CMS Price Transparency Data

MRI, lower back (no contrast)

Facility: Hermann Area District Hospital

Billing Code: 72148 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72148
Insurance Median: $927
Cash Discount Price: $1,240
vs. Medicare Baseline: 3.80x Medicare

The contracted insurance negotiated median rate for a MRI, lower back (no contrast) at Hermann Area District Hospital is $927. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,240. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 3.80x the Medicare baseline. Located in 509 W 18Th St, Hermann, MO.

Cash / Self-Pay

$1,240

Average discount available for prompt cash payment at this facility.

Insurance Median

$927

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$243.77

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $243.77 (100%)

Cash / Self-Pay: $1,240 (509%)

Insurance Median: $927 (380%)

Cash: $1,240 (509% of Medicare)

Ins. Median: $927 (380% of 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 380% of the Medicare baseline (a markup of 280%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

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 Mcaid - All Plans	$249	102%
Ambetter / Centene	$259 - $1,454	106%
Blue Cross Blue Shield	$269 - $1,384	110%
UnitedHealthcare	$269 - $890	110%
Care Partners Mcaid- All Plans	$562	231%
Tricare	$818	336%
Choicecare Mcr Adv- All Plans	$868	356%
American Hlth Mcr Adv- All Plans	$909	373%
Humana	$909	373%
Aetna	$927 - $1,963	380%
Healthlink Hmo	$927	380%
Wellcare Mcr Adv - All Plans	$927	380%
Healthlink Ppo - All Other Plans	$1,030	423%
Cigna	$1,126	462%
Harmony Hp Mcaid- All Plans	$1,198	491%
Healthcare Usa Mcaid- All Plans	$1,343	551%
Multiplan/Phcs - All Plans	$1,550	636%
Coventry - All Plans	$1,756	720%
Comp Results - All Plans	$1,859	763%
Three Rivers - All Plans	$1,859	763%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $1,240.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 72148.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Hermann Area District Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 72148.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.