CMS Price Transparency Data

MRI, lower back (no contrast)

Facility: Avita Ontario

Billing Code: 72148 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72148
Insurance Median: $2,025
Cash Discount Price: $4,006
vs. Medicare Baseline: 8.31x Medicare

The contracted insurance negotiated median rate for a MRI, lower back (no contrast) at Avita Ontario is $2,025. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,006. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 8.31x the Medicare baseline. Located in 715 Richland Mall, Ontario, OH.

Cash / Self-Pay

$4,006

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,025

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: $4,006 (1643%)

Insurance Median: $2,025 (831%)

Cash: $4,006 (1643% of Medicare)

Ins. Median: $2,025 (831% 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 831% of the Medicare baseline (a markup of 731%). 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
Caresource	$431	177%
Medicaid / KanCare	$431	177%
Molina	$431 - $5,629	177%
Ohiorise	$431	177%
United_Healthcare	$431 - $4,006	177%
Blue Cross Blue Shield	$444 - $3,518	182%
Amerihealth	$453	186%
Buckeye	$466 - $3,518	191%
Humana	$466 - $3,518	191%
Aetna	$1,605 - $4,006	658%
Medicare (plans)	$1,605 - $3,518	658%
Mount_Carmel	$1,605 - $3,518	658%
Medical_Mutual	$1,637 - $3,770	672%
Cigna	$3,671	1506%

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 $4,006.
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 Avita Ontario 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.