $1,157 | 325% |
| Medi-Cal Healthnet | $1,157 | 325% |
| Medstar Dc Healthy Family | $1,157 | 325% |
| Medstar Md Health Choice | $1,157 | 325% |
| Mo Home State Health Plan | $1,157 | 325% |
| Molina Centennial Care | $1,157 | 325% |
| Nascentia Health Options | $1,157 | 325% |
| Nebraska Total Care | $1,157 | 325% |
| New York Cancer Services Program | $1,157 | 325% |
| Nextlevel Health | $1,157 | 325% |
| Oregon Screenwise | $1,157 | 325% |
| Pace Of Southwest Michigan | $1,157 | 325% |
| Paramount Advantage | $1,157 | 325% |
| Parkland Community Health Plan | $1,157 | 325% |
| Partners Behavioral Lme | $1,157 | 325% |
| Peach State Healthplan | $1,157 | 325% |
| Presbyterian Centennial Care | $1,157 | 325% |
| Prestige Health Choice | $1,157 | 325% |
| Priority Partners | $1,157 | 325% |
| Rx 340B Pass Along | $1,157 | 325% |
| Rx Assistance/Rx Manufacturer Assistance 0 Copay | $1,157 | 325% |
| Rx Medi-Cal | $1,157 | 325% |
| Rx Meridian Rx | $1,157 | 325% |
| Sandhills Center Lme | $1,157 | 325% |
| Screening For Life | $1,157 | 325% |
| Sunshine State Health Plan | $1,157 | 325% |
| Superior Health | $1,157 | 325% |
| Tenncare | $1,157 | 325% |
| Texas Children'S Health Plan | $1,157 | 325% |
| Trillium Community Ohp | $1,157 | 325% |
| Tufts Health Public Plans | $1,157 | 325% |
| Vaya Health Lme | $1,157 | 325% |
| Wellsense Health Plan | $1,157 | 325% |
| Wi Womens Wellness | $1,157 | 325% |
| Mountain Health Co-Op | $2,315 | 649% |
| Pacificsource Health Plans | $2,315 - $3,627 | 649% |
| Allegiance | $2,932 | 823% |
| Correctional Health Partners | $3,009 | 844% |
| Columbia Health Network | $3,086 | 866% |
| Healthnet | $3,241 | 909% |
| Allied National Global Care | $3,472 | 974% |
| Asrm - Reliance Standard Life Insurance | $3,472 | 974% |
| Christian Care Ministry | $3,472 | 974% |
| Dean Health | $3,472 | 974% |
| Fallon Health | $3,472 | 974% |
| Family Life Insurance Company | $3,472 | 974% |
| First Choice Health | $3,472 | 974% |
| Ghc Scw | $3,472 | 974% |
| International Benefit Administrators | $3,472 | 974% |
| Lifetime Benefit Solutions | $3,472 | 974% |
| Manhattan Life | $3,472 | 974% |
| Pai | $3,472 | 974% |
| Pan-American Life | $3,472 | 974% |
| Paramount Hmo | $3,472 | 974% |
| Phcs | $3,472 | 974% |
| Trinity Health Share | $3,472 | 974% |
| Lifewise | $3,588 | 1007% |
| Priority Health | $3,627 | 1018% |
| Allied Benefit Systems | $3,654 | 1025% |
| Ameriben | $3,654 | 1025% |
| Asr Health Benefits | $3,654 | 1025% |
| Christian Brother Services | $3,654 | 1025% |
| Geha | $3,654 - $3,704 | 1025% |
| Healthez | $3,654 | 1025% |
| Luminare Health (Detroit) | $3,654 | 1025% |
| Rural Carrier Health Benefit Plan | $3,654 | 1025% |
| First Health | $3,665 | 1028% |
| Medi Share | $3,665 | 1028% |
| Providence | $3,665 | 1028% |