MRI, lower back (no contrast)
Facility: William Newton Hospital
Billing Code: 72148 (CPT)
- CPT Billing Code: 72148
- Insurance Median: $930
- Cash Discount Price: $2,583
- vs. Medicare Baseline: 3.82x 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 382% of the Medicare baseline (a markup of 282%). 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 | $525 - $930 | 215% |
| Triwest- All Plans | $902 | 370% |
| Ambetter / Centene | $930 - $2,583 | 382% |
| UnitedHealthcare | $930 - $2,325 | 382% |
| Providrs Care Nexus | $1,581 | 649% |
| Providrs Care - All Other Plans | $1,808 | 742% |
Consumer Guidance & Cost Commentary
For the MRI, lower back (no contrast) procedure at William Newton Hospital in Winfield, KS, the cash price is $2,583, which matches the facility's gross charge and the median cash rate. While the hospital is a Critical Access Hospital owned by the local government, the negotiated rates paid by insurance plans range from $525 to $2,583, with a median allowed amount of $930. This negotiated rate is significantly lower than the cash price, meaning patients with high-deductible plans or those without insurance might save money by paying the cash price directly, provided they qualify for the facility's self-pay or prompt-pay discounts. It is important to note that while the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, patients should still verify their specific plan's network status and deductible requirements before scheduling to avoid unexpected costs.
When evaluating the value of this service, it is helpful to compare the facility's pricing against the Medicare benchmark, which serves as a scientifically validated baseline for healthcare costs. The Medicare amount for this procedure is $243.77, indicating that the cash price of $2,583 represents a substantial markup over the federal government's cost basis. Although the data does not provide specific county or state average comparisons for this exact procedure, the wide variation in negotiated rates across different payers—from as low as $525 with Blue Cross Blue Shield to the full $2,583 with Ambetter/Centene—highlights the importance of checking your specific insurance plan's allowed amount. To ensure you are receiving the best possible rate, patients should request an itemized bill to review all CPT