CMS Price Transparency Data

MRI, lower back (no contrast)

Facility: Iowa Specialty Hospital - Clarion

Billing Code: 72148 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72148
Insurance Median: $605
Cash Discount Price: $1,463
vs. Medicare Baseline: 2.48x Medicare

The contracted insurance negotiated median rate for a MRI, lower back (no contrast) at Iowa Specialty Hospital - Clarion is $605. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,463. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 2.48x the Medicare baseline. Located in 1316 South Main Street, Clarion, IA.

Cash / Self-Pay

$1,463

Average discount available for prompt cash payment at this facility.

Insurance Median

$605

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: $1,463 (600%)

Insurance Median: $605 (248%)

Cash: $1,463 (600% of Medicare)

Ins. Median: $605 (248% 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 248% of the Medicare baseline (a markup of 148%). 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
Tricare	$65 - $1,373	27%
Triwest Va - All Plans	$65 - $1,373	27%
Aetna	$73 - $3,766	30%
Healthscope Stellar-All Plans	$108 - $2,339	44%
Health Partners Ish-All Other Plans	$128 - $3,544	53%
Wellmark Hmo	$138 - $763	57%
Wellmark Ppo - All Other Plans	$154 - $839	63%
UnitedHealthcare	$188 - $4,208	77%
Auxiant Clarion Schools-All Plans	$291 - $2,880	119%
Health Partners Prestage	$335 - $3,322	137%
Cigna	$446 - $4,297	183%
Midlands Choice-All Plans	$446 - $4,297	183%

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 $1,463.
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 Iowa Specialty Hospital - Clarion 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.