CMS Price Transparency Data

MRI, lower back (no contrast)

Facility: St Nicholas Hospital

Billing Code: 72148 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 72148
  • Insurance Median: $1,335
  • Cash Discount Price: $2,338
  • vs. Medicare Baseline: 5.48x Medicare
The contracted insurance negotiated median rate for a MRI, lower back (no contrast) at St Nicholas Hospital is $1,335. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,338. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 5.48x the Medicare baseline. Located in 3100 Superior Ave, Sheboygan, WI.
Cash / Self-Pay
$2,338

Average discount available for prompt cash payment at this facility.

Insurance Median
$1,335

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: $2,338 (959%)
Insurance Median: $1,335 (548%)
Cash: $2,338 (959% of Medicare)
Ins. Median: $1,335 (548% 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 548% of the Medicare baseline (a markup of 448%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash 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
Blue Cross Blue Shield $52 - $1,611 21%
Community Care Family Care $52 - $103 21%
Managed Health Services $52 - $103 21%
Medicaid / KanCare $52 - $103 21%
Meridian Health Plan $52 - $103 21%
Molina Healthcare $55 - $234 23%
Triology $55 - $2,798 23%
Security Health Plan $94 - $2,261 39%
Aetna $117 - $3,542 48%
Humana $117 - $3,011 48%
Medica $117 - $234 48%
Medicare (plans) $117 - $234 48%
UnitedHealthcare $117 - $1,436 48%
Naphcare $263 - $526 108%
P360 Small Group $1,335 548%
Prevea Health Network $1,335 548%
Molina Healthcare Of Wi $1,771 727%
Hshs Employees $1,920 788%
Arise Health Plan $2,125 872%
Wea Provider Network $2,196 - $2,550 901%
Cigna $2,479 1017%
Interplan $2,479 1017%
Network Health Plan $2,479 1017%
Health Care Alliance $2,586 1061%
Health Eos $2,656 1090%
Healthsmart $2,656 1090%
Wisconsin Physician Service $2,834 1163%
Multiplan/Phcs $2,975 1220%
Choicecare $3,011 1235%
North Central Healthcare Alliance $3,259 1337%
First Health $3,365 1380%
Caterpillar, Inc. $3,542 1453%
Cofinity $3,542 1453%
Live360 $3,542 1453%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 3100 Superior Ave, Sheboygan, WI 53081
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals