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 January 1, 2025.
Outpatient / ER
$1,608cash price (self-pay)
$2,474list price
$365–$2,632range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Amerigroup | Medicaid/Peachcare | $365 |
| Peach State | Medicaid | $504 |
| Wellcare | Medicaid | $504 |
| UHC | Medicare Advantage | $668 |
| Aetna | Medicare Advantage | $668 |
| Ambetter | Medicare Advantage | $668 |
| Anthem BCBS | Medicare Advantage | $668 |
| Care Improvement Plus | Medicare Advantage | $668 |
| Caresource | Medicare Advantage | $668 |
| Centene | Medicare Advantage | $668 |
| Cigna HealthSpring | Medicare Advantage | $668 |
| Coventry | Medicare Advantage | $668 |
| Eon Health Plan | Medicare Advantage | $668 |
| Humana | Medicare Advantage | $668 |
| Kaiser Permanente | Medicare Advantage | $668 |
| Molina | Medicare Advantage | $668 |
| Pruitthealth Premier | Medicare Advantage | $668 |
| Todays Options PFFS | Medicare Advantage | $668 |
| Todays Options PPO | Medicare Advantage | $668 |
| VACCN United | Veterans Affairs | $668 |
| Wellcare | Medicare Advantage | $668 |
| Anthem | Pathway Program | $839 |
| Anthem | HMO | $1,787 |
| Anthem | PPO | $1,787 |
| COVENTRY | All Products | $1,856 |
| First Health | All Products | $1,856 |
| Humana | All Products | $1,856 |
| PHCS | All Products | $1,856 |
| Aetna | All Products | $1,979 |
| MERITAIN | All Products | $1,979 |
Inpatient
$1,608cash price (self-pay)
$2,474list price
$478–$2,227range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Anthem | Pathway Program | $478 |
| Anthem | HMO | $1,256 |
| Anthem | PPO | $1,256 |
| NOVA | All Products | $2,103 |
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