CMS Price Transparency Data

MRI, lower back (no contrast)

Facility: Fort Memorial Hospital

Billing Code: 72148 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$172

about 0.7× the $244 Medicare rate · typically $155–$312

modeled estimate · not a bill or quote

What this hospital charges insurers

$173

About the fair price

about $1 over the fair price · 0.7× Medicare

Medicare pays $244 Fair price $172 This hospital $173 Cash price $1,440 Hospital's list price $4,500

How we calculate the fair BaseRate →

How this hospital compares to other WI hospitals

A typical price — 3 charge more and 5 charge less, among the 9 WI hospitals compared.

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 $172 (about 0.7× the $244 Medicare rate). Fort Memorial Hospital charges insurers about $173, or about $1,440 in cash — about the fair price. Located in Fort Atkinson, 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	$65 - $233	27%
Blue Cross Blue Shieldmajor	$64 - $1,434	26%
Aetnamajor	$164 - $3,544	67%
Cignamajor	$440 - $4,489	180%
Humanamajor	$65 - $330	27%
Dean Health Plan	$65 - $1,864	27%
Molina	$65 - $233	27%
Quartz	$65 - $1,923	27%
+ 8 smaller / regional plans	$63 - $4,155

Government programs also on file: Medicare, Medicaid.

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 1,440), 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 Fort Memorial 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 Fort Memorial Hospital

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

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