CMS Price Transparency Data

MRI, brain (with and without contrast)

Facility: St Clair Hospital

Billing Code: 70553 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70553
Insurance Median: $545
Cash Discount Price: $613
vs. Medicare Baseline: 1.53x Medicare

The contracted insurance negotiated median rate for a MRI, brain (with and without contrast) at St Clair Hospital is $545. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $613. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 1.53x the Medicare baseline. Located in 1000 Bower Hill Road, Pittsburgh, PA.

Cash / Self-Pay

$613

Average discount available for prompt cash payment at this facility.

Insurance Median

$545

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: $613 (172%)

Insurance Median: $545 (153%)

Cash: $613 (172% of Medicare)

Ins. Median: $545 (153% 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.

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
Highmark	$303 - $760	85%
Amerihealth	$340 - $390	95%
Humana	$340	95%
UnitedHealthcare	$340 - $1,115	95%
Upmc	$340 - $2,499	95%
Aetna	$350 - $911	98%
Geisinger	$350 - $390	98%
Cigna	$353 - $409	99%
Pa Health And Wellness	$353 - $390	99%
Health Partners	$357 - $390	100%
The Health Plan	$357 - $816	100%
Lantern	$731	205%

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 $613.
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 St Clair Hospital 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.