CMS Price Transparency Data

MRI, lower back (no contrast)

Facility: Good Samaritan Medical Center LLC

Billing Code: 72148 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72148
Insurance Median: $1,365
Cash Discount Price: Unavailable
vs. Medicare Baseline: 5.60x Medicare

The contracted insurance negotiated median rate for a MRI, lower back (no contrast) at Good Samaritan Medical Center LLC is $1,365. 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 $243.77, this hospital’s rate is 5.60x the Medicare baseline. Located in 200 Exempla Cir, Lafayette, CO.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,365

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%)

Insurance Median: $1,365 (560%)

Ins. Median: $1,365 (560% 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 560% of the Medicare baseline (a markup of 460%). 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
Aarp	$240	98%
UnitedHealthcare	$240 - $1,851	98%
Kaiser Snp	$243	100%
Select Health	$243	100%
Aetna	$429 - $2,862	176%
Geha	$467 - $1,851	192%
Preferred One	$467 - $1,273	192%
Kaiser Perm Hmo	$590 - $1,344	242%
Denv Hlth Med Plan	$632	259%
Kaiser Self Funded	$734 - $1,344	301%
Kaiser Perm Ppo/Pos	$745 - $1,385	306%
Allegiance	$798	327%
Cigna	$798 - $3,191	327%
Blue Cross Blue Shield	$1,171 - $2,686	480%
Humana	$1,340	550%
Cofinity	$2,299	943%
First Health Network	$2,299	943%
Private Hlthcare Sys	$2,393	982%
Multiplan Inc	$2,712	1113%

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: 72148.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Good Samaritan Medical Center LLC is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 72148.
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.