CMS Price Transparency Data

MRI, brain (with and without contrast)

Facility: St Luke's Hospital - Carbon Campus

Billing Code: 70553 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70553
Insurance Median: $743
Cash Discount Price: $12,760
vs. Medicare Baseline: 2.08x Medicare

The contracted insurance negotiated median rate for a MRI, brain (with and without contrast) at St Luke's Hospital - Carbon Campus is $743. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $12,760. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 2.08x the Medicare baseline. Located in 500 St Luke's Drive, Lehighton, PA.

Cash / Self-Pay

$12,760

Average discount available for prompt cash payment at this facility.

Insurance Median

$743

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: $12,760 (3580%)

Insurance Median: $743 (208%)

Cash: $12,760 (3580% of Medicare)

Ins. Median: $743 (208% 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 208% of the Medicare baseline (a markup of 108%). 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	$355 - $3,769	100%
Highmark	$355 - $998	100%
Aetna	$363 - $5,366	102%
Geisinger	$363 - $4,323	102%
Humana	$370	104%
Upmc Health Plan	$373 - $4,214	105%
UnitedHealthcare	$384 - $4,443	108%
Highmark Wholecare	$390	109%
Amerihealth Caritas	$407	114%
Jefferson Health Plan	$488	137%
Oscar	$3,990	1119%
Cigna	$4,208	1181%

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 $12,760.
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 St Luke's Hospital - Carbon Campus 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.