CMS Price Transparency Data
MRI, brain (with and without contrast)
Facility: St Charles Medical Center Prineville
Billing Code: 70553 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 70553
- Insurance Median: $1,750
- Cash Discount Price: $5,001
- vs. Medicare Baseline: 4.91x Medicare
The contracted insurance negotiated median rate for a MRI, brain (with and without contrast) at St Charles Medical Center Prineville is $1,750. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $5,001. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 4.91x the Medicare baseline. Located in 384 Se Combs Flat Road, Prineville, OR.
Cash / Self-Pay
$5,001
Average discount available for prompt cash payment at this facility.
Insurance Median
$1,750
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: $5,001 (1403%)
Insurance Median: $1,750 (491%)
Cash: $5,001 (1403% of Medicare)
Ins. Median: $1,750 (491% 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 491% of the Medicare baseline (a markup of 391%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
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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 | $260 - $2,188 | 73% |
| Pacificsource Community Solutions [525] | $345 - $382 | 97% |
| Auto Allstate Insurance [602] | $495 | 139% |
| Auto American Family Insurance [603] | $495 | 139% |
| Auto Country Insurance Claims [604] | $495 | 139% |
| Auto Dairyland Insurance [617] | $495 | 139% |
| Auto Farmers [605] | $495 | 139% |
| Auto Geico Claims Oregon [606] | $495 | 139% |
| Auto Hartford [612] | $495 | 139% |
| Auto Liberty Mutual Auto Ins [613] | $495 | 139% |
| Auto Mutual Of Enumclaw [610] | $495 | 139% |
| Auto Nationwide Allied Insuranc [601] | $495 | 139% |
| Auto Oregon Mutual [614] | $495 | 139% |
| Auto Progressive [608] | $495 | 139% |
| Auto Safeco Concentra [600] | $495 | 139% |
| Auto State Farm Claims [609] | $495 | 139% |
| Auto Sublimity Insurance [616] | $495 | 139% |
| Auto Travelers Insurance [615] | $495 | 139% |
| Auto Usaa [611] | $495 | 139% |
| Generic Auto [649] | $495 | 139% |
| Generic Workers Comp [699] | $495 | 139% |
| Otj Broadspire Services [670] | $495 | 139% |
| Otj Ccmsi [618] | $495 | 139% |
| Otj Chartis Claims [650] | $495 | 139% |
| Otj City County Ins Services [662] | $495 | 139% |
| Otj Corvel [676] | $495 | 139% |
| Otj Esis West Wc Claims [653] | $495 | 139% |
| Otj Gallagher Bassett [654] | $495 | 139% |
| Otj Hartford [655] | $495 | 139% |
| Otj Intermountain Claims Inc [666] | $495 | 139% |
| Otj Liberty Mutual Wausau Underwriters [671] | $495 | 139% |
| Otj Penser No American [663] | $495 | 139% |
| Otj Pinnacle Risk Mgmt [661] | $495 | 139% |
| Otj Saif [667] | $495 | 139% |
| Otj Sedgwick Cms [660] | $495 | 139% |
| Otj Sedgwick [668] | $495 | 139% |
| Otj Travelers Insurance [672] | $495 | 139% |
| Otj Tristar [673] | $495 | 139% |
| Otj Dept Of Labor Federal Emp [652] | $519 | 146% |
| Otj Us Department Of Labor [669] | $519 | 146% |
| Kaiser Permanente [334] | $768 - $5,413 | 215% |
| Moda [310] | $831 - $5,376 | 233% |
| Providence Health Plan [347] | $831 - $5,469 | 233% |
| Blue Cross Blue Shield | $1,121 - $1,925 | 315% |
| Bridgespan [342] | $1,121 | 315% |
| Asuris Northwest Health [202] | $1,319 | 370% |
| Healthcare Management Admin [201] | $1,319 | 370% |
| Regence Group Administrators [203] | $1,319 | 370% |
| Aetna | $1,750 - $5,438 | 491% |
| Ageright Advantage [142] | $1,750 | 491% |
| Champ Va [700] | $1,750 | 491% |
| Cigna | $1,750 - $3,938 | 491% |
| Covid19 Hrsa Uninsured Testing And Treatment Fund | $1,750 | 491% |
| Devoted Health Inc [145] | $1,750 | 491% |
| Health Market Care Assured [134] | $1,750 | 491% |
| Health Net Med Adv [135] | $1,750 | 491% |
| Humana | $1,750 | 491% |
| Indian Health [704] | $1,750 | 491% |
| Kaiser Permanente Med Adv [136] | $1,750 | 491% |
| Law Enforcement [701] | $1,750 - $3,100 | 491% |
| Medicare (plans) | $1,750 - $2,030 | 491% |
| Samaritan Health Plan Med Adv [141] | $1,750 | 491% |
| Unicare [133] | $1,750 | 491% |
| UnitedHealthcare | $1,750 - $5,776 | 491% |
| Veterans [706] | $1,750 | 491% |
| Wellcare [132] | $1,750 | 491% |
| Tricare | $1,907 | 535% |
| Advanced Health [534] | $2,188 | 614% |
| Allcare Health Plan [538] | $2,188 | 614% |
| Cascade Health Alliance [532] | $2,188 | 614% |
| Columbia Pacific Coordinated Care Llc [539] | $2,188 | 614% |
| Health Share Care Oregon [526] | $2,188 | 614% |
| Health Share Kaiser [543] | $2,188 | 614% |
| Health Share Ohsu Ohp [552] | $2,188 | 614% |
| Health Share Providence [548] | $2,188 | 614% |
| Health Share [537] | $2,188 | 614% |
| Intercommunity Health [530] | $2,188 | 614% |
| Jackson Care Connect [542] | $2,188 | 614% |
| Primary Health Of Jospehine County Llc [547] | $2,188 | 614% |
| Umpqua Health [533] | $2,188 | 614% |
| Willamette Valley Community Health [536] | $2,188 | 614% |
| Yamhill County Coordinated Care Org [550] | $2,188 | 614% |
| Pacificsource [345] | $2,500 - $3,419 | 701% |
| Us Benefits [326] | $3,938 | 1105% |
| Rocky Mountain Administrators [405] | $5,001 | 1403% |
| Rx Internal [4100003] | $5,107 | 1433% |
| First Choice Health [317] | $5,413 | 1519% |
| Samaritan [376] | $5,413 | 1519% |
| Meritain Health [300] | $5,438 | 1526% |
| Health Net [340] | $5,876 | 1649% |
| Administrative Concepts Inc [402] | $6,126 | 1719% |
| First Health [339] | $6,126 | 1719% |
| Manhattan Life Insurance Company [379] | $6,126 | 1719% |
| Philadelphia American Life Insurance Company [395] | $6,126 | 1719% |
| Planned Administrators Inc [375] | $6,126 | 1719% |