CMS Price Transparency Data

MRI, brain (with and without contrast)

Facility: UPMC Altoona

Billing Code: 70553 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70553
Insurance Median: $2,170
Cash Discount Price: $2,604
vs. Medicare Baseline: 6.09x Medicare

The contracted insurance negotiated median rate for a MRI, brain (with and without contrast) at UPMC Altoona is $2,170. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,604. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 6.09x the Medicare baseline. Located in 620 Howard Avenue, Altoona, PA.

Cash / Self-Pay

$2,604

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,170

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: $2,604 (731%)

Insurance Median: $2,170 (609%)

Cash: $2,604 (731% of Medicare)

Ins. Median: $2,170 (609% 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 609% of the Medicare baseline (a markup of 509%). 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
Aetna	$269 - $2,300	75%
UnitedHealthcare	$282 - $2,225	79%
Upmc Health Plan	$296 - $4,154	83%
Geisinger	$374 - $2,387	105%
Highmark Wholecare (Prev Gateway)	$399 - $2,170	112%
Health Partners Plans (Jefferson Health Plan)	$406	114%
Amerihealth Caritas	$420	118%
Upmc Work Partners	$425	119%
Pa Health & Wellness	$458	128%
Blue Cross Blue Shield	$1,203	338%
Cigna	$2,170	609%
Preferred Healthcare System	$2,170	609%
Private Health Care Systems	$3,472	974%

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 $2,604.
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 Altoona 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.