CMS Price Transparency Data

MRI, lower back (no contrast)

Facility: St Nicholas Hospital

Billing Code: 72148 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$273

about 1.1× the $244 Medicare rate · typically $191–$690

modeled estimate · not a bill or quote

What this hospital charges insurers

$176

Below the fair price — a good deal

about $97 under the fair price · 0.7× Medicare

Medicare pays $244 Fair price $273 This hospital $176 Cash price $2,338 Hospital's list price $3,542

How we calculate the fair BaseRate →

How this hospital compares to other WI hospitals

On the higher side — 6 of 8 other WI hospitals charge less.

Cheapest $74 Priciest $233

Black dot = this hospital, among the 9 WI hospitals with a price for this procedure. Full list below.

⚠ The cash price looks unusually high next to the insurance price — it may be the full list price, not a real cash discount. Call to confirm the self-pay rate.

A fair price for a MRI, lower back (no contrast) is about $273 (about 1.1× the $244 Medicare rate). St Nicholas Hospital charges insurers about $176, or about $2,338 in cash — below the fair price — a good deal. Located in Sheboygan, WI.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

5 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$117 - $1,513	48%
Blue Cross Blue Shieldmajor	$52 - $1,611	21%
Aetnamajor	$117 - $3,542	48%
Cignamajor	$2,479	1017%
Humanamajor	$117 - $3,011	48%
Health Net	$1,335 - $1,444	548%
Medica	$117 - $234	48%
Meridian	$52 - $107	21%
Molina	$55 - $1,771	23%
Security Health Plan	$94 - $2,261	39%
+ 15 smaller / regional plans	$52 - $3,542

Government programs also on file: Medicare, Medicaid.

Excludes 6 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 2,338), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 72148.

Insurance Before you use insurance

Call your insurance company to confirm St Nicholas Hospital is in-network.
Ask your insurer whether prior approval is required for CPT code 72148.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at St Nicholas Hospital

Compare: MRI, lower back (no contrast) at other WI hospitals

Insurance negotiated median for the same procedure, sorted lowest first.