CMS Price Transparency Data

MRI, lower back (no contrast)

Facility: Hospital for Special Surgery

Billing Code: 72148 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72148
Insurance Median: $1,166
Cash Discount Price: $2,185
vs. Medicare Baseline: 4.78x Medicare

The contracted insurance negotiated median rate for a MRI, lower back (no contrast) at Hospital for Special Surgery is $1,166. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,185. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 4.78x the Medicare baseline. Located in 535 East 70Th Street, New York, NY.

Cash / Self-Pay

$2,185

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,166

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: $2,185 (896%)

Insurance Median: $1,166 (478%)

Cash: $2,185 (896% of Medicare)

Ins. Median: $1,166 (478% 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 478% of the Medicare baseline (a markup of 378%). 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
UnitedHealthcare	$53 - $2,020	22%
Fidelis	$56 - $59	23%
Metro Plus	$75 - $78	31%
Emblem	$76 - $100	31%
Blue Cross Blue Shield	$103 - $2,268	42%
Nyship	$121	50%
Horizon	$125	51%
Cigna	$157 - $1,071	64%
Aetna	$180 - $966	74%
Fidelis Essential [1323]	$511 - $1,136	210%
Apwu [1016]	$964 - $1,071	395%
Nalc [1090]	$964 - $1,071	395%
Qualcare [1101]	$964 - $1,071	395%
Wellfleet [1361]	$964 - $1,071	395%
Affinity By Molina Health Plan [1005]	$966 - $2,115	396%
Christian Brothers [1034]	$966	396%
Connecticare [1039]	$966 - $2,268	396%
Medicare (plans)	$966	396%
Meritain Health [1085]	$966	396%
Nippon Life [1092]	$966	396%
Webtpa [1356]	$966	396%
Emblem Health [1043]	$1,021 - $2,268	419%
Oxford [1096]	$1,166 - $1,505	478%
Student Resources [1103]	$1,296 - $1,672	532%
Harvard Pilgrim [1057]	$1,566 - $2,020	642%
Geha [1053]	$1,672	686%

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 $2,185.
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 Hospital for Special Surgery 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.