CMS Price Transparency Data

MRI, brain (no contrast)

Facility: UPMC Kane

Billing Code: 70551 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70551
Insurance Median: $575
Cash Discount Price: $1,203
vs. Medicare Baseline: 2.36x Medicare

The contracted insurance negotiated median rate for a MRI, brain (no contrast) at UPMC Kane is $575. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,203. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 2.36x the Medicare baseline. Located in 4372 Route 6, Kane, PA.

Cash / Self-Pay

$1,203

Average discount available for prompt cash payment at this facility.

Insurance Median

$575

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: $1,203 (493%)

Insurance Median: $575 (236%)

Cash: $1,203 (493% of Medicare)

Ins. Median: $575 (236% 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 236% of the Medicare baseline (a markup of 136%). 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	$94 - $1,633	39%
Blue Cross Blue Shield	$99 - $1,384	41%
Highmark Wholecare (Prev Gateway)	$102 - $1,423	42%
Aetna	$103 - $1,440	42%
UnitedHealthcare	$104 - $1,523	43%
Amerihealth Caritas	$107 - $1,495	44%
Horizon Health Plan	$188 - $2,619	77%
Cigna	$188 - $84,217	77%
Multiplan	$201 - $2,806	82%
Intergroup	$214 - $2,993	88%
Health Coalition Partners	$214 - $2,993	88%
Focus Healthcare	$255 - $3,554	105%
Geisinger	$469	192%
PA Health & Wellness	$575	236%
UPMC Work Partners	$1,125	462%

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 $1,203.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 70551.

Insurance In-Network Protection Plan

Contact your insurance company to confirm UPMC Kane is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 70551.
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.