MRI lower back without contrast at Lake Granbury Medical Center. CPT 72148.
What Lake Granbury Medical Center publishes for this service, straight from its standard-charges file, last updated April 1, 2026.
Outpatient / ER
$417cash price (self-pay)
$2,318list price
$139–$6,223range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| NODE Tricare | NODE Tricare | $228 |
| NODE ChampVA | NODE ChampVA | $240 |
| NODE Aetna CHIP Medicaid TX | NODE Aetna CHIP Medicaid TX | $294 |
| NODE Cook Childrens Health Plan CHIP Medicaid TX | NODE Cook Childrens | $294 |
| Medicaid | NODE TX Medicaid | $294 |
| NON PAR TX Medicaid | NODE TX Medicaid NON PAR | $294 |
| NODE UHC CHIP/STAR KIDS Medicaid TX | NODE UHC CHIP Medicaid TX | $294 |
| NODE UHC STAR KIDS Medicaid TX | NODE UHC STAR KIDS Medicaid TX | $294 |
| NODE UHC STAR Medicaid TX | NODE UHC STAR Medicaid TX | $294 |
| Healthspring | NODE Cigna Healthspring Medicaid TX | $309 |
| NODE Molina CHIP Medicaid TX | NODE Molina CHIP Medicaid TX | $309 |
| NODE Molina Medicaid TX | NODE Molina STAR Medicaid TX | $309 |
| Amerigroup | NODE Wellpoint CHIP Medicaid TX | $331 |
| NODE Superior CHIP/STAR KIDS/ STAR HEALTH Medicaid TX | NODE Superior | $338 |
| NODE Superior STAR KIDS Medicaid TX | NODE Superior STAR KIDS Medicaid | $338 |
| Superior | NODE Superior STAR Medicaid TX | $338 |
| NODE Superior STAR PLUS Medicaid TX | NODE Superior STAR PLUS Medicaid | $338 |
| BCBS TX | BCBS TX Blue ADV | $377 |
| NODE Aetna STAR KIDS Medicaid TX | NODE Aetna STAR KIDS Medicaid TX | $400 |
| NODE Cook Childrens Health Plan STAR KIDS Medicaid TX | NODE Cook Chil | $400 |
| CHS Group Health Plan BCBST | CHS Group Health Plan BCBST | $584 |
| Cigna | Cigna New Business | $589 |
| United Healthcare | NODE UHC STAR PLUS Medicaid TX | $912 |
| Cigna | Cigna ALL | $913 |
| NODE Molina STAR PLUS Medicaid TX | NODE Molina STAR PLUS Medicaid TX | $958 |
| Aetna | Aetna Whole Health | $1,055 |
| Aetna | NODE Aetna STAR Medicaid TX | $1,059 |
| NODE Cook Childrens Health Plan Medicaid TX | NODE Cook Childrens Heal | $1,059 |
| Aetna | Aetna NBD | $1,113 |
| Aetna | Aetna PPO HMO | $1,240 |
Inpatient
$626cash price (self-pay)
$2,318list price
$255–$6,223range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Self Pay | Self Pay | $255 |
| CHS Group Health Plan BCBST | CHS Group Health Plan BCBST | $584 |
| Cigna | Cigna New Business | $589 |
| United Healthcare | UHC APA | $985 |
| Aetna | Aetna Whole Health | $1,055 |
| Aetna | Aetna NBD | $1,113 |
| Aetna | Aetna PPO HMO | $1,240 |
| Healthsmart | Healthsmart ACCEL | $1,275 |
| Aetna | Aetna NAB First Health Rental | $1,319 |
| Aetna | Aetna Auto | $1,592 |
| Healthsmart | Healthsmart PPO HPO | $1,623 |
| Santa Fe Hospital Association | Santa Fe Hospital Association | $1,854 |
| Multiplan | Multiplan Complementary | $2,040 |
| Galaxy Health | Galaxy Health PPO | $2,202 |
| MedCorp Southwest | MedCorp Southwest | $2,202 |
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