CMS Price Transparency Data

MRI, brain (with and without contrast)

Facility: Clarion Hospital

Billing Code: 70553 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70553
Insurance Median: $771
Cash Discount Price: $1,680
vs. Medicare Baseline: 2.16x Medicare

The contracted insurance negotiated median rate for a MRI, brain (with and without contrast) at Clarion Hospital is $771. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,680. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 2.16x the Medicare baseline. Located in One Hospital Drive, Clarion, PA.

Cash / Self-Pay

$1,680

Average discount available for prompt cash payment at this facility.

Insurance Median

$771

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: $1,680 (471%)

Insurance Median: $771 (216%)

Cash: $1,680 (471% of Medicare)

Ins. Median: $771 (216% 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 216% of the Medicare baseline (a markup of 116%). 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
Upmc	$336 - $2,995	94%
Medicaid / KanCare	$339	95%
Highmark	$340 - $1,020	95%
Highmark Community Blue	$342	96%
Amerihealth	$344 - $373	97%
Cigna	$344 - $1,500	97%
Martin'S Point - Usfhp	$344 - $1,050	97%
Medicare (plans)	$344	97%
Tricare	$344	97%
UnitedHealthcare	$344	97%
Aetna	$354 - $2,670	99%
Geisinger	$361 - $406	101%
Devoted Health Plan	$364 - $1,200	102%
The Health Plan	$364 - $807	102%
Gateway	$368 - $1,110	103%
Pa Health & Wellness	$368	103%
Jefferson Health Plan	$373	105%
American Health Plan	$378	106%
Highmark - Ind.& Managed Care	$771 - $1,020	216%
Peak Health	$807 - $2,100	226%
Devon	$2,250	631%
Workers Comp	$2,476	695%

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 $1,680.
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 Clarion Hospital 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.