CMS Price Transparency Data

MRI, lower back (no contrast)

Facility: Davis County Hospital

Billing Code: 72148 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72148
Insurance Median: $1,450
Cash Discount Price: $2,632
vs. Medicare Baseline: 5.95x Medicare

The contracted insurance negotiated median rate for a MRI, lower back (no contrast) at Davis County Hospital is $1,450. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,632. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 5.95x the Medicare baseline. Located in 509 North Madison Street, Bloomfield, IA.

Cash / Self-Pay

$2,632

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,450

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: $2,632 (1080%)

Insurance Median: $1,450 (595%)

Cash: $2,632 (1080% of Medicare)

Ins. Median: $1,450 (595% 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 595% of the Medicare baseline (a markup of 495%). 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
Blue Cross Blue Shield	$295 - $325	121%
Aetna	$1,316	540%
Choicecare Mcr Adv	$1,421	583%
Home State Hlth Exch - All Other Plans	$1,421	583%
Home State Hlth Mcr	$1,421	583%
Mt Carmel Hp-All Plans	$1,421	583%
Tricare	$1,421	583%
Amerigroup Mcr Adv-All Other Plans	$1,450	595%
American Hp Mcr Adv-All Plans	$1,492	612%
Home State Hlth Mcaid	$1,579	648%
Iowa Total Care Mcaid-All Plans	$1,611	661%
Molina Mcaid-All Plans	$1,634	670%
Amerigroup Mcaid	$1,642	674%
Midlands Choice - All Plans	$1,842	756%
Preferred Hlth Choices - All Plans	$1,974	810%
Choicecare Comm - All Other Plans	$2,500	1026%

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 $2,632.
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 Davis County Hospital 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.