MRI lower back without contrast at Sioux Valley Memorial Hospital Association. CPT 72148.
What Sioux Valley Memorial Hospital Association publishes for this service, straight from its standard-charges file, last updated March 31, 2026.
Outpatient / ER
$1,958cash price (self-pay)
$2,176list price
$1,153–$1,197range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| AETNA | Medicare | $1,153 |
| BLUE CROSS | Medicare | $1,153 |
| HEALTH PARTNERS | Medicare | $1,153 |
| HUMANA | Medicare | $1,153 |
| UHC | Medicare | $1,153 |
| WellPoint | Medicare | $1,153 |
| Iowa Total Care | Medicaid | $1,197 |
| Molina | Medicaid | $1,197 |
Inpatient
$1,958cash price (self-pay)
$2,176list price
$2,176–$2,176range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Admin Concepts | Commercial | $2,176 |
| AETNA | Commercial | $2,176 |
| AETNA | Medicare | $2,176 |
| American Republic | Commercial | $2,176 |
| APW | All Plans | $2,176 |
| Auxiant | Commercial | $2,176 |
| Avera | Commercial | $2,176 |
| Bankers Life | Commercial | $2,176 |
| BLUE CROSS | Commercial | $2,176 |
| BLUE CROSS | Medicare | $2,176 |
| CHAMPUS | Commercial | $2,176 |
| CIGNA | Commercial | $2,176 |
| HEALTH PARTNERS | Commercial | $2,176 |
| HEALTH PARTNERS | Medicare | $2,176 |
| HUMANA | Medicare | $2,176 |
| Iowa Total Care | Commercial | $2,176 |
| Iowa Total Care | Medicaid | $2,176 |
| Liability | Commercial | $2,176 |
| MERIDIAN | Commercial | $2,176 |
| MERITAIN | Commercial | $2,176 |
| MIDLANDS | Commercial | $2,176 |
| MOLINA | Commercial | $2,176 |
| Molina | Medicaid | $2,176 |
| Mutual of Omaha | Commercial | $2,176 |
| Occunet | Commercial | $2,176 |
| PHYSICIANS MUTUAL | Commercial | $2,176 |
| Private Healthcare | Commercial | $2,176 |
| Sanford | Commercial | $2,176 |
| UHC | Commercial | $2,176 |
| UHC | Medicare | $2,176 |
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All common services at Sioux Valley Memorial Hospital Association