CMS Price Transparency Data

MRI, brain (with and without contrast)

Facility: UPMC Hamot

Billing Code: 70553 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70553
Insurance Median: $2,611
Cash Discount Price: $7,916
vs. Medicare Baseline: 7.33x Medicare

The contracted insurance negotiated median rate for a MRI, brain (with and without contrast) at UPMC Hamot is $2,611. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $7,916. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 7.33x the Medicare baseline. Located in 201 State Street, Erie, PA.

Cash / Self-Pay

$7,916

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,611

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: $7,916 (2221%)

Insurance Median: $2,611 (733%)

Cash: $7,916 (2221% of Medicare)

Ins. Median: $2,611 (733% 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 733% of the Medicare baseline (a markup of 633%). 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
Blue Cross Blue Shield	$282 - $5,814	79%
Upmc Health Plan	$373 - $1,904	105%
UnitedHealthcare	$390 - $1,478	109%
Fidelis	$393	110%
Aetna	$401 - $9,236	113%
Wellcare	$405	114%
Amerihealth Caritas	$424 - $529	119%
Cigna	$424 - $5,278	119%
Highmark Wholecare (Prev Gateway)	$424 - $6,597	119%
Pa Health & Wellness	$424 - $578	119%
Geisinger	$471	132%
Health Partners Plans (Jefferson Health Plan)	$511	143%
Independent Health	$567 - $755	159%
Univera	$1,979 - $5,805	555%
Upmc Work Partners	$2,611	733%
Intergroup	$8,576 - $10,555	2406%
Multiplan	$9,236 - $10,555	2591%

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 $7,916.
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 Hamot 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.