CMS Price Transparency Data

MRI, brain (with and without contrast)

Facility: CHI St Lukes Health Memorial San Augustine

Billing Code: 70553 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 70553
  • Insurance Median: $725
  • Cash Discount Price: $2,177
  • vs. Medicare Baseline: 2.03x Medicare
The contracted insurance negotiated median rate for a MRI, brain (with and without contrast) at CHI St Lukes Health Memorial San Augustine is $725. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,177. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 2.03x the Medicare baseline. Located in 511 Hospital St, San Augustine, TX.
Cash / Self-Pay
$2,177

Average discount available for prompt cash payment at this facility.

Insurance Median
$725

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: $2,177 (611%)
Insurance Median: $725 (203%)
Cash: $2,177 (611% of Medicare)
Ins. Median: $725 (203% 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 203% of the Medicare baseline (a markup of 103%). 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.

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 $339 - $3,629 95%
Humana $339 - $10,160 95%
Wellpoint $349 - $725 98%
Blue Cross Blue Shield $354 - $1,524 99%
United $354 - $14,515 99%
Cigna $356 - $1,654 100%
Scanhealth $361 101%
Md Save $424 119%
Superior $462 - $725 130%
Tchp $464 130%
Angelina County $926 260%
Brookshire Brothers $1,017 285%
PHCS $9,870 - $11,612 2769%
Multiplan $10,160 2850%
Galaxy $13,064 3665%
Entrust $15,096 4235%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 511 Hospital St, San Augustine, TX 75972
  • CMS Rating: No CMS Rating
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Rural Emergency Hospital