MRI, lower back (no contrast)
Facility: Holton Community Hospital
Billing Code: 72148 (CPT)
- CPT Billing Code: 72148
- Insurance Median: $1,717
- Cash Discount Price: $1,552
- vs. Medicare Baseline: 7.04x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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 704% of the Medicare baseline (a markup of 604%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
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 | $521 | 214% |
| Aetna | $1,097 - $2,069 | 450% |
| UnitedHealthcare | $1,097 - $2,069 | 450% |
| Humana | $1,108 | 455% |
| Kansas Superior Select - All Plans | $1,118 | 459% |
| Preferred Health Fn Select - All Other Plans | $1,717 | 704% |
| Preferred Health Freedom | $1,717 | 704% |
| Preferred Health Professionals | $1,717 | 704% |
| Wppa Providers - All Plans | $1,966 | 806% |
| Medicaid / KanCare | $2,069 | 849% |
Consumer Guidance & Cost Commentary
For the MRI, lower back (no contrast) procedure at Holton Community Hospital, the facility's cash median price of $1,552 is lower than the gross charge of $2,069, offering a potential savings for patients with high-deductible plans. While the hospital's negotiated rates with major payers like Aetna and UnitedHealthcare range from $1,097 to $2,069, these amounts often exceed the cash price due to administrative costs and contract structures. It is important to note that Medicaid/KanCare pays the full gross amount of $2,069, whereas the facility's median negotiated rate across all plans is $1,717. Patients should verify their specific plan's allowed amount before scheduling, as assuming in-network status guarantees the lowest price can lead to unexpected costs if the insurer's rate is higher than the cash option.
To avoid balance billing or errors, consumers should request an itemized bill that lists specific CPT codes rather than accepting summary invoices that obscure individual charges. Since over 80% of hospital bills contain mistakes such as unbundled codes or services not rendered, asking for a line-by-line audit before paying is a critical step to reduce medical debt. Additionally, patients should inquire about prompt-pay discounts, which can reduce the total bill by 20% to 50% if paid upfront, bypassing the costly insurance claims cycle. While the facility is a Critical Access Hospital in Holton, KS, with no state or county average data provided for this specific code, understanding the difference between the Medicare benchmark of $243.77 and the actual charges helps clarify the true cost basis of the service.