MRI lower back without contrast at Holy Cross Hospital - Davis. CPT 72148.
What Holy Cross Hospital - Davis publishes for this service, straight from its standard-charges file, last updated February 11, 2026.
Outpatient / ER
$2,129cash price (self-pay)
$5,323list price
$85.05–$5,323range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Select Health | Commercial PPO/POS/HMO | $85.05 |
| Managed Medicaid | Managed Medicaid | $95.67 |
| UUHP | Managed Medicaid | $95.67 |
| Humana | Managed Medicare | $110 |
| Managed Medicare | Managed Medicare | $110 |
| Medicare | Medicare | $110 |
| Employer Direct Healthcare | Commercial PPO/POS/HMO | $138 |
| MotivHealth | Commercial PPO/POS/HMO | $146 |
| Regence Blue Cross Blue Shield | Commercial PAR | $233 |
| Regence Blue Cross Blue Shield | Commercial PPO | $233 |
| Regence Blue Cross Blue Shield | Commercial Savewell | $233 |
| Regence Blue Cross Blue Shield | Commercial UVU | $233 |
| Molina | Commercial PPO/POS/HMO | $259 |
| Cigna Healthcare | Commercial Local Plus | $490 |
| Centura Employee Plan | Commercial PPO/POS/HMO/EPO | $543 |
| Cigna Healthcare | Commercial HMO/NBP/OAP | $601 |
| UUHP | Commercial Health Plus | $784 |
| UUHP | Commercial Healthy Preferred | $843 |
| UUHP | Commercial Healthy Premier | $937 |
| Cigna Healthcare | Commercial All Other | $1,018 |
| PEHP | Commercial Capital Network | $2,273 |
| Aetna | Commercial Peak Performance | $2,352 |
| PEHP | Commercial Summit Exclusive | $2,356 |
| PEHP | Commercial Summit | $2,709 |
| Wise | Commercial PPO | $2,768 |
| Aetna | Commercial Standard Network | $2,805 |
| Regence Blue Cross Blue Shield | Commercial Blue Option | $2,954 |
| PEHP | Commercial Advantage | $3,087 |
| Deseret Mutual Benefit Administrators | Commercial PPO/POS/HMO | $3,268 |
| Multiplan | Commercial Primary | $3,673 |
Inpatient
$2,129cash price (self-pay)
$5,323list price
$1,980–$5,323range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Regence Blue Cross Blue Shield | Commercial Savewell | $1,980 |
| PEHP | Commercial Capital Network | $2,273 |
| Molina | Commercial PPO/POS/HMO | $2,286 |
| Aetna | Commercial Peak Performance | $2,352 |
| Regence Blue Cross Blue Shield | Commercial UVU | $2,439 |
| PEHP | Commercial Summit Exclusive | $2,518 |
| Select Health | Commercial PPO/POS/HMO | $2,616 |
| PEHP | Commercial Summit | $2,709 |
| Aetna | Commercial Standard Network | $2,805 |
| Wise | Commercial PPO | $2,821 |
| Regence Blue Cross Blue Shield | Commercial PPO | $2,869 |
| PEHP | Commercial Advantage | $3,087 |
| Regence Blue Cross Blue Shield | Commercial Blue Option | $3,194 |
| Regence Blue Cross Blue Shield | Commercial PAR | $3,194 |
| Deseret Mutual Benefit Administrators | Commercial PPO/POS/HMO | $3,268 |
| Multiplan | Commercial Primary | $3,673 |
| Aetna | Commercial Signature | $3,869 |
| Aetna | Commercial Extended Network | $3,992 |
| Aetna | Commercial Indemnity | $4,258 |
| Aetna Rental Networks | Commercial PPO/POS/HMO | $4,498 |
| EMI Health | Commercial PPO/POS/HMO | $4,631 |
| Multiplan | Commercial Complementary | $4,844 |
| United Healthcare | Commercial Behavioral Health | $5,323 |
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