CMS Price Transparency Data

MRI, brain (with and without contrast)

Facility: UPMC Carlisle

Billing Code: 70553 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70553
Insurance Median: $1,870
Cash Discount Price: $2,855
vs. Medicare Baseline: 5.25x Medicare

The contracted insurance negotiated median rate for a MRI, brain (with and without contrast) at UPMC Carlisle is $1,870. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,855. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 5.25x the Medicare baseline. Located in 361 Alexander Spring Road, Carlisle, PA.

Cash / Self-Pay

$2,855

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,870

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: $2,855 (801%)

Insurance Median: $1,870 (525%)

Cash: $2,855 (801% of Medicare)

Ins. Median: $1,870 (525% 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 525% of the Medicare baseline (a markup of 425%). 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	$338 - $2,603	95%
Humana	$342	96%
UnitedHealthcare	$352 - $3,502	99%
Aetna	$356 - $2,327	100%
Cigna	$359 - $2,007	101%
Geisinger	$359 - $3,437	101%
Pa Health & Wellness	$369 - $578	104%
Amerihealth Caritas	$431	121%
Highmark Wholecare (Prev Gateway)	$431	121%
Upmc Health Plan	$441 - $3,812	124%
Health Partners Plans (Jefferson Health Plan)	$462	130%
Keystone Autism Services	$547	153%
Premier Comp Solutions	$650	182%
Prime Net	$652 - $3,597	183%
Onecall	$700	196%
Keystone Health Plan	$952 - $2,603	267%
Upmc Work Partners	$2,491	699%
Wellspan Population Health	$3,093 - $3,806	868%
Multiplan	$4,044	1135%

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 $2,855.
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 UPMC Carlisle 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.