MRI lower back without contrast at Suburban Behavioral Health Campus of Roxborough Memorial Hospital. CPT 72148.
What Suburban Behavioral Health Campus of Roxborough Memorial Hospital publishes for this service, straight from its standard-charges file, last updated September 1, 2026.
Outpatient / ER
$243cash price (self-pay)
$3,951list price
$187–$3,832range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Health Partners Plan | Health Partners Plan Medicaid | $187 |
| Traditional Medicaid | Traditional Medicaid | $187 |
| Humana Military Tricare | Humana Military Tricare | $195 |
| Keystone | Keystone First Medicaid | $198 |
| UHC | UHC Medicaid | $212 |
| Health Partners Plan | Health Partners Plan Medicare | $244 |
| Independence Blue Cross | IBC Medicare | $244 |
| PA Health & Wellness | PA Health & Wellness Medicare & Duals | $244 |
| Traditional Medicare | Traditional Medicare | $244 |
| Tricare | Tricare | $244 |
| UHC | UHC Medicare | $244 |
| UHC | UHC Va Ccn | $244 |
| Providers Partner Health Plan | Provider Partners Health Plan | $251 |
| Keystone | Keystone First Medicare | $254 |
| Ally-Align Medicare | Ally-Align Medicare | $256 |
| Spartan | Spartan Plan | $256 |
| Auto Insurance | Auto Insurance | $268 |
| Worker Compensation | Worker Compensation | $276 |
| PA Health & Wellness | PA Health & Wellness Commercial Insurance Excha | $293 |
| Employer Direct Healthcare | Employer Direct Healthcare | $342 |
| Health Partners Plan | Health Partners Plan Exchange | $366 |
| Naphcare | Naphcare | $378 |
| UHC | UHC Exchange | $384 |
| UHC | UHC Commercial All Payer | $510 |
| Highmark | Highmark Commercial (02-01-2024 to 12-31-2026) | $532 |
| Cigna | Cigna Commercial (05-01-2023 to 12-31-2026) | $577 |
| Independence Blue Cross | IBC Commercial HMO PPO | $1,156 |
| Independence Blue Cross | IBC Indemnity | $1,156 |
| Independence Blue Cross | IBC PPACA | $1,271 |
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All common services at Suburban Behavioral Health Campus of Roxborough Memorial Hospital