CMS Price Transparency Data

MRI, lower back (no contrast)

Facility: San Dimas Community Hospital

Billing Code: 72148 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 72148
  • Insurance Median: $305
  • Cash Discount Price: $305
  • vs. Medicare Baseline: 1.25x Medicare
The contracted insurance negotiated median rate for a MRI, lower back (no contrast) at San Dimas Community Hospital is $305. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $305. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 1.25x the Medicare baseline. Located in 1350 W Covina Blvd, San Dimas, CA.
Cash / Self-Pay
$305

Average discount available for prompt cash payment at this facility.

Insurance Median
$305

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: $305 (125%)
Insurance Median: $305 (125%)
Cash: $305 (125% of Medicare)
Ins. Median: $305 (125% 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.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash 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
Aids Healthcare Foundation $181 - $311 74%
Blue Shield Of Promise $181 74%
Heritage Provider Network Inc $181 - $397 74%
La Care Health Plan $181 - $305 74%
Molina Healthcare $181 - $305 74%
Traditional Medi-Cal $181 74%
Blue Cross Blue Shield $190 - $2,240 78%
Health Net Of Ca $194 - $446 80%
Rios $290 119%
Blue Shield Of Ca $305 - $564 125%
Central Health Plan $305 125%
Choice Physicians Network $305 125%
Citrus Valley Physicians Group $305 125%
Elite Health Plan $305 125%
Health Excel Inc $305 125%
Medicare (plans) $305 125%
Patient Choice Health Plan $305 125%
Primecare Medical Network $305 - $397 125%
Renal Payer Solutions $305 125%
Tricare $305 125%
UnitedHealthcare $305 - $541 125%
Brand New Day $308 - $458 126%
Imperial Health Plan Inc $324 133%
Aetna $390 160%
Ca Foundation For Medical Care $402 165%
Worker Comp $402 165%
Employer Direct Healthcare $428 176%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 1350 W Covina Blvd, San Dimas, CA 91773
  • CMS Rating: ★★☆☆☆
  • Ownership Type: Proprietary
  • Hospital Type: Acute Care Hospitals