CMS Price Transparency Data

MRI, brain (with and without contrast)

Facility: Lexington Memorial Hospital Inc

Billing Code: 70553 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70553
Insurance Median: $2,180
Cash Discount Price: $2,453
vs. Medicare Baseline: 6.12x Medicare

The contracted insurance negotiated median rate for a MRI, brain (with and without contrast) at Lexington Memorial Hospital Inc is $2,180. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,453. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 6.12x the Medicare baseline. Located in 250 Hospital Drive Po Box 1817, Lexington, NC.

Cash / Self-Pay

$2,453

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,180

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: $2,453 (688%)

Insurance Median: $2,180 (612%)

Cash: $2,453 (688% of Medicare)

Ins. Median: $2,180 (612% 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 612% of the Medicare baseline (a markup of 512%). 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
Amerihealth	$924 - $1,348	259%
Carolina Complete	$924	259%
Healthy Blue	$924	259%
Partners	$924	259%
UnitedHealthcare	$933 - $2,197	262%
Vaya	$933	262%
Wellcare	$933	262%
Alliance	$943	265%
Trillium	$952	267%
Medcost	$1,074 - $3,281	301%
Blue Cross Blue Shield	$1,364 - $2,187	383%
Aetna	$1,393 - $4,532	391%
Ambetter / Centene	$1,408	395%
Oscar	$1,570 - $2,158	440%
Cigna	$2,134 - $2,173	599%
Directnet	$2,899	813%
Healthgram Lexington Home Brands	$3,532	991%
Healthgram	$3,924	1101%
Private Healthcare Systems	$4,022	1128%
Beechstreet	$4,316	1211%
Humana	$4,316	1211%
Multiplan	$4,414	1238%
National Provider Network	$4,414	1238%

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 $2,453.
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 Lexington Memorial Hospital Inc 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.