MRI lower back without contrast at WellSpan Good Samaritan Hospital. CPT 72148.
What WellSpan Good Samaritan Hospital publishes for this service, straight from its standard-charges file, last updated January 1, 2026.
Outpatient / ER
$454cash price (self-pay)
$2,225list price
$239–$2,128range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Blue_Cross_BlueJourney_Medicare | All_Plans | $239 |
| Highmark_Medicare | All_Plans | $241 |
| Aetna_Advantra_Medicare | All_Plans | $246 |
| Aetna_Medicare | All_Plans | $246 |
| Geisinger_Gold_Medicare | All_Plans | $251 |
| Devoted_Medicare | All_Plans | $251 |
| United_Medicare | ISNP_DSNP_Plans | $251 |
| Highmark_Wholecare_Gateway_Medicare | All_Plans | $252 |
| Amerihealth_Medicare | All_Plans | $252 |
| UPMC_Medicare | UPMC_for_Life_Community_HealthChoices | $252 |
| UPMC_Medicare | UPMC_for_Life_Complete_Care | $252 |
| Jefferson_Health_Medicare_Advantage | All_Plans | $258 |
| PA_Health_&_Wellness_Medicare | All_Plans | $258 |
| Highmark_Wholecare_Gateway_Medicaid | All_Plans | $320 |
| Geisinger_Medicaid | All_Plans | $320 |
| Health_Partners_Medicaid | All_Other_Plans | $320 |
| PA_Health_&_Wellness_Medicaid | All_Plans | $320 |
| UPMC_Medicaid | All_Plans | $320 |
| Blue_Cross | Capital_Blue_Performance_PPO | $325 |
| Amerihealth_Caritas_Medicaid | All_Plans | $364 |
| Highmark | Higmark_Healthy_Kids | $370 |
| Health_Partners_Medicaid | Kidz_Partners | $394 |
| United_Medicaid | Community_Plan_For_Kids | $418 |
| WellSpan_Capital_Blue_Cross | All_Plans | $466 |
| Highmark | Choice_Blue_PPO | $722 |
| Highmark | Performance_Blue | $722 |
| Highmark | Blue_Cross_High_Performance_Network | $722 |
| Highmark | All_Other_Plans | $870 |
| Aetna_Better_Health_Kids | All_Plans | $871 |
| Cigna | All_Plans | $1,158 |
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