MRI lower back without contrast at CHI Health Good Samaritan. CPT 72148.
What CHI Health Good Samaritan publishes for this service, straight from its standard-charges file, last updated February 28, 2026.
Outpatient / ER
$1,821cash price (self-pay)
$2,986list price
$197–$2,777range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Amerigroup | Medicaid|All Plans | $197 |
| Centene | Medicaid|IA Total Care | $197 |
| IAMolina | Medicaid|All Plans | $201 |
| BCBS - NE | Medicare|All Plans | $229 |
| Humana | Medicare|All Plans | $229 |
| Medica | Medicare|All Plans | $229 |
| PACE | Medicare|All Plans | $229 |
| United | Medicare|All Plans | $229 |
| Centene | Medicare|All Plans | $236 |
| Medica | Commercial|ACO | $239 |
| Amerigroup | Medicare|All Plans | $240 |
| Great Plains | Medicare|All Plans | $240 |
| Medica | Commercial|CHI Health | $384 |
| Medica | Commercial|All Other Plans | $402 |
| AMPS | Commercial|All Plans | $508 |
| United | Medicaid|Community Plan | $627 |
| Centene | Medicaid|NE Total Care | $633 |
| Greater Omaha Packing | Commercial|Narrow Network | $987 |
| Millard Public Schools | Commercial|Narrow Network | $987 |
| One World | Commercial|Narrow Network | $987 |
| Greater Omaha Packing | Commercial|Broad Network | $1,135 |
| Millard Public Schools | Commercial|Broad Network | $1,135 |
| One World | Commercial|Broad Network | $1,135 |
| Timpte | Commercial|Broad Network | $1,135 |
| Creighton University Employees | Commercial|All Plans | $1,463 |
| ELAP | Commercial|All Plans | $1,732 |
| United | Commercial|All Plans | $2,269 |
| Medica | Commercial|Open Access | $2,329 |
| Midlands Choice | Commercial|Premier | $2,329 |
| Midlands Choice | Commercial|Standard | $2,747 |
Inpatient
$1,821cash price (self-pay)
$2,986list price
$1,463–$2,777range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Creighton University Employees | Commercial|All Plans | $1,463 |
| United | Commercial|All Plans | $2,269 |
| Medica | Commercial|Open Access | $2,329 |
| Midlands Choice | Commercial|Premier | $2,329 |
| Midlands Choice | Commercial|Standard | $2,747 |
| MultiPlan PHCS | Commercial|All Plans | $2,777 |
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