CMS Price Transparency Data

MRI, brain (with and without contrast)

Facility: Children's Hospital of Philadelphia

Billing Code: 70553 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70553
Insurance Median: $4,008
Cash Discount Price: $12,733
vs. Medicare Baseline: 11.24x Medicare

The contracted insurance negotiated median rate for a MRI, brain (with and without contrast) at Children's Hospital of Philadelphia is $4,008. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $12,733. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 11.24x the Medicare baseline. Located in 3401 Civic Center Blvd, Philadelphia, PA.

Cash / Self-Pay

$12,733

Average discount available for prompt cash payment at this facility.

Insurance Median

$4,008

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: $12,733 (3572%)

Insurance Median: $4,008 (1124%)

Cash: $12,733 (3572% of Medicare)

Ins. Median: $4,008 (1124% 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 1124% of the Medicare baseline (a markup of 1024%). 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
Geisinger Medical Assistance	$363	102%
Highmark Wholecare	$404	113%
UnitedHealthcare	$1,734 - $2,114	486%
Horizon Nj Health	$1,964	551%
Medicaid / KanCare	$2,101	589%
Health Partners	$2,400	673%
Aetna	$2,887 - $3,351	810%
Upmc Medical Assistance	$3,476	975%
Keystone First Chip	$3,947	1107%
Geisinger Health Plan Commercial	$3,989	1119%
Keystone Health Plan East	$4,026	1130%
Blue Cross Blue Shield	$4,495 - $5,101	1261%
Jefferson Health Plans	$6,023	1690%
Cigna	$6,367	1786%
Highmark	$6,367	1786%
Qualcare	$7,003	1965%
First Health Network	$8,277	2322%
Devon Health, Intergroup, Multiplan, Valley Preferred/Populytics	$10,187	2858%
Private Health Care Systems	$10,187	2858%
Choice Care Network	$11,460	3215%

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 $12,733.
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 Children's Hospital of Philadelphia 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.