CMS Price Transparency Data

MRI, brain (with and without contrast)

Facility: PAM Specialty Hospital of Wilkes-Barre

Billing Code: 70553 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70553
Insurance Median: $2,971
Cash Discount Price: $3,961
vs. Medicare Baseline: 8.34x Medicare

The contracted insurance negotiated median rate for a MRI, brain (with and without contrast) at PAM Specialty Hospital of Wilkes-Barre is $2,971. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,961. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 8.34x the Medicare baseline. Located in 575 North River St, Wilkes-Barre, PA.

Cash / Self-Pay

$3,961

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,971

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: $3,961 (1111%)

Insurance Median: $2,971 (834%)

Cash: $3,961 (1111% of Medicare)

Ins. Median: $2,971 (834% 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 834% of the Medicare baseline (a markup of 734%). 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
America'S Choice	$2,773	778%
Intergroup	$2,971	834%
Provider Network Of Amercia	$2,971	834%
Quik Trip	$2,971	834%
Usa Managed Care Organization	$2,971	834%
Velocity Provider Ppo Network	$2,971	834%
Devon Health Services	$3,169	889%
Multiplan/Phcs	$3,169	889%
Prime Health Services	$3,367	945%
Medincrease	$3,565	1000%

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 $3,961.
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 PAM Specialty Hospital of Wilkes-Barre 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.