CMS Price Transparency Data

MRI, brain (with and without contrast)

Facility: Lehigh Valley Hospital - Macungie

Billing Code: 70553 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70553
Insurance Median: $492
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.38x Medicare

The contracted insurance negotiated median rate for a MRI, brain (with and without contrast) at Lehigh Valley Hospital - Macungie is $492. 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 1.38x the Medicare baseline. Located in 3369 State Route 100, Macungie, PA.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$492

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: $492 (138%)

Ins. Median: $492 (138% 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
Blue Cross Blue Shield	$364 - $2,810	102%
Highmark Blue Shield	$367 - $978	103%
Humana	$367	103%
Amerihealth	$375	105%
Cigna	$375 - $1,036	105%
Geisinger	$375 - $1,598	105%
Aetna	$382 - $1,815	107%
Jefferson Health Partners	$382 - $727	107%
Upmc	$385 - $1,771	108%
Gateway	$389	109%
Emblem	$393 - $1,622	110%
Pa Health & Wellness (Allwell)	$400	112%
Highmark Wholecare/Gateway	$431	121%
Pa Health & Wellness	$458	128%
Amerihealth Caritas	$492	138%
Ambetter / Centene	$1,103	309%
Valley Preferred	$2,120	595%

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 - Macungie 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.