MRI lower back without contrast at Evans Memorial Hospital. CPT 72148.
What Evans Memorial Hospital publishes for this service, straight from its standard-charges file, last updated March 26, 2026.
Outpatient / ER
—cash price (self-pay)
$5,250list price
$208–$4,463range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Humana Medicare | HMO | $208 |
| Ambetter | EPO | $270 |
| Caresource Commercial | EPO | $291 |
| Caresource Medicaid | HMO | $812 |
| Amerigroup Medicaid | HMO | $827 |
| Peach State Medicaid | HMO | $828 |
| Cigna | PPO | $3,150 |
| United Healthcare | PPO | $3,413 |
| Aetna Commercial | PPO | $4,463 |
Inpatient
—cash price (self-pay)
$5,250list price
$3,413–$3,607range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| United Healthcare | PPO | $3,413 |
| Cigna | PPO | $3,607 |
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