CMS Price Transparency Data

MRI, lower back (no contrast)

Facility: UPMC Horizon

Billing Code: 72148 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72148
Insurance Median: $3,087
Cash Discount Price: $4,861
vs. Medicare Baseline: 12.66x Medicare

The contracted insurance negotiated median rate for a MRI, lower back (no contrast) at UPMC Horizon is $3,087. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,861. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 12.66x the Medicare baseline. Located in 110 North Main Street, Greenville, PA.

Cash / Self-Pay

$4,861

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,087

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$243.77

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $243.77 (100%)

Cash / Self-Pay: $4,861 (1994%)

Insurance Median: $3,087 (1266%)

Cash: $4,861 (1994% of Medicare)

Ins. Median: $3,087 (1266% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $243.77 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 1266% of the Medicare baseline (a markup of 1166%). 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	$206 - $1,949	85%
Aetna	$237 - $4,861	97%
UnitedHealthcare	$242 - $3,241	99%
Amerihealth Caritas	$249 - $400	102%
Cigna	$249 - $3,241	102%
Highmark Wholecare (Prev Gateway)	$249 - $380	102%
Pa Health & Wellness	$249 - $437	102%
Geisinger	$356	146%
Health Partners Plans (Jefferson Health Plan)	$386	158%
Blue Cross Blue Shield	$432 - $3,695	177%
Upmc Work Partners	$1,247	512%
Intergroup	$5,266	2160%
Coventry/First Health	$5,347	2193%
Health Coalition Partners	$5,671	2326%
Private Health Care Systems	$6,482	2659%
Prime Net	$6,644	2726%
Humana	$6,887	2825%

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 $4,861.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 72148.

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 72148.
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.