CMS Price Transparency Data

MRI, lower back (no contrast)

Facility: Lexington Memorial Hospital Inc

Billing Code: 72148 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72148
Insurance Median: $1,297
Cash Discount Price: $1,459
vs. Medicare Baseline: 5.32x Medicare

The contracted insurance negotiated median rate for a MRI, lower back (no contrast) at Lexington Memorial Hospital Inc is $1,297. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,459. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 5.32x the Medicare baseline. Located in 250 Hospital Drive Po Box 1817, Lexington, NC.

Cash / Self-Pay

$1,459

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,297

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: $1,459 (599%)

Insurance Median: $1,297 (532%)

Cash: $1,459 (599% of Medicare)

Ins. Median: $1,297 (532% 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 532% of the Medicare baseline (a markup of 432%). 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
Amerihealth	$550 - $802	226%
Carolina Complete	$550	226%
Healthy Blue	$550	226%
Partners	$550	226%
UnitedHealthcare	$555 - $1,307	228%
Vaya	$555	228%
Wellcare	$555	228%
Alliance	$561	230%
Trillium	$566	232%
Medcost	$639 - $1,952	262%
Blue Cross Blue Shield	$811 - $1,301	333%
Aetna	$829 - $2,696	340%
Ambetter / Centene	$837	343%
Oscar	$934 - $1,284	383%
Cigna	$1,269 - $1,293	521%
Directnet	$1,725	708%
Healthgram Lexington Home Brands	$2,101	862%
Healthgram	$2,334	957%
Private Healthcare Systems	$2,393	982%
Beechstreet	$2,568	1053%
Humana	$2,568	1053%
Multiplan	$2,626	1077%
National Provider Network	$2,626	1077%

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 $1,459.
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 Lexington Memorial Hospital Inc 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.