MRI lower back without contrast at Dallam Hartley Counties Hospital District. CPT 72148.
What Dallam Hartley Counties Hospital District publishes for this service, straight from its standard-charges file, last updated May 4, 2026.
Outpatient / ER
$125cash price (self-pay)
$166list price
$66.49–$157range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| BCBS Blue Advantage | PPO | $66.49 |
| Baylor Scott and White Medicare Advantage | HMO | $96.41 |
| BCBS Blue Essentials HMO | HMO | $105 |
| Cigna Commercial | PPO | $113 |
| BCBS Blue Traditional/PPO | PPO | $116 |
| United Healthcare Commercial | PPO | $130 |
| Provider Network of America | PPO | $145 |
| Baylor Scott and White Medicaid Replacement | HMO | $157 |
Inpatient
$125cash price (self-pay)
$166list price
$1.00–$121range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| United Healthcare Commercial | PPO | $1.00 |
| BCBS Blue Advantage | PPO | $93.09 |
| BCBS Blue Essentials HMO | HMO | $105 |
| BCBS Blue Traditional/PPO | PPO | $116 |
| Cigna Commercial | PPO | $121 |
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All common services at Dallam Hartley Counties Hospital District