MRI lower back without contrast at Pennsylvania Hospital. CPT 72148.
What Pennsylvania Hospital publishes for this service, straight from its standard-charges file, last updated March 20, 2026.
Outpatient / ER
$9,181cash price (self-pay)
$9,181list price
$187–$9,181range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Managed Medicaid Other | Managed Medicaid Other | $187 |
| PA Health and Wellness Medicaid | PA Health and Wellness Medicaid | $215 |
| Keystone Mercy Health Plan | Keystone Mercy Health Plan | $240 |
| TriCare | TriCare | $251 |
| PA Medical Assistance | Medicaid | $256 |
| UPMC | UPMC Medicaid | $280 |
| US Family Health Plan | US Family Health Plan | $288 |
| UnitedHealthcare Community (fka AmeriChoice MA) | UnitedHealthcare Com | $369 |
| UnitedHealthcare | UnitedHealthcare Compass Exchange | $482 |
| Keystone HMO Proactive | Keystone HMO Proactive | $522 |
| Independence Blue Cross/Keystone Health Plan East | Keystone Health Pl | $522 |
| IBC Commercial HPN | IBC Commercial HPN | $539 |
| Horizon Blue Cross of New Jersey | Horizon Blue Cross of NJ-PPO | $650 |
| Horizon Blue Cross of New Jersey | Horizon Blue Cross of NJ-Indemnity | $650 |
| UnitedHealthcare New Business | UnitedHealthcare New Business | $1,022 |
| Independence Blue Cross/Personal Choice | Personal Choice-IBC PPO | $1,031 |
| UnitedHealthcare Non Options | UnitedHealthcare Non Options | $1,441 |
| Horizon NJ Health | Horizon NJ Health | $1,614 |
| PGM - Regie de l'assurance Maladie Quebec | PGM - Regie de lassurance | $2,112 |
| Preferred Health Care Eliance | Preferred Health Care Eliance | $2,387 |
| PGM - Kuwait Defense | PGM - Kuwait Defense | $3,213 |
| Qualcare | Qualcare | $3,489 |
| Wissahickon Hospice | Wissahickon Hospice | $3,672 |
| Pgm - Chop | Pgm - Chop | $3,672 |
| Olympus | Olympus | $4,462 |
| URN-Cancer Resource Services | URN-Cancer Resource Services | $4,591 |
| PGM - Royal Embassy of Saudi Arabia | PGM - Royal Embassy of Saudi Ara | $5,509 |
| PGM - Ontario Ministry of Health and Long-Term Care (OHIP) | PGM - Ont | $5,968 |
| PGM - Embassy of Qatar | PGM - Embassy of Qatar | $5,968 |
| PGM - Embassy of the United Emirates/IPC | PGM - Embassy of the United | $6,427 |
Inpatient
$9,181cash price (self-pay)
$9,181list price
$1,552–$9,181range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Horizon NJ Health | Horizon NJ Health | $1,552 |
| PGM - Regie de l'assurance Maladie Quebec | PGM - Regie de lassurance | $2,112 |
| Preferred Health Care Eliance | Preferred Health Care Eliance | $2,387 |
| Devon | Devon Premier | $3,489 |
| Pgm - Chop | Pgm - Chop | $3,672 |
| Coventry | HealthAmerica/Coventry SEPA | $3,672 |
| PGM - Kuwait Defense | PGM - Kuwait Defense | $4,131 |
| HealthAmerica/Coventry | HealthAmerica/HealthAssurance | $4,499 |
| URN-Cancer Resource Services | URN-Cancer Resource Services | $4,591 |
| First Health Global | First Health Global | $4,591 |
| Coventry | Coventry of Delaware | $4,682 |
| PGM - Royal Embassy of Saudi Arabia | PGM - Royal Embassy of Saudi Ara | $5,509 |
| Health Net | Health Net | $5,509 |
| PGM - Ontario Ministry of Health and Long-Term Care (OHIP) | PGM - Ont | $5,968 |
| Preferred Care | Preferred Care | $7,345 |
| PGM - Kuwait Oil | PGM - Kuwait Oil | $7,345 |
| PGM - Kuwait Health Division | PGM - Kuwait Health Division | $7,345 |
| Intergroup | Intergroup | $7,345 |
| Humana Choice Care | Humana Choice Care | $7,345 |
| Health America/CCN | First Health/ Coventry National | $7,345 |
| Devon Health Services Inc | Devon Health Services | $7,345 |
| UPMC | UPMC Medicaid | $9,181 |
| UnitedHealthcare Non Options | UnitedHealthcare Non Options | $9,181 |
| United Behavioral Health | United Behavioral Health | $9,181 |
| Quest Behavioral Health | Quest Behavioral Health | $9,181 |
| Managed Medicaid Other | Managed Medicaid Other | $9,181 |
| International PFS | International PFS | $9,181 |
| Horizon Blue Cross of New Jersey | Horizon Blue Cross of NJ-PPO | $9,181 |
| Horizon Blue Cross of New Jersey | Horizon Blue Cross of NJ-Indemnity | $9,181 |
| Health Partners | Health Partners Medicaid | $9,181 |
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