CMS Price Transparency Data

MRI, lower back (no contrast)

Facility: Fort Memorial Hospital

Billing Code: 72148 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72148
Insurance Median: $222
Cash Discount Price: $1,440
vs. Medicare Baseline: 0.91x Medicare

The contracted insurance negotiated median rate for a MRI, lower back (no contrast) at Fort Memorial Hospital is $222. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,440. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 0.91x the Medicare baseline. Located in 611 Sherman Ave E, Fort Atkinson, WI.

Cash / Self-Pay

$1,440

Average discount available for prompt cash payment at this facility.

Insurance Median

$222

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: $1,440 (591%)

Insurance Median: $222 (91%)

Cash: $1,440 (591% of Medicare)

Ins. Median: $222 (91% 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.

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
Mercycare	$63 - $3,518	26%
Blue Cross Blue Shield	$64 - $1,434	26%
Dean Health Plan	$65 - $1,864	27%
Humana	$65 - $330	27%
Molina	$65 - $233	27%
Quartz	$65 - $1,923	27%
UnitedHealthcare	$65 - $233	27%
Managed Health Services	$82 - $108	34%
Medicaid / KanCare	$99	41%
Aetna	$164 - $3,544	67%
Alliance	$182 - $3,391	75%
Fort Care	$222 - $643	91%
Centivo	$225 - $1,000	92%
Medicare (plans)	$233	96%
Group Health Cooperative	$281 - $3,057	115%
Veteran Evaluation Services	$284	117%
Trilogy	$407 - $4,155	167%
Cigna	$440 - $4,489	180%

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 $1,440.
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 Fort Memorial Hospital 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.