MRI lower back without contrast at Good Samaritan Hospital. CPT 72148.
What Good Samaritan Hospital publishes for this service, straight from its standard-charges file, last updated September 1, 2026.
Outpatient / ER
$22,183cash price (self-pay)
$22,183list price
$117–$22,183range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Santa Clara Family Health Plan | Medicaid | $117 |
| Physicians Medical Group | MCD | $181 |
| Anthem | Medi-Cal | $200 |
| Physician Health Network | MGMCD | $200 |
| United | AllPayerAppendix | $518 |
| Anthem | ExchangeEPO | $652 |
| Anthem | BlueConnection | $687 |
| Anthem | COMM | $687 |
| MedCare Partners | MGMCR | $3,327 |
| Aetna | AWH | $4,973 |
| Aetna | HMO | $5,074 |
| Aetna | PPO | $5,074 |
| Blue Shield | COMM | $5,314 |
| Blue Shield | EPN | $5,314 |
| United | OptionsPPO | $5,657 |
| United | GlobalBenefitPlan | $9,982 |
| NX Health Network | COMM | $13,310 |
| Sutter Select | COMM | $13,310 |
| MultiPlan | Primary | $14,419 |
| ChoiceCare Humana | COMM | $15,528 |
| First Health | COMM | $16,859 |
| Cigna BH | COMMBH | $17,746 |
| HealthSmart | WCOMP | $17,746 |
| Intercontinental Corporation | COMM | $17,746 |
| MultiPlan | Complementary | $17,746 |
| PHA Pacific Health Alliance | COMM | $17,746 |
| PPO Next | COMM | $17,746 |
| PPO Next | PPO | $17,746 |
| HealthSmart | COMM | $18,855 |
| First Health | WCOMP | $22,183 |
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