CMS Price Transparency Data

MRI, brain (with and without contrast)

Facility: UPMC Children's Hospital of Pittsburgh

Billing Code: 70553 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70553
Insurance Median: $3,747
Cash Discount Price: $4,699
vs. Medicare Baseline: 10.51x Medicare

The contracted insurance negotiated median rate for a MRI, brain (with and without contrast) at UPMC Children's Hospital of Pittsburgh is $3,747. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,699. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 10.51x the Medicare baseline. Located in One Children's Hospital Drive, Pittsburgh, PA.

Cash / Self-Pay

$4,699

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,747

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: $4,699 (1318%)

Insurance Median: $3,747 (1051%)

Cash: $4,699 (1318% of Medicare)

Ins. Median: $3,747 (1051% 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 1051% of the Medicare baseline (a markup of 951%). 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
Health Plan Of Upper Ohio Valley	$340 - $5,091	95%
Blue Cross Blue Shield	$361 - $5,149	101%
Aetna	$363 - $4,308	102%
Amerihealth Caritas	$368 - $1,270	103%
Cigna	$368 - $4,308	103%
Upmc Health Plan	$782 - $4,730	219%
UnitedHealthcare	$1,068 - $3,681	300%
Health Partners Plans (Jefferson Health Plan)	$1,312	368%
Highmark Wholecare (Prev Gateway)	$1,368	384%
Pa Health & Wellness	$1,374	385%
Geisinger	$1,394 - $3,520	391%
Intergroup	$5,091 - $6,657	1428%
Coventry/First Health	$6,266	1758%
Saudi Armed Forces	$6,266	1758%
Health Payors Organization	$6,657	1868%
Multiplan	$6,657	1868%
National Provider Network	$7,049	1978%
Private Health Care Systems	$7,049	1978%

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 $4,699.
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 Children's Hospital of Pittsburgh 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.