CMS Price Transparency Data

MRI, brain (no contrast)

Facility: Lehigh Valley Hospital - Pocono

Billing Code: 70551 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70551
Insurance Median: $409
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.68x Medicare

The contracted insurance negotiated median rate for a MRI, brain (no contrast) at Lehigh Valley Hospital - Pocono is $409. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 1.68x the Medicare baseline. Located in 206 East Brown Street, East Stroudsburg, PA.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$409

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$243.77

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $243.77 (100%)

Insurance Median: $409 (168%)

Ins. Median: $409 (168% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $243.77 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 Blue Shield	$257 - $1,126	105%
Amerihealth	$260	107%
Cigna	$260 - $622	107%
UnitedHealthcare	$262 - $388	107%
Aetna	$265 - $1,398	109%
Geisinger	$265 - $598	109%
Jefferson Health Partners	$265 - $504	109%
Devoted Health	$267	110%
Humana	$267	110%
Upmc	$267 - $1,228	110%
Gateway	$270	111%
Emblem	$272 - $1,457	112%
Pa Health & Wellness (Allwell)	$277	114%
Amerihealth Caritas	$371	152%
Highmark Wholecare/Gateway	$429	176%
Pa Health & Wellness	$456	187%
Ambetter / Centene	$765	314%
Valley Preferred	$1,470	603%

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 $X.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 70551.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Lehigh Valley Hospital - Pocono is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 70551.
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.