MRI lower back without contrast at Champlain Valley Physicians Hospital. CPT 72148.
What Champlain Valley Physicians Hospital publishes for this service, straight from its standard-charges file, last updated April 28, 2026.
Outpatient / ER
$223cash price (self-pay)
$223list price
$33.24–$5,370range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| United Healthcare | Managed Medicaid/Essential Plans | $46.28 |
| Empire BlueCross BlueShield | Essential Plans/Managed Medicaid | $59.50 |
| Empire BlueCross BlueShield | Managed Medicaid Aliessa | $59.50 |
| Fidelis Care | Managed Medicaid | $66.11 |
| Fidelis Care | Essential Plans | $69.42 |
| United Healthcare Empire Plan | Commercial PPO for NY State Employees | $75.59 |
| MVP | Commercial | $89.68 |
| Excellus BlueCross BlueShield | Managed Medicaid/Essential Plans | $92.66 |
| Capital District Physicians' Health Plan | Essential Plans | $123 |
| Capital District Physicians' Health Plan | Managed Medicaid | $123 |
| Excellus BlueCross BlueShield | Medicare Advantage | $173 |
| Humana Military | TRICARE | $173 |
| Aetna | Medicare Advantage | $181 |
| Capital District Physicians' Health Plan | Medicare Advantage | $181 |
| Empire BlueCross BlueShield | Medicare Advantage | $181 |
| Fidelis Care | Medicare Advantage | $181 |
| United Healthcare | Medicare Advantage | $181 |
| Veterans Affairs Community Care Network | Veterans Administration | $181 |
| Martins Point | TRICARE Prime/Department of Defense | $191 |
| MVP | Medicare Advantage | $223 |
| St. Regis | HMO | $237 |
| Wellpath | FCI Ray Brook | $268 |
| Empire BlueCross BlueShield | Individual Network | $289 |
| MVP | Essential Plans | $520 |
| MVP | Managed Medicaid | $520 |
| Excellus BlueCross BlueShield | Commercial | $762 |
| Empire BlueCross BlueShield | Blue Access | $1,756 |
| Empire BlueCross BlueShield | HMO | $1,843 |
| Empire BlueCross BlueShield | IND | $1,845 |
| Empire BlueCross BlueShield | PPO | $1,846 |
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