MRI lower back without contrast at Methodist Southlake Medical Center. CPT 72148.
What Methodist Southlake Medical Center publishes for this service, straight from its standard-charges file, last updated March 23, 2026.
Outpatient / ER
$1,473cash price (self-pay)
$4,910list price
$187–$4,910range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Champva [1000] | Mhs Hb Tricare Msmc | $231 |
| Tricare [1001] | Mhs Hb Tricare Msmc | $231 |
| Ust Health Proof [1005] | Mhs Hb UHC Medicare Complete Msmc | $240 |
| United Healthcare Medicare Managed Care [3044] | Mhs Hb UHC Medicare C | $240 |
| Globalhealth [1003] | Mhs Hb Global Health Msmc | $252 |
| Humana Commercial [2051] | Mhs Hb Humana Medicare Msmc | $254 |
| United Healthcare Managed Care [3021] | Mhs Hb UHC Exchange Msmc | $257 |
| Oscar Insurance Company [2057] | Mhs Hb Oscar HMO Msmc | $312 |
| Bright Healthcare [2222] | Mhs Hb Bright Health Msmc | $336 |
| Molina [3017] | Mhs Hb Molina Marketplace Msmc | $348 |
| Aetna [3000] | Mhs Hb Aetna Exchange Msmc | $389 |
| Aetna [3000] | Mhs Hb Aetna Cvs Msmc | $389 |
| Allied National [2031] | Mhs Hb 90 Degree Msmc | $396 |
| Entrust/90 Degree [2058] | Mhs Hb 90 Degree Msmc | $396 |
| Cigna [3004] | Mhs Hb Custom Ink Msmc | $444 |
| Evry Health [1013] | Mhs Hb Evry Msmc | $480 |
| Healthscope Benefits [2052] | Mhs Hb Dart Member Care Msmc | $648 |
| Dart Member Care [3039] | Mhs Hb Dart Member Care Msmc | $648 |
| BCBS [3001] | Mhs Hb BCBS My Blue Health Msmc | $837 |
| Friday Health Plan [2061] | Mhs Hb Friday Health Msmc | $850 |
| Aetna Commercial [2042] | Mhs Hb Aetna TX Pref Plus II Msmc | $1,241 |
| Aetna Managed Care [2068] | Mhs Hb Aetna TX Pref Plus II Msmc | $1,241 |
| Aetna Commercial [2042] | Mhs Hb Aetna Texas Advantage Msmc | $1,340 |
| Aetna Managed Care [2068] | Mhs Hb Aetna Whole Health Msmc | $1,340 |
| Aetna Managed Care [2068] | Mhs Hb Aetna Texas Advantage Msmc | $1,340 |
| BCBS [3001] | Mhs Hb BCBS High Performance Network Msmc | $1,382 |
| BCBS [3001] | Mhs Hb BCBS Premier Msmc | $1,382 |
| BCBS [3001] | Mhs Hb BCBS City Of Dallas Msmc | $1,436 |
| BCBS [3001] | Mhs Hb BCBS HMO Msmc | $1,466 |
| Aetna [3000] | Mhs Hb Aetna HMO PPO Msmc | $1,489 |
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