MRI lower back without contrast at Samaritan Hospital. CPT 72148.
What Samaritan Hospital publishes for this service, straight from its standard-charges file, last updated March 31, 2026.
Outpatient / ER
$153cash price (self-pay)
$153list price
$44.52–$5,357range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Molina Medicare Advantage | Pb Xr 100% Default | $153 |
| Commonwealth Care Alliance | Pb Xr 100% Default | $153 |
| Union Health Service | Pb Xr 100% Default | $153 |
| Rx Allwin | Pb Xr 100% Default | $153 |
| Pace Of Southwest Michigan | Pb Xr 100% Default | $153 |
| Health Choices | Pb Xr 100% Default | $153 |
| The Health Plan | Pb Xr 100% Default | $153 |
| Harvard Pilgrim Healthcare | Pb Xr 100% Default | $153 |
| Dentaquest | Pb Xr 100% Default | $153 |
| Everence | Pb Xr 100% Default | $153 |
| Blue Cross - NY (Anthem) Medicare Advantage | Empire BCBS Medicare Adv | $292 |
| Mvp Medicare Advantage | Mvp Medicare Advantage | $298 |
| Eddy Seniorcare Pace | Eddy Senior Care | $298 |
| Capital District Physicians Health Plan Medicare Advantage | Cdphp Med | $298 |
| Hudson Headwaters Pace | Hudson Headwaters Pace | $322 |
| Fidelis Medicare | Fidelis Medicare Advantage | $326 |
| Blue Cross - NY (Excellus) Medicare Advantage | Blue Shield Of Ne New | $328 |
| Blue Shield - NY Highmark Northeastern Medicare Advantage | Blue Shiel | $328 |
| Emblem Health Medicare Advantage | Emblem Medicare Advantage | $333 |
| Nascentia Health Plus | Nascentia Health Plus Medicare Advantage | $334 |
| Mvp Medicaid Advantage | Mvp Medicaid | $412 |
| Blue Cross - Ia (Wellmark) | Blue Shield Of Ne New York HMO | $457 |
| Blue Cross - La | Blue Shield Of Ne New York PPO | $571 |
| Blue Cross - Ms | Blue Shield Of Ne New York PPO | $571 |
| Blue Cross - Ia (Wellmark) | Blue Shield Of Ne New York PPO | $571 |
| Blue Cross - Mt | Blue Shield Of Ne New York PPO | $571 |
| Blue Cross - Sc | Blue Shield Of Ne New York PPO | $571 |
| Blue Cross - Tn | Blue Shield Of Ne New York PPO | $571 |
| Blue Cross - TX | Blue Shield Of Ne New York PPO | $571 |
| Blue Cross - Pa (Capital) | Blue Shield Of Ne New York PPO | $571 |
Inpatient
$183cash price (self-pay)
$183list price
$44.52–$645range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Harvard Pilgrim Healthcare | Pb Xr 100% Default | $183 |
| Molina Medicare Advantage | Pb Xr 100% Default | $183 |
| The Health Plan | Pb Xr 100% Default | $183 |
| Rx Allwin | Pb Xr 100% Default | $183 |
| Dentaquest | Pb Xr 100% Default | $183 |
| Pace Of Southwest Michigan | Pb Xr 100% Default | $183 |
| Union Health Service | Pb Xr 100% Default | $183 |
| Everence | Pb Xr 100% Default | $183 |
| Health Choices | Pb Xr 100% Default | $183 |
| Commonwealth Care Alliance | Pb Xr 100% Default | $183 |
| Asuris Northwest Health | Pb Xr 100% Default | $183 |
| Centurion Of Idaho | Pb Xr 100% Default | $183 |
| United Commercial Travelers | Pb Xr 100% Default | $183 |
| Saint Alphonsus Rehab Hospital | Pb Xr 100% Default | $183 |
| Centivo | Pb Xr 100% Default | $183 |
| Native American | Pb Xr 100% Default | $183 |
| Claimdoc | Pb Xr 100% Default | $183 |
| Community Care Health HMO Oon | Pb Xr 100% Default | $183 |
| Auto Acuity | Pb Xr 100% Default | $183 |
| Pekin | Pb Xr 100% Default | $183 |
| United Healthcare Medicare | Pb Xr 100% Default | $183 |
| Security Health Medicare | Pb Xr 100% Default | $183 |
| Priority Health | Pb Xr 100% Default | $183 |
| Wc Donegal Insurance Group | Pb Xr 100% Default | $183 |
| Prairie States | Pb Xr 100% Default | $183 |
| Upper Peninsula Health Plan (Uphp) Medicare | Pb Xr 100% Default | $183 |
| Rx Benecard Pbf | Pb Xr 100% Default | $183 |
| The Loomis Company | Pb Xr 100% Default | $183 |
| Teresian House | Pb Xr 100% Default | $183 |
| Rx Healthe Systems | Pb Xr 100% Default | $183 |
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