CMS Price Transparency Data

MRI, lower back (no contrast)

Facility: Saint Clare's Hospital/ Denville Campus

Billing Code: 72148 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72148
Insurance Median: $345
Cash Discount Price: $276
vs. Medicare Baseline: 1.42x Medicare

The contracted insurance negotiated median rate for a MRI, lower back (no contrast) at Saint Clare's Hospital/ Denville Campus is $345. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $276. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 1.42x the Medicare baseline. Located in 25 Pocono Road, Denville, NJ.

Cash / Self-Pay

$276

Average discount available for prompt cash payment at this facility.

Insurance Median

$345

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: $276 (113%)

Insurance Median: $345 (142%)

Cash: $276 (113% of Medicare)

Ins. Median: $345 (142% 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.

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
Humana	$221	91%
UnitedHealthcare	$230 - $345	94%
Aetna	$277 - $587	114%
Amerihealth	$277 - $766	114%
Clover Health	$277	114%
Horizon	$277 - $575	114%
Medicare (plans)	$277	114%
Tricare	$277	114%
Wellcare	$277 - $374	114%
Wellpoint Amerigroup	$277	114%
Ally-Align (Fka Spartan Health Plan)	$291	119%
Employer Direct Healthcare	$387	159%
Cigna	$428	176%
Fairprice Healthcare Holdings - Fphh	$443	182%
Coventry	$553	227%
Brighton Health Plan Solutions (Fka Magnacare)	$709	291%

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 $276.
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 Saint Clare's Hospital/ Denville Campus 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.