CMS Price Transparency Data

MRI, lower back (no contrast)

Facility: St Josephs Community Hospital West Bend

Billing Code: 72148 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72148
Insurance Median: $2,981
Cash Discount Price: $2,604
vs. Medicare Baseline: 12.23x Medicare

The contracted insurance negotiated median rate for a MRI, lower back (no contrast) at St Josephs Community Hospital West Bend is $2,981. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,604. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 12.23x the Medicare baseline. Located in 3200 Pleasant Valley Road, West Bend, WI.

Cash / Self-Pay

$2,604

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,981

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: $2,604 (1068%)

Insurance Median: $2,981 (1223%)

Cash: $2,604 (1068% of Medicare)

Ins. Median: $2,981 (1223% 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 1223% of the Medicare baseline (a markup of 1123%). 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
Allwell	$235	96%
Blue Cross Blue Shield	$235 - $4,024	96%
Community Care	$235	96%
Health Partners	$235 - $3,077	96%
Humana	$235	96%
Icare	$235	96%
Molina	$235	96%
Network Health Plan	$235 - $1,880	96%
Security Health Plan Secure Savers	$235	96%
UnitedHealthcare	$235 - $2,440	96%
Aetna	$239 - $3,314	98%
Care Wisconsin	$242	99%
Centivo	$1,420 - $1,562	583%
Froedtert South	$1,988	816%
Chorus Community Health Plan	$2,036	835%
Common Ground	$2,840	1165%
Sheboygan Employers Health Network	$2,854	1171%
Health Payment Systems	$2,981 - $3,827	1223%
Wisconsin Physician Services	$3,787	1554%
Trilogy	$3,882	1592%
Americas Choice	$4,119	1690%
Healtheos	$4,119	1690%
Multiplan/Private Healthcare Systems	$4,119	1690%
First Health Network	$4,166	1709%
Hfn	$4,261	1748%
Ibsi Passport	$4,261	1748%
Cigna	$4,497	1845%
Healthsmart	$4,497	1845%

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 $2,604.
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 St Josephs Community Hospital West Bend 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.