CMS Price Transparency Data

MRI, brain (with and without contrast)

Facility: Gundersen Moundview Hospital and Clinics

Billing Code: 70553 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70553
Insurance Median: $2,512
Cash Discount Price: $2,148
vs. Medicare Baseline: 7.05x Medicare

The contracted insurance negotiated median rate for a MRI, brain (with and without contrast) at Gundersen Moundview Hospital and Clinics is $2,512. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,148. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 7.05x the Medicare baseline. Located in 402 W Lake St, Friendship, WI.

Cash / Self-Pay

$2,148

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,512

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: $2,148 (603%)

Insurance Median: $2,512 (705%)

Cash: $2,148 (603% of Medicare)

Ins. Median: $2,512 (705% 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 705% of the Medicare baseline (a markup of 605%). 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
Amerigroup	$174	49%
Blue Cross Blue Shield	$1,244 - $5,593	349%
Iowa Total Care	$1,244	349%
Managed Health Service	$1,244	349%
UnitedHealthcare	$1,591	446%
Dean Health Plan	$1,872	525%
Health Partners	$1,926 - $3,697	540%
Security Health Plan	$1,926	540%
Ucare	$1,926 - $3,350	540%
Quartz	$2,282	640%
Wps	$3,228	906%
Wps - Arise	$3,228	906%
Alliance	$3,350 - $3,978	940%
Aspirus Arise Health	$3,475	975%
Humana	$3,559	999%
Multiplan/Healtheos	$3,685 - $4,020	1034%
Coventry Health Care	$3,978	1116%

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 $2,148.
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 Gundersen Moundview Hospital and Clinics 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.