CMS Price Transparency Data

MRI, brain (no contrast)

Facility: Sanford Clear Lake Medical Center

Billing Code: 70551 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70551
Insurance Median: $3,172
Cash Discount Price: $3,094
vs. Medicare Baseline: 13.01x Medicare

The contracted insurance negotiated median rate for a MRI, brain (no contrast) at Sanford Clear Lake Medical Center is $3,172. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,094. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 13.01x the Medicare baseline. Located in 701 Third Avenue South, Clear Lake, SD.

Cash / Self-Pay

$3,094

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,172

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: $3,094 (1269%)

Insurance Median: $3,172 (1301%)

Cash: $3,094 (1269% of Medicare)

Ins. Median: $3,172 (1301% 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 1301% of the Medicare baseline (a markup of 1201%). 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
Blue Cross Blue Shield	$1,156	474%
Sanford Health Plan Align	$1,984	814%
Security Health Plan	$2,127	873%
Ucare	$2,131 - $3,398	874%
Wellmark Sd	$2,131	874%
Aetna	$2,150 - $3,360	882%
Health Partners	$2,150 - $2,900	882%
Medicare (plans)	$2,150	882%
UnitedHealthcare	$2,150 - $3,229	882%
Primewest	$2,193	900%
Sanford Health Plan	$2,681 - $3,596	1100%
Medica	$3,190 - $3,411	1309%
Wellmark	$3,326 - $3,364	1364%
Cigna	$3,480	1428%
First Choice Health Network	$3,480	1428%
Healthez	$3,480	1428%
Multiplan	$3,480	1428%

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 $3,094.
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 Sanford Clear Lake Medical Center 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.