CMS Price Transparency Data

MRI, brain (with and without contrast)

Facility: UPMC St Margaret

Billing Code: 70553 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70553
Insurance Median: $2,750
Cash Discount Price: $5,810
vs. Medicare Baseline: 7.72x Medicare

The contracted insurance negotiated median rate for a MRI, brain (with and without contrast) at UPMC St Margaret is $2,750. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $5,810. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 7.72x the Medicare baseline. Located in 815 Freeport Road, Pittsburgh, PA.

Cash / Self-Pay

$5,810

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,750

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: $5,810 (1630%)

Insurance Median: $2,750 (772%)

Cash: $5,810 (1630% of Medicare)

Ins. Median: $2,750 (772% 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 772% of the Medicare baseline (a markup of 672%). 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	$294 - $1,061	82%
Aetna	$358 - $3,874	100%
Highmark Wholecare (Prev Gateway)	$368 - $4,842	103%
Pa Health & Wellness	$368 - $578	103%
UnitedHealthcare	$373	105%
Amerihealth Caritas	$529	148%
Blue Cross Blue Shield	$1,214 - $7,241	341%
Premier Comp Solutions	$2,429	681%
Upmc Work Partners	$2,611	733%
Cigna	$2,712 - $3,874	761%
Coventry/First Health	$6,779	1902%
Private Health Care Systems	$7,747	2173%
Selectcare	$7,747	2173%
Humana	$8,231	2309%

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 $5,810.
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 St Margaret 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.