CMS Price Transparency Data

MRI, lower back (no contrast)

Facility: Valley West Community Hospital

Billing Code: 72148 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72148
Insurance Median: $3,513
Cash Discount Price: $3,837
vs. Medicare Baseline: 14.41x Medicare

The contracted insurance negotiated median rate for a MRI, lower back (no contrast) at Valley West Community Hospital is $3,513. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,837. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 14.41x the Medicare baseline. Located in 11 East Pleasant Avenue, Sandwich, IL.

Cash / Self-Pay

$3,837

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,513

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: $3,837 (1574%)

Insurance Median: $3,513 (1441%)

Cash: $3,837 (1574% of Medicare)

Ins. Median: $3,513 (1441% 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 1441% of the Medicare baseline (a markup of 1341%). 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	$1,042 - $4,479	427%
Global Excel [1712]	$1,042	427%
Humana	$1,042	427%
Aetna	$1,392 - $3,799	571%
Health'S Finest Network [126]	$2,467 - $4,660	1012%
The Alliance [1703]	$2,979	1222%
Choicecare [177]	$3,695	1516%
Healthlink [125]	$4,112	1687%
Multiplan/Phcs [142]	$4,386 - $5,482	1799%
First Health Plan [6034]	$5,482	2249%
UnitedHealthcare	$5,482	2249%

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 $3,837.
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 Valley West 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.