MRI lower back without contrast at Intermountain Health Orem Community Hospital. CPT 72148.
What Intermountain Health Orem Community Hospital publishes for this service, straight from its standard-charges file, last updated August 5, 2026.
Outpatient / ER
$3,095cash price (self-pay)
$4,127list price
$69.44–$3,920range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Health Plan of Nevada | Medicaid | $121 |
| SelectHealth | Med Individual ACA | $121 |
| SelectHealth | Medicaid | $121 |
| SelectHealth | Signature Individual ACA | $121 |
| SelectHealth | Value Individual ACA | $121 |
| Aetna | Medicare Adv HMO | $121 |
| Aetna | Medicare Adv PPO | $121 |
| American Health | Medicare Adv UT HMO I-SNP | $121 |
| Health Partners of Nevada | Medicare Advantage | $121 |
| Healthy U | Medicaid | $121 |
| Humana | Medicare Choice PPO | $121 |
| Molina | Medicaid | $121 |
| Molina | Medicare Advantage | $121 |
| Molina | Medicare Choice Care HMO | $121 |
| Molina | Medicare Complete Care HMO SNP | $121 |
| Regence BCBS | MedAdvantage PPO | $121 |
| SelectHealth | Medicare Advantage | $121 |
| UHC | Medicare Advantage | $121 |
| Intermountain Caregiver Plan | Share Network | $1,202 |
| SelectHealth | FEHBP | $1,202 |
| Intermountain Caregiver Plan | Med Network | $1,322 |
| SelectHealth | CHP | $1,322 |
| SelectHealth | Commercial | $1,322 |
| EMI | Commercial | $1,646 |
| Deseret Mutual | All Other | $1,718 |
| Deseret Mutual | Select | $1,718 |
| Regence BCBS | BlueOption | $1,806 |
| AWH Connected | Connected Utah | $1,863 |
| EMI Health | Mint | $1,964 |
| EMI Health | Network Care | $1,964 |
Inpatient
$3,095cash price (self-pay)
$4,127list price
$99.04–$3,920range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Donor Connect | Other | $99.04 |
| Health Plan of Nevada | Medicaid | $1,238 |
| Intermountain Caregiver Plan | Share Network | $1,750 |
| Intermountain Caregiver Plan | Med Network | $1,989 |
| SelectHealth | CHP | $1,989 |
| SelectHealth | Commercial | $1,989 |
| EMI | Commercial | $2,228 |
| Deseret Mutual | All Other | $2,373 |
| Deseret Mutual | Select | $2,373 |
| Regence BCBS | BlueOption | $2,548 |
| Cigna | Open Access Flex | $2,600 |
| AWH Connected | Connected Utah | $2,620 |
| EMI Health | Mint | $2,864 |
| EMI Health | Network Care | $2,864 |
| PEHP | Advantage State | $2,872 |
| BYU Risk Management | Workers Comp | $2,889 |
| Corporation of the President | Workers Comp | $2,889 |
| Regence BCBS | High Performance | $2,889 |
| Regence BCBS | FEHBP | $2,909 |
| PEHP | Advantage Non-State | $2,930 |
| AG Administrators | USU Athletics | $2,971 |
| BYU Athletics | Commercial | $2,971 |
| Campbell Scientific | Commercial | $2,971 |
| CorVel Corporation | Workers Comp | $2,971 |
| Franklin County | Commercial | $2,971 |
| Juniper Systems | Commercial | $2,971 |
| LW Miller | Commercial | $2,971 |
| Injury Care of Nevada | Workers Comp | $3,095 |
| Regence BCBS | Traditional | $3,136 |
| Managed Care Admin | Commercial | $3,219 |
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All common services at Intermountain Health Orem Community Hospital