CMS Price Transparency Data

MRI, lower back (no contrast)

Facility: Gundersen St Josephs Hospital and Clinics

Billing Code: 72148 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72148
Insurance Median: $2,357
Cash Discount Price: $1,829
vs. Medicare Baseline: 9.67x Medicare

The contracted insurance negotiated median rate for a MRI, lower back (no contrast) at Gundersen St Josephs Hospital and Clinics is $2,357. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,829. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 9.67x the Medicare baseline. Located in 400 Water Ave, Hillsboro, WI.

Cash / Self-Pay

$1,829

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,357

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: $1,829 (750%)

Insurance Median: $2,357 (967%)

Cash: $1,829 (750% of Medicare)

Ins. Median: $2,357 (967% 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 967% of the Medicare baseline (a markup of 867%). 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
Amerigroup	$103	42%
Security Health Plan	$618	254%
Blue Cross Blue Shield	$636 - $3,214	261%
Iowa Total Care	$636	261%
Managed Health Service	$636	261%
Ucare	$1,637 - $2,518	672%
UnitedHealthcare	$1,668 - $2,200	684%
Quartz	$1,716	704%
Alliance	$2,514 - $4,123	1031%
Cigna	$2,581	1059%
Aspirus Arise Health	$2,613	1072%
Humana	$2,676	1098%
Multiplan/Healtheos	$2,739 - $2,991	1124%
Coventry Health Care	$2,991	1227%

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 $1,829.
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 Gundersen St Josephs Hospital and Clinics 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.