MRI lower back without contrast at HSS Southampton Outpatient Center. CPT 72148.
What HSS Southampton Outpatient Center publishes for this service, straight from its standard-charges file, last updated April 1, 2026.
Outpatient / ER
$400cash price (self-pay)
$400list price
$53.19–$2,268range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| UHC | Medicare Managed Care | $53.19 |
| Fidelis | Medicaid Managed Care | $56.02 |
| Fidelis | Essential Plans 3,4 | $59.14 |
| Fidelis | Essential Plans 1,2 | $59.14 |
| Metro Plus | Medicaid Managed Care | $74.70 |
| Metro Plus | Essential Plans 3,4 | $74.70 |
| Emblem | Medicare Managed Care | $75.98 |
| Metro Plus | Essential Plans 1,2 | $77.81 |
| Emblem | Commercial | $100 |
| Emblem | City of NY Plans | $100 |
| Anthem NY | Exchange | $103 |
| UHC | Commercial | $119 |
| NYSHIP | Commercial | $121 |
| Anthem NY | Commercial | $121 |
| Horizon | Commercial | $125 |
| CIGNA | Commercial | $157 |
| Aetna | Commercial | $180 |
| Cigna [1035] | Cigna International [103507] | $1,071 |
| Apwu [1016] | Apwu [101600] | $1,071 |
| Cigna [1035] | Local 831 [103508] | $1,071 |
| Cigna [1035] | Cigna EPO [103502] | $1,071 |
| Qualcare [1101] | Qualcare [110100] | $1,071 |
| Cigna [1035] | Cigna Great West [103506] | $1,071 |
| Cigna [1035] | Cigna Indemnity [103505] | $1,071 |
| Cigna [1035] | Cigna HMO [103503] | $1,071 |
| Fidelis Essential [1323] | Fidelis Essential [132300] | $1,136 |
| Oxford [1096] | Oxford HMO [109605] | $1,242 |
| Umr [1106] | Umr HMO [110601] | $1,379 |
| United Healthcare [1107] | United Healthcare Select Plus [110710] | $1,379 |
| United Healthcare [1107] | United Healthcare EPO [110704] | $1,379 |
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