MRI lower back without contrast at Ascension Seton Northwest (Ascension Seton). CPT 72148.
What Ascension Seton Northwest (Ascension Seton) publishes for this service, straight from its standard-charges file, last updated January 1, 2026.
Outpatient / ER
$1,144cash price (self-pay)
$3,179list price
$156–$1,969range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Champva | 1136_champva Austin 20180301 | $156 |
| BCBS Chip/Chip Perinate | 4168_blue Cross Chip (Chi,Dcn) Outpatient 20 | $199 |
| BCBS Chip/Chip Perinate | 4168_blue Cross Chip/Star Kids (Chi,Dcn) Out | $199 |
| BCBS Chip/Chip Perinate | 4172_blue Cross Chip (Nw) Outpatient 2024120 | $199 |
| BCBS Chip/Chip Perinate | 4172_blue Cross Chip/Star Kids (Nw) Outpatie | $199 |
| BCBS Star Kids | 5003_blue Cross Star Kids (Chi,Dcn) Outpatient 202412 | $199 |
| BCBS Star Kids | 5011_blue Cross Star Kids (Nw) Outpatient 20241201 | $199 |
| Superior Ambetter | 3880_superior Ambetter (Chi,Dcn) Outpatient 202409 | $199 |
| BCBS Star | 3693_chirp Blue Cross Star (Chi,Dcn) Inpatient 20240901 | $211 |
| BCBS Star | 4219_chirp Blue Cross Star (Chi,Dcn) Outpatient 20241201 | $211 |
| BCBS Star | 4223_chirp Blue Cross Star (Nw) Outpatient 20241201 | $211 |
| Dell Chip/Chip Perinate | 4179_dell Chip/Star Kids (Chi,Dcn) Outpatien | $211 |
| Dell Chip/Chip Perinate | 4183_dell Chip/Star Kids (Nw) Outpatient 202 | $211 |
| Dell Star | 4230_chirp Dell Star (Chi,Dcn) Outpatient 20241201 | $211 |
| Dell Star | 4234_chirp Dell Star (Nw) Outpatient 20241201 | $211 |
| Superior Ambetter | 3879_superior Ambetter (Chi,Dcn) Inpatient 2024090 | $211 |
| BCBS Chip/Chip Perinate | 3594_blue Cross Chip/Star Kids (Chi,Dcn) Inp | $213 |
| BCBS Chip/Chip Perinate | 3598_blue Cross Chip/Star Kids (Nw) Inpatien | $213 |
| BCBS Star | 3697_chirp Blue Cross Star (Nw) Inpatient 20240901 | $213 |
| Dell Chip/Chip Perinate | 3605_dell Chip/Star Kids (Chi,Dcn) Inpatient | $213 |
| Dell Chip/Chip Perinate | 3609_dell Chip/Star Kids (Nw) Inpatient 2024 | $213 |
| Dell Star | 3704_chirp Dell Star (Chi,Dcn) Inpatient 20240901 | $213 |
| Dell Star | 3708_chirp Dell Star (Nw) Inpatient 20240901 | $213 |
| Champva | 1135_champva Rest_tx 20180301 | $218 |
| BCBS Bav Exchange | 4127_blue Cross Blue Shield Bav Exchange 20250101 | $247 |
| BCBS Hpn | 4440_blue Cross Blue Shield Hpn 20250501 | $855 |
| BCBS Hpn | 4497_blue Cross Blue Shield Hpn (Dell, Williamson,Hays) 202 | $855 |
| BCBS HMO Essentials | 4095_blue Cross Blue Shield HMO Essentials 20250 | $941 |
| BCBS PPO | 4094_blue Cross Blue Shield PPO 20250101 | $1,042 |
| Superior Star | 3509_chirp Superior Star (Chi,Dcn) Inpatient 20240901 | $1,272 |
Inpatient
—cash price (self-pay)
—list price
$230–$422range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Aarp Mc Wellmed | 4656_medicare Advantage Aarp Wellmed Inpatient (Aus, | $230 |
| Sendero Chap | 4651_sendero Chap Inpatient 20251001 | $232 |
| Addr Cancer Together | 4681_addr Cancer Together Inpatient 20251001 | $234 |
| Aetna Mcr Replacement | 4659_medicare Advantage Aetna Inpatient 202510 | $234 |
| Ascension Complete Medicare Replacement | 4682_medicare Advantage Asce | $234 |
| Covid Hrsa | 4693_covid Hrsa Unin Q80 Inpatient 20251001 | $234 |
| Cshcn Cidc | 4694_cshcn Cidc Ip (Adult) 20251001 | $234 |
| Devoted Health Mcr Replacement | 4684_medicare Advantage Devoted Healt | $234 |
| Humana Mcr Replacement | 4661_medicare Advantage Humana Inpatient (Aus | $234 |
| Medicare Oon | 4666_medicare Advantage Inpatient Oon 20251001 | $234 |
| Medicare Replacement | 4665_medicare Advantage Inpatient 100% 20251001 | $234 |
| Research Study | 4650_research Study Ip 20251001 | $234 |
| Smarthealth | 4680_smarthealth Ip 20251001 | $234 |
| Superior Allwell | 4686_medicare Advantage Superior Allwell Inpatient | $234 |
| Tricare | 4696_tricare Inpatient 20251001 | $234 |
| Wellcare Med Advantage | 4691_medicare Advantage Wellcare Inpatient 20 | $234 |
| Welmed Medicare | 4669_medicare Advantage Welmed Inpatient (Aus,Nw,Sw, | $234 |
| UHC Mcr Replacement | 4687_medicare Advantage United Healthcare Inpati | $239 |
| Connected Senior Care | 4660_medicare Advantage Connected Senior Care | $241 |
| Pphp Mcr Advantage | 4668_medicare Advantage Pphp Inpatient 20251001 | $246 |
| TX Independence Hp | 4671_tx Independence Hp Ip 20251001 | $246 |
| Occunet | 4674_occunet Ip 20251001 | $328 |
| Sendero Idealcare | 4675_sendero Idealcare Ip 20251001 | $410 |
| Superior Ambetter | 4652_superior Ambetter Inpatient 20251001 | $422 |
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All common services at Ascension Seton Northwest (Ascension Seton)