CMS Price Transparency Data

MRI, lower back (no contrast)

Facility: Holy Family Memorial

Billing Code: 72148 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72148
Insurance Median: $1,940
Cash Discount Price: $1,650
vs. Medicare Baseline: 7.96x Medicare

The contracted insurance negotiated median rate for a MRI, lower back (no contrast) at Holy Family Memorial is $1,940. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,650. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 7.96x the Medicare baseline. Located in 2300 Western Ave, Manitowoc, WI.

Cash / Self-Pay

$1,650

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,940

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: $1,650 (677%)

Insurance Median: $1,940 (796%)

Cash: $1,650 (677% of Medicare)

Ins. Median: $1,940 (796% 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 796% of the Medicare baseline (a markup of 696%). 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
Blue Cross Blue Shield	$230 - $2,364	94%
Community Care Incorporated	$230	94%
Health Partners	$230 - $1,950	94%
Humana	$230	94%
Icare	$230	94%
Molina	$230 - $248	94%
Network Health Plan	$230 - $1,880	94%
Security Health Plan	$230 - $2,400	94%
UnitedHealthcare	$230 - $2,440	94%
Allwell	$234	96%
Medical College Of Wisconsin	$990	406%
Centivo	$1,200 - $1,380	492%
Dean Health Plan	$1,500	615%
Health Payment Systems	$1,551	636%
Sheboygan Employers Health Network	$1,800	738%
Chorus Community Health Plan	$1,929	791%
Trilogy	$1,980	812%
Cigna	$2,160	886%
Wps Health Plan	$2,220	911%
Aspirus	$2,400	985%
Healtheos	$2,400	985%
Multiplan/Private Healthcare Systems	$2,400	985%
Preferred One	$2,400	985%
Healthsmart	$2,490	1021%
First Health Network	$2,640	1083%

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 $1,650.
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 Holy Family Memorial 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.