CMS Price Transparency Data

MRI, lower back (no contrast)

Facility: Stoughton Hospital

Billing Code: 72148 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72148
Insurance Median: $2,109
Cash Discount Price: $2,637
vs. Medicare Baseline: 8.65x Medicare

The contracted insurance negotiated median rate for a MRI, lower back (no contrast) at Stoughton Hospital is $2,109. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,637. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 8.65x the Medicare baseline. Located in 900 Ridge St, Stoughton, WI.

Cash / Self-Pay

$2,637

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,109

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: $2,637 (1082%)

Insurance Median: $2,109 (865%)

Cash: $2,637 (1082% of Medicare)

Ins. Median: $2,109 (865% 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 865% of the Medicare baseline (a markup of 765%). 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
Medicaid / KanCare	$290	119%
Tricare	$1,141	468%
Dean Health Insurance Comm - All Other Plans	$1,249	512%
Dean Health Insurance Epo	$1,249	512%
Healthnet Mcr Adv - All Plans	$1,275	523%
Dean Health Insurance Med Adv	$1,342	551%
Humana	$1,342 - $4,315	551%
Quartz Mcr Adv	$1,342	551%
Security Health/First Health - All Plans	$1,342	551%
Aetna	$1,438 - $4,075	590%
UnitedHealthcare	$2,109 - $3,835	865%
Quartz Health Solutions - All Other Lans	$3,409	1398%
Geha - All Plans	$3,596	1475%
Cigna	$3,835	1573%
Wisconsin Ppo Ppa Direct - All Plans	$3,835	1573%
Blue Cross Blue Shield	$4,171	1711%
Wps - All Plans	$4,315	1770%
Alliance - All Plans	$19,176	7866%

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 $2,637.
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 Stoughton 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.