CMS Price Transparency Data

MRI, lower back (no contrast)

Facility: Pocahontas Memorial Hospital

Billing Code: 72148 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72148
Insurance Median: $1,593
Cash Discount Price: $1,470
vs. Medicare Baseline: 6.53x Medicare

The contracted insurance negotiated median rate for a MRI, lower back (no contrast) at Pocahontas Memorial Hospital is $1,593. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,470. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 6.53x the Medicare baseline. Located in 150 Duncan Road, Buckeye, WV.

Cash / Self-Pay

$1,470

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,593

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: $1,470 (603%)

Insurance Median: $1,593 (653%)

Cash: $1,470 (603% of Medicare)

Ins. Median: $1,593 (653% 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 653% of the Medicare baseline (a markup of 553%). 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	$1,260	517%
Wellpoint West Virginia, Inc. - Commercial-Hmo	$1,470	603%
Aetna	$1,470 - $1,512	603%
Unicare Health Plan of Wv, Inc. - Commercial-Hmo	$1,470	603%
Medicare (plans)	$1,593	653%
Highmark Senior Solutions Company - Commercial-Ppo	$1,601	657%
Wv Treasury Peia - Commercial-Ppo	$1,617	663%
UnitedHealthcare	$1,638	672%
Blue Cross Blue Shield	$1,823	748%
Humana	$2,064	847%

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 $1,470.
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 Pocahontas Memorial 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.