MRI, lower back (no contrast)
Facility: Decatur Health
Billing Code: 72148 (CPT)
- CPT Billing Code: 72148
- Insurance Median: $803
- Cash Discount Price: $948
- vs. Medicare Baseline: 3.29x 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 329% of the Medicare baseline (a markup of 229%). 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 |
|---|---|---|
| Wppa/Providrs Care- All Plans | $632 | 259% |
| UnitedHealthcare | $642 - $803 | 263% |
| Humana | $649 | 266% |
| Blue Cross Blue Shield | $678 | 278% |
| Aetna | $948 - $1,053 | 389% |
| Midlands Choice- All Plans | $948 | 389% |
| Medicaid / KanCare | $1,063 | 436% |
Consumer Guidance & Cost Commentary
For the MRI of the lower back (no contrast) at Decatur Health in Oberlin, Kansas, the cash price is $948.00, which is notably lower than the facility's negotiated rates with major insurers like Aetna ($948.00 to $1,053.00) and UnitedHealthcare ($642.00 to $803.00). While the cash price aligns with the cash median, patients with high-deductible plans may find paying out-of-pocket cheaper than their insurance would allow, as commercial negotiated rates often include administrative overhead that pushes the final bill higher than the actual service cost. It is important to verify your specific plan's deductible status before scheduling, as paying the full negotiated rate without meeting your deductible can result in significantly higher out-of-pocket expenses than expected.
When evaluating the cost against federal benchmarks, the Medicare amount for this procedure is $243.77, which serves as the objective baseline for fair pricing. The facility's cash price of $948.00 represents a markup of 3.3 times the Medicare rate, which falls within the typical range where commercial rates average 200% to 300% of Medicare, though fair pricing is often defined as 120% to 150%. To potentially reduce this cost, patients should ask the hospital directly about "self-pay" or "prompt-pay" discounts, which can offer a fee reduction of 20% to 50% for upfront payment by bypassing the costly insurance claims processing cycle. Always request a full itemized bill before paying to ensure no errors or unbundled charges are included