CMS Price Transparency Data

MRI, lower back (no contrast)

Facility: Pinckneyville Community Hospital

Billing Code: 72148 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72148
Insurance Median: $1,317
Cash Discount Price: $2,235
vs. Medicare Baseline: 5.40x Medicare

The contracted insurance negotiated median rate for a MRI, lower back (no contrast) at Pinckneyville Community Hospital is $1,317. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,235. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 5.40x the Medicare baseline. Located in 5383 State Route 154, Pinckneyville, IL.

Cash / Self-Pay

$2,235

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,317

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: $2,235 (917%)

Insurance Median: $1,317 (540%)

Cash: $2,235 (917% of Medicare)

Ins. Median: $1,317 (540% 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 540% of the Medicare baseline (a markup of 440%). 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
Umwa Mcr Adv - All Plans	$68 - $1,487	28%
UnitedHealthcare	$68 - $3,296	28%
Wellcare Mcr Adv - All Plans	$68 - $1,487	28%
Aetna	$70 - $3,618	29%
Humana	$70 - $1,487	29%
Ambetter / Centene	$71 - $1,317	29%
Blue Cross Blue Shield	$71 - $2,894	29%
Medicaid / KanCare	$71 - $1,317	29%
Cigna	$82 - $3,316	34%
Healthlink Hmo	$279 - $3,156	114%
Healthlink Ppo - All Other Plans	$279 - $3,316	114%
Phcs Savility	$382 - $3,417	157%
Multiplan - All Plans	$405 - $3,618	166%
Phcs - All Other Plans	$405 - $3,296	166%
Healthlink Work Comp	$3,316	1360%

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 $2,235.
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 Pinckneyville Community 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.