CMS Price Transparency Data

MRI, brain (with and without contrast)

Facility: UPMC Mercy

Billing Code: 70553 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70553
Insurance Median: $3,968
Cash Discount Price: $6,512
vs. Medicare Baseline: 11.13x Medicare

The contracted insurance negotiated median rate for a MRI, brain (with and without contrast) at UPMC Mercy is $3,968. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $6,512. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 11.13x the Medicare baseline. Located in 1400 Locust Street, Pittsburgh, PA.

Cash / Self-Pay

$6,512

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,968

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: $6,512 (1827%)

Insurance Median: $3,968 (1113%)

Cash: $6,512 (1827% of Medicare)

Ins. Median: $3,968 (1113% 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 1113% of the Medicare baseline (a markup of 1013%). 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	$284 - $3,812	80%
Aetna	$358 - $4,342	100%
Amerihealth Caritas	$368 - $536	103%
Highmark Wholecare (Prev Gateway)	$368 - $5,427	103%
Pa Health & Wellness	$368 - $578	103%
UnitedHealthcare	$390	109%
Blue Cross Blue Shield	$1,203 - $6,842	338%
Premier Comp Solutions	$2,472	694%
Upmc Work Partners	$2,657	745%
Bravo	$2,714	761%
Cigna	$3,690 - $6,512	1035%
Coventry/First Health	$4,776	1340%
Intergroup	$5,427 - $8,683	1523%
Private Health Care Systems	$8,140	2284%
American Healthcare Group	$8,683	2436%
National Provider Network	$8,900	2497%
Health Payors Organization	$9,769	2741%
Multiplan	$9,769	2741%

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 $6,512.
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 Mercy 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.