MRI, lower back (no contrast)
Facility: Community Memorial Healthcare, Inc.
Billing Code: 72148 (CPT)
- CPT Billing Code: 72148
- Insurance Median: $1,328
- Cash Discount Price: $2,573
- vs. Medicare Baseline: 5.45x 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 545% of the Medicare baseline (a markup of 445%). 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 | $553 | 227% |
| Aetna | $1,184 - $1,930 | 486% |
| UnitedHealthcare | $1,472 | 604% |
Consumer Guidance & Cost Commentary
For this MRI of the lower back at Community Memorial Healthcare in Marysville, Kansas, the cash price is $2,573, which matches the facility's median paid amount. While the facility is a Critical Access Hospital with a voluntary non-profit ownership, the cash rate is significantly higher than the state average, indicating that paying out-of-pocket here may not be the most cost-effective option for patients with high-deductible plans. Because commercial insurance negotiated rates often include administrative overhead and contract dynamics that can inflate the baseline price by 20% to 40%, it is possible for the insurance allowed amount to exceed the cash price. In this specific case, the highest negotiated rate among the three payers listed is $1,930, which is lower than the cash price, suggesting that using insurance coverage for this service could result in lower out-of-pocket costs compared to paying cash directly.
Patients should be aware that balance billing is generally prohibited for emergency care and non-emergency services at in-network facilities under the No Surprises Act, meaning they should not pay surprise bills immediately without disputing them with their insurer. Additionally, since over 80% of hospital bills contain errors, patients should request a full itemized CPT-coded bill rather than accepting a summary invoice to identify any unbundled codes or services not rendered. Before scheduling, it is advisable to verify your deductible status and ask the hospital directly about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if paid upfront, as these discounts bypass the costly claims processing cycle that insurance billing entails.