CMS Price Transparency Data

MRI, brain (with and without contrast)

Facility: Punxsutawney Area Hospital

Billing Code: 70553 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70553
Insurance Median: $311
Cash Discount Price: $727
vs. Medicare Baseline: 0.87x Medicare

The contracted insurance negotiated median rate for a MRI, brain (with and without contrast) at Punxsutawney Area Hospital is $311. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $727. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 0.87x the Medicare baseline. Located in 81 Hillcrest Drive, Punxsutawney, PA.

Cash / Self-Pay

$727

Average discount available for prompt cash payment at this facility.

Insurance Median

$311

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: $727 (204%)

Insurance Median: $311 (87%)

Cash: $727 (204% of Medicare)

Ins. Median: $311 (87% 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.

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
Highmark Wholecare	$62 - $339	17%
UnitedHealthcare	$71 - $1,413	20%
Tricare	$92 - $331	26%
Aetna	$101 - $1,041	28%
Amerihealth Caritas	$101 - $358	28%
Highmark	$101 - $7,623	28%
Geisinger Health Plan	$103 - $365	29%
United Mine Workers Of America	$103 - $364	29%
Upmc Health Plan	$103 - $3,363	29%
Cigna	$105 - $2,098	29%
Ambetter / Centene	$108 - $383	30%
Pa Health And Wellness Commercial	$129 - $728	36%
Geisinger	$144 - $1,019	40%
Humana	$358	100%
Pa Workers Compensation	$446 - $3,532	125%

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 $727.
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 Punxsutawney Area 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.