CMS Price Transparency Data

MRI, brain (with and without contrast)

Facility: UPMC Horizon

Billing Code: 70553 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70553
Insurance Median: $2,341
Cash Discount Price: $3,602
vs. Medicare Baseline: 6.57x Medicare

The contracted insurance negotiated median rate for a MRI, brain (with and without contrast) at UPMC Horizon is $2,341. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,602. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 6.57x the Medicare baseline. Located in 110 North Main Street, Greenville, PA.

Cash / Self-Pay

$3,602

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,341

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: $3,602 (1011%)

Insurance Median: $2,341 (657%)

Cash: $3,602 (1011% of Medicare)

Ins. Median: $2,341 (657% 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 657% of the Medicare baseline (a markup of 557%). 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 Health Plan	$305 - $3,812	86%
Aetna	$351 - $3,602	98%
UnitedHealthcare	$358 - $2,401	100%
Amerihealth Caritas	$368 - $529	103%
Cigna	$368 - $2,401	103%
Highmark Wholecare (Prev Gateway)	$368 - $503	103%
Pa Health & Wellness	$368 - $578	103%
Geisinger	$471	132%
Health Partners Plans (Jefferson Health Plan)	$511	143%
Blue Cross Blue Shield	$608 - $2,883	171%
Upmc Work Partners	$2,417	678%
Intergroup	$3,902	1095%
Coventry/First Health	$3,962	1112%
Health Coalition Partners	$4,202	1179%
Private Health Care Systems	$4,802	1347%
Prime Net	$4,922	1381%
Humana	$5,103	1432%

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 $3,602.
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 Horizon 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.