MRI, lower back (no contrast)
Facility: Ellsworth County Medical Center
Billing Code: 72148 (CPT)
- CPT Billing Code: 72148
- Insurance Median: $866
- Cash Discount Price: $962
- vs. Medicare Baseline: 3.55x 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 355% of the Medicare baseline (a markup of 255%). 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 |
|---|---|---|
| Healthy Blue Mcr Adv | $452 | 185% |
| Triwest -All Plans | $452 | 185% |
| Va Ccn-All Plans | $452 | 185% |
| Humana | $452 - $914 | 185% |
| Blue Cross Blue Shield | $495 - $521 | 203% |
| UnitedHealthcare | $625 - $962 | 256% |
| First Health - All Plans | $866 | 355% |
| Aetna | $866 | 355% |
| Cigna | $914 | 375% |
| Medicaid / KanCare | $962 | 395% |
| Healthy Blue Mcaid- All Other Plans | $962 | 395% |
| Coventry Mcaid-All Plans | $962 | 395% |
| Providers Care-Wppa-All Plans | $1,443 | 592% |
Consumer Guidance & Cost Commentary
For the MRI of the lower back (no contrast) at Ellsworth County Medical Center, the cash price is $962.00, which matches the facility's gross charge and the Medicaid rate. This cash rate is significantly higher than the state average for this procedure, which is $746.00. While commercial insurance plans like Humana and UnitedHealthcare have negotiated rates ranging from $452 to $962, these amounts often exceed the cash price. Patients with high-deductible plans may find it financially advantageous to pay the cash price directly, as the insurance negotiated rates can sometimes be higher than what a self-pay patient would owe. To secure the lowest possible rate, it is recommended to contact the hospital directly to inquire about self-pay or prompt-pay discounts, which can reduce the bill by 20% to 50% if paid in full upfront.
The facility operates as a Critical Access Hospital in Ellsworth, Kansas, and its pricing is benchmarked against the Medicare rate of $243.77. Commercial negotiated rates for this service average 200% to 300% of the Medicare amount, whereas fair pricing is typically defined as 120% to 150% of the Medicare rate. Because the cash price of $962.00 is well above the Medicare benchmark, patients should be aware that commercial insurance contracts may not always result in lower out-of-pocket costs compared to paying cash. If a patient receives a bill that includes charges for services not rendered or unbundled components, they should request an itemized billing audit to identify errors before making a payment. Additionally, under the No Surprises Act, patients