CMS Price Transparency Data

MRI, brain (with and without contrast)

Facility: Hospital for Special Surgery

Billing Code: 70553 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70553
Insurance Median: $1,166
Cash Discount Price: $1,431
vs. Medicare Baseline: 3.27x Medicare

The contracted insurance negotiated median rate for a MRI, brain (with and without contrast) at Hospital for Special Surgery is $1,166. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,431. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 3.27x the Medicare baseline. Located in 535 East 70Th Street, New York, NY.

Cash / Self-Pay

$1,431

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,166

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: $1,431 (401%)

Insurance Median: $1,166 (327%)

Cash: $1,431 (401% of Medicare)

Ins. Median: $1,166 (327% 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 327% of the Medicare baseline (a markup of 227%). 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
UnitedHealthcare	$82 - $2,020	23%
Fidelis	$86 - $90	24%
Metro Plus	$114 - $119	32%
Emblem	$117 - $154	33%
Blue Cross Blue Shield	$164 - $2,191	46%
Nyship	$187	52%
Horizon	$198	56%
Cigna	$240 - $1,071	67%
Aetna	$284 - $964	80%
Affinity By Molina Health Plan [1005]	$964 - $2,115	270%
Apwu [1016]	$964 - $1,071	270%
Christian Brothers [1034]	$964	270%
Connecticare [1039]	$964 - $2,191	270%
Medicare (plans)	$964	270%
Meritain Health [1085]	$964	270%
Nalc [1090]	$964 - $1,071	270%
Nippon Life [1092]	$964	270%
Qualcare [1101]	$964 - $1,071	270%
Webtpa [1356]	$964	270%
Wellfleet [1361]	$964 - $1,071	270%
Fidelis Essential [1323]	$1,136	319%
Oxford [1096]	$1,166 - $1,505	327%
Emblem Health [1043]	$1,296 - $2,191	364%
Student Resources [1103]	$1,296 - $1,672	364%
Harvard Pilgrim [1057]	$1,566 - $2,020	439%
Geha [1053]	$1,672	469%

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 $1,431.
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 Hospital for Special Surgery 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.