CMS Price Transparency Data

MRI, brain (no contrast)

Facility: St Luke's Hospital - Carbon Campus

Billing Code: 70551 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70551
Insurance Median: $581
Cash Discount Price: $5,749
vs. Medicare Baseline: 2.38x Medicare

The contracted insurance negotiated median rate for a MRI, brain (no contrast) at St Luke's Hospital - Carbon Campus is $581. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $5,749. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 2.38x the Medicare baseline. Located in 500 St Luke's Drive, Lehighton, PA.

Cash / Self-Pay

$5,749

Average discount available for prompt cash payment at this facility.

Insurance Median

$581

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%)

Cash / Self-Pay: $5,749 (2358%)

Insurance Median: $581 (238%)

Cash: $5,749 (2358% of Medicare)

Ins. Median: $581 (238% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 238% of the Medicare baseline (a markup of 138%). 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
Blue Cross Blue Shield	$241 - $2,430	99%
Highmark	$241 - $676	99%
Aetna	$245 - $2,417	101%
Geisinger	$245 - $1,948	101%
Humana	$250	103%
Upmc Health Plan	$253 - $1,898	104%
UnitedHealthcare	$260 - $2,002	107%
Highmark Wholecare	$388	159%
Amerihealth Caritas	$405	166%
Jefferson Health Plan	$486	199%
Oscar	$1,797	737%
Cigna	$1,896	778%

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 $5,749.
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 St Luke's Hospital - Carbon Campus 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.