MRI lower back without contrast at Good Samaritan Hospital (GSH). CPT 72148.
What Good Samaritan Hospital (GSH) publishes for this service, straight from its standard-charges file, last updated April 1, 2026.
Outpatient / ER
$1,763cash price (self-pay)
$2,939list price
$136–$2,957range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Encore Prime | Commercial | $238 |
| Aetna | Medicare Advantage | $252 |
| Allwell | MCR ADV/PPO/HMO | $252 |
| Anthem MCR | MCR ADV/PPO/HMO | $252 |
| Anthem MCR | Medicare Advantage | $252 |
| Anthem | MCR ADV/PPO/HMO | $252 |
| Cigna | Medicare Advantage | $252 |
| Humana | Medicare Advantage | $252 |
| Indiana University | MCR ADV/PPO/HMO | $252 |
| MHS Ambetter | Commercial | $252 |
| Alliance Coal | Commercial | $379 |
| CareSource | Commercial | $379 |
| Aetna | Medicaid | $458 |
| Anthem HIP | HIP | $458 |
| Anthem Pathways | Medicaid | $458 |
| Anthem | Medicaid | $458 |
| BCBS | Medicare Advantage | $458 |
| Caresource HIP | Medicaid | $458 |
| Caresource | Medicaid | $458 |
| Meridian | Medicaid | $458 |
| Hope Trust | Commercial | $505 |
| Anthem | HealthSync | $1,350 |
| Amish | Commercial | $1,470 |
| Anthem | Exchange | $1,639 |
| United Healthcare | Commercial | $1,928 |
| Aetna | Commercial | $1,961 |
| Indiana University | Commercial | $2,240 |
| Direct Health | Direct Health | $2,254 |
| SIHO | Commercial | $2,254 |
| Cigna | Commercial | $2,322 |
Inpatient
$1,763cash price (self-pay)
$2,939list price
$1,710–$2,939range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Anthem | Exchange | $1,710 |
| United Healthcare | Commercial | $1,946 |
| Anthem | Trad/PPO/HMO | $2,137 |
| Direct Health | Direct Health | $2,254 |
| SIHO | Commercial | $2,254 |
| Cigna | Commercial | $2,322 |
| Sagamore | Commercial | $2,322 |
| Corvel | Workers Comp | $2,410 |
| Aetna | Commercial | $2,463 |
| Anthem | HealthSync | $2,528 |
| HealthLink | HMO | $2,586 |
| Encore Prime | Commercial | $2,645 |
| Humana | Commercial | $2,645 |
| HealthLink | PPO | $2,733 |
| Molina | Medicaid | $2,939 |
| Underwriters Safety | Commercial | $2,939 |
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