CMS Price Transparency Data

MRI, lower back (no contrast)

Facility: Clay County Hospital

Billing Code: 72148 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72148
Insurance Median: $181
Cash Discount Price: $4,181
vs. Medicare Baseline: 0.74x Medicare

The contracted insurance negotiated median rate for a MRI, lower back (no contrast) at Clay County Hospital is $181. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,181. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 0.74x the Medicare baseline. Located in 911 Stacy Burk Dr, Flora, IL.

Cash / Self-Pay

$4,181

Average discount available for prompt cash payment at this facility.

Insurance Median

$181

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: $4,181 (1715%)

Insurance Median: $181 (74%)

Cash: $4,181 (1715% of Medicare)

Ins. Median: $181 (74% 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.

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
Aetna	$68 - $3,303	28%
Ambetter / Centene	$68 - $1,129	28%
Blue Cross Blue Shield	$68 - $3,069	28%
Medica(Wellfirst)	$68 - $2,592	28%
Meridian	$68 - $1,129	28%
Molina	$68 - $114	28%
UnitedHealthcare	$68 - $3,345	28%
Wellcare	$68 - $1,129	28%
Healthlink	$231 - $3,345	95%
Cigna	$285 - $3,345	117%
Usa Mco	$338 - $3,972	139%

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 $4,181.
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 Clay 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.