CMS Price Transparency Data

MRI, brain (with and without contrast)

Facility: UPMC Kane

Billing Code: 70553 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70553
Insurance Median: $917
Cash Discount Price: $1,605
vs. Medicare Baseline: 2.57x Medicare

The contracted insurance negotiated median rate for a MRI, brain (with and without contrast) at UPMC Kane is $917. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,605. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 2.57x the Medicare baseline. Located in 4372 Route 6, Kane, PA.

Cash / Self-Pay

$1,605

Average discount available for prompt cash payment at this facility.

Insurance Median

$917

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: $1,605 (450%)

Insurance Median: $917 (257%)

Cash: $1,605 (450% of Medicare)

Ins. Median: $917 (257% 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 257% of the Medicare baseline (a markup of 157%). 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	$149 - $2,807	42%
Blue Cross Blue Shield	$157 - $1,822	44%
Highmark Wholecare (Prev Gateway)	$162 - $1,874	45%
Aetna	$164 - $1,895	46%
UnitedHealthcare	$165 - $2,004	46%
Amerihealth Caritas	$170 - $1,968	48%
Cigna	$298 - $110,849	84%
Horizon Health Plan	$298 - $3,447	84%
Multiplan	$319 - $3,693	89%
Intergroup	$340 - $3,939	95%
Health Coalition Partners	$340 - $3,939	95%
Focus Healthcare	$404 - $4,678	113%
Geisinger	$471	132%
PA Health & Wellness	$578	162%
UPMC Work Partners	$2,380	668%

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 $1,605.
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 Kane 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.