MRI lower back without contrast at Good Samaritan University Hospital. CPT 72148.
What Good Samaritan University Hospital publishes for this service, straight from its standard-charges file, last updated February 19, 2026.
Outpatient / ER
—cash price (self-pay)
$4,232list price
$280–$5,136range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| BCBS-NY Empire | MA | $280 |
| Aetna | Medicare | $286 |
| Centerlight Healthcare | PACE | $286 |
| Centers Plan For Healthy Living | Medicare | $286 |
| Agewell New York | Medicare HMO | $296 |
| BCBS-NY Empire | Blue Access Small Group | $419 |
| BCBS-NY Empire | Blue Access Large Group | $497 |
| Affinity Health Plan | CHP | $505 |
| Affinity Health Plan | HARP | $505 |
| Affinity Health Plan | MEDICAID | $505 |
| Centerlight Healthcare | MEDICAID | $505 |
| BCBS-NY Empire | Commercial | $552 |
| American Plan Administrators | Commercial | $644 |
| Amerihealth Administrators | Commercial | $644 |
| Benefit Services | Commercial | $644 |
| Brighton | Create IDN | $751 |
| Brighton | Create Flex | $772 |
| Affinity Health Plan | EP 1&2 | $1,136 |
| Affinity Health Plan | EP 3&4 | $1,136 |
| APWU | Commercial | $1,968 |
| Centivo | PPO Cigna Medical | $1,968 |
| Cigna | Commercial | $1,968 |
| Daniel H Cook | Associates | $1,968 |
| Centivo | Commercial | $2,694 |
| Allied Wellfare Fund | Commercial | $2,751 |
| American Group Administrators | Commercial | $2,751 |
| Bakery & Confectionery Union | Commercial | $2,751 |
| Cigna | Indemnity | $2,751 |
| Comprehensive Benefits Consultant | Commercial | $2,751 |
| Aetna | Narrow Network | $2,876 |
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