CMS Price Transparency Data

MRI, brain (with and without contrast)

Facility: UPMC Presbyterian Shadyside

Billing Code: 70553 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70553
Insurance Median: $7,863
Cash Discount Price: $9,808
vs. Medicare Baseline: 22.06x Medicare

The contracted insurance negotiated median rate for a MRI, brain (with and without contrast) at UPMC Presbyterian Shadyside is $7,863. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $9,808. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 22.06x the Medicare baseline. Located in 200 Lothrop Street, Pittsburgh, PA.

Cash / Self-Pay

$9,808

Average discount available for prompt cash payment at this facility.

Insurance Median

$7,863

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: $9,808 (2752%)

Insurance Median: $7,863 (2206%)

Cash: $9,808 (2752% of Medicare)

Ins. Median: $7,863 (2206% 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 2206% of the Medicare baseline (a markup of 2106%). 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	$323 - $368	91%
Amerihealth Caritas	$368 - $536	103%
Cigna	$368	103%
Highmark Wholecare (Prev Gateway)	$368 - $8,174	103%
Pa Health & Wellness	$368 - $578	103%
Upmc Health Plan	$373 - $7,665	105%
Aetna	$375 - $4,087	105%
Health Partners Plans (Jefferson Health Plan)	$511	143%
Geisinger	$528	148%
Blue Cross Blue Shield	$1,214 - $8,060	341%
Premier Comp Solutions	$2,472	694%
Upmc Work Partners	$2,657	745%
Multiplan	$3,089 - $13,078	867%
Preferred Healthcare System	$10,626	2981%
Coventry/First Health	$11,443	3210%
Fidelis	$12,260	3440%
Intergroup	$12,260 - $13,895	3440%
Health Coalition Partners	$13,078	3669%
Private Health Care Systems	$13,078	3669%
Selectcare	$13,078	3669%
Health Payors Organization	$13,895	3898%
Humana	$13,895	3898%

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 $9,808.
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 Presbyterian Shadyside 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.