MRI lower back without contrast at Dupont Hospital. CPT 72148.
What Dupont Hospital publishes for this service, straight from its standard-charges file, last updated April 1, 2026.
Outpatient / ER
$512cash price (self-pay)
$1,898list price
$222–$2,526range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| NODE Tricare | NODE Tricare | $240 |
| Department of Veterans Affairs | NODE ChampVA | $252 |
| Anthem BCBS | Anthem IN Medicaid | $458 |
| CareSource | CareSource HHW IN Medicaid | $458 |
| CareSource | CareSource IN HIP | $458 |
| Humana PathWays IN Medicaid | Humana PathWays IN Medicaid | $458 |
| Medicaid | IN Medicaid | $458 |
| Medicaid Non-Par | IN Medicaid Non-Par | $458 |
| Managed Health Services | MHS HCC IN Medicaid | $458 |
| Managed Health Services | MHS HHW IN Medicaid | $458 |
| Managed Health Services | MHS IN HIP | $458 |
| Amish Aid | Amish Aid | $512 |
| Lutheran Preferred | Lutheran Preferred CHS Employees | $564 |
| PHP Freedom Network | PHP Freedom Network | $591 |
| Cigna | Cigna HMO | $613 |
| Lutheran Preferred | Lutheran Preferred Three Rivers Plus | $656 |
| Cigna | Cigna PPO | $689 |
| Lutheran Preferred | Lutheran Preferred Exclusive Plus | $690 |
| Lutheran Network | Lutheran Preferred Exclusive Plus MRM | $690 |
| Lutheran Preferred | Lutheran Preferred Fixed | $690 |
| Lutheran Preferred | Lutheran Preferred Inclusive | $690 |
| Lutheran Preferred | Lutheran Preferred Three Rivers | $690 |
| Aetna | Aetna NBD | $702 |
| Aetna PSSD J and J | Aetna PSSD JJ | $702 |
| Lutheran Preferred | Lutheran Preferred Exclusive | $725 |
| Physicians Health Plan | PHP Platinum Network | $735 |
| Physicians Health Plan | PHP Options | $843 |
| Aetna | Aetna | $848 |
| Physicians Health Plan | PHP Classic Network | $952 |
| Medical Mutual of OH | Medical Mutual of Ohio | $1,006 |
Inpatient
$854cash price (self-pay)
$1,898list price
$564–$2,526range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Lutheran Preferred | Lutheran Preferred CHS Employees | $564 |
| Cigna | Cigna HMO | $613 |
| Cigna | Cigna PPO | $689 |
| Aetna | Aetna NBD | $702 |
| Aetna PSSD J and J | Aetna PSSD JJ | $702 |
| Physicians Health Plan | PHP Platinum Network | $735 |
| Aetna | Aetna | $848 |
| Self Pay | Self Pay | $854 |
| Medical Mutual of OH | Medical Mutual of Ohio | $1,006 |
| Lutheran Preferred | Lutheran Preferred Choice | $1,044 |
| Lutheran Preferred | Lutheran Preferred Exclusive | $1,044 |
| Lutheran Preferred | Lutheran Preferred CCSI | $1,139 |
| Prime Health Services | Prime Health Services | $1,424 |
| Prime Health Services | Prime Health Services Auto | $1,424 |
| FrontPath | FrontPath Health Coalition | $1,518 |
| Encore Health Network | Encore Fully Funded | $1,556 |
| Advantage Health Solutions | Advantage Health Solutions | $1,575 |
| Multiplan | Multiplan PPO Primary Network | $1,632 |
| Allied Benefit Systems | Allied Benefit Systems | $1,708 |
| Encore Health Network | Encore Self Funded | $1,708 |
| Multiplan | Multiplan PPO Complimentary Network | $1,708 |
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