CMS Price Transparency Data

MRI, lower back (no contrast)

Facility: SSM Health St Agnes Hospital-Fond Du Lac

Billing Code: 72148 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$418

about 1.7× the $244 Medicare rate · typically $264–$647

modeled estimate · not a bill or quote

What this hospital charges insurers

$455

About the fair price

about $37 over the fair price · 1.9× Medicare

Medicare pays $244 Fair price $418 This hospital $455 Cash price $2,257 Hospital's list price $4,104

How we calculate the fair BaseRate →

How this hospital compares to other WI hospitals

Highest price of the 9 WI hospitals we have prices for — worth calling around.

Cheapest $74 Priciest $455

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 $418 (about 1.7× the $244 Medicare rate). SSM Health St Agnes Hospital-Fond Du Lac charges insurers about $455, or about $2,257 in cash — about the fair price. Located in Fond Du Lac, WI.

What each insurance company pays

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

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

✓ Blue Cross Blue Shield UnitedHealthcareAetnaCignaHumanaKaiser 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
Blue Cross Blue Shieldmajor	$236 - $508	97%
Molina	$177	73%
WellCare	$241	99%
+ 1 smaller / regional plan	$455

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 2,257), 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 SSM Health St Agnes Hospital-Fond Du Lac 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 SSM Health St Agnes Hospital-Fond Du Lac

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

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