MRI lower back without contrast at Dell Children's Medical Center (Ascension Seton). CPT 72148.
What Dell Children's Medical Center (Ascension Seton) publishes for this service, straight from its standard-charges file, last updated June 17, 2024.
Outpatient / ER
—cash price (self-pay)
—list price
$139–$1,969range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Champva | 1136_champva Austin 20180301 | $156 |
| Champva | 1135_champva Rest_tx 20180301 | $178 |
| Superior Ambetter | 2498_superior Ambetter (Chi,Dcn) 20220901 | $211 |
| Amerigroup Chip | 2344_amerigroup Chip/Star Kids (Chi,Dcn) 20220901 | $212 |
| Amerigroup Star | 2295_chirp Amerigroup Star (Chi,Dcn) 20220901 | $212 |
| BCBS Star | 2296_chirp Blue Cross Star (Chi,Dcn) 20220901 | $212 |
| Dell Chip | 2365_dell Chip/Star Kids (Chi,Dcn) 20220901 | $212 |
| Dell Star | 2297_chirp Dell Star (Chi,Dcn) 20220901 | $212 |
| BCBS Chip | 2354_blue Cross Chip/Star Kids (Chi,Dcn) 20220901 | $213 |
| BCBS Bav Exchange | 2564_blue Cross Blue Shield Bav Exchange 20230101 | $237 |
| Humana HMO | 2668_humana HMO 20230701 | $250 |
| Tricare | 1229_tricare Cah Outpatient 20170101 | $264 |
| Tricare | 475_tricare Outpatient 20161001 | $264 |
| Seton Performance Plus | 785_seton Performance EPO PPO (Aus,Nw,Sw,Hay) | $755 |
| Seton Performance Plus | 788_seton Performance EPO PPO (Wil,Del,Brk,Ba | $755 |
| BCBS HMO Essentials | 2562_blue Cross Blue Shield HMO Essentials 20230 | $806 |
| BCBS PPO | 2560_blue Cross Blue Shield PPO 20230101 | $894 |
| Aetna HMO | 2691_aetna HMO 20230701 | $1,238 |
| Aetna Aco HMO | 2692_aetna Aco HMO 20230701 | $1,378 |
| Aetna Multi-Tier Whole Health Sha | 2693_aetna Multi-Tier Whole Health | $1,428 |
| Cigna Oap | 1141_cigna Oap (Wil,Del,Brk) 20190701 | $1,478 |
| Cigna Oap | 1142_cigna Oap (Aus,Nw,Sw,Hay) 20190701 | $1,478 |
| Aetna | 235_aetna POS 20140601 | $1,549 |
| Aetna Choice | 236_aetna Elect Choice 20140601 | $1,549 |
| Aetna HMO Exchange | 1377_aetna HMO Exchange 20200101 | $1,571 |
| Cigna HMO | 2666_cigna HMO (Aus,Nw,Sw,Hay) 20230701 | $1,750 |
| Cigna HMO | 2667_cigna HMO (Wil,Del) 20230701 | $1,750 |
| Aetna Sha Aisd | 2694_aetna Sha Aisd 20230701 | $1,969 |
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All common services at Dell Children's Medical Center (Ascension Seton)