CMS Price Transparency Data

MRI, brain (with and without contrast)

Facility: Lehigh Valley Hospital - Pocono

Billing Code: 70553 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70553
Insurance Median: $436
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.22x Medicare

The contracted insurance negotiated median rate for a MRI, brain (with and without contrast) at Lehigh Valley Hospital - Pocono is $436. 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 $356.43, this hospital’s rate is 1.22x 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

$436

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%)

Insurance Median: $436 (122%)

Ins. Median: $436 (122% 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
Amerihealth Caritas	$373	105%
Geisinger	$373 - $883	105%
Highmark Blue Shield	$380 - $1,664	107%
Amerihealth	$384	108%
Cigna	$384 - $1,036	108%
UnitedHealthcare	$387 - $390	109%
Aetna	$391 - $2,066	110%
Jefferson Health Partners	$391 - $745	110%
Devoted Health	$395	111%
Humana	$395	111%
Upmc	$395 - $1,814	111%
Gateway	$399	112%
Emblem	$402 - $2,153	113%
Pa Health & Wellness (Allwell)	$410	115%
Highmark Wholecare/Gateway	$431	121%
Pa Health & Wellness	$458	128%
Ambetter / Centene	$1,130	317%
Valley Preferred	$2,172	609%

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: 70553.

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 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.