MRI lower back without contrast at Gifford Medical Center. CPT 72148.
What Gifford Medical Center publishes for this service, straight from its standard-charges file, last updated February 12, 2026.
Outpatient / ER
$108cash price (self-pay)
$215list price
$66.39–$3,120range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Blue Cross Blue Shield of New Hampshire | Qualified Health Plan | $95.22 |
| Blue Cross Blue Shield of Vermont | Medicare Advantage | $96.75 |
| Martins Point Health Care | Commercial | $96.75 |
| United Healthcare | Medicare Advantage | $96.75 |
| United Healthcare | VA CCN | $96.75 |
| Blue Cross Blue Shield of New Hampshire | SHOP On Exchange | $129 |
| Blue Cross Blue Shield of Vermont | Vermont Health Plan | $171 |
| Cigna | Commercial | $172 |
| Blue Cross Blue Shield of Vermont | Managed Care | $174 |
| Blue Cross Blue Shield of Vermont | Commercial | $183 |
| Multiplan | Commercial | $200 |
| Aetna of VT | Commercial | $204 |
| United Healthcare | Commercial | $204 |
| Blue Cross Blue Shield of New Hampshire | Commercial | $550 |
| Blue Cross Blue Shield of New Hampshire | SHOP Off Exchange | $550 |
| MVP Health Care of NY | Commercial | $600 |
| MVP Health Care of NY | Medicare Advantage | $600 |
| Harvard Pilgrim Health Care | HMO | $1,400 |
| Harvard Pilgrim Health Care | PPO | $1,400 |
Inpatient
$108cash price (self-pay)
$1,750list price
$159–$3,120range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Blue Cross Blue Shield of New Hampshire | Commercial | $1,295 |
| Blue Cross Blue Shield of New Hampshire | SHOP Off Exchange | $1,295 |
| Blue Cross Blue Shield of Vermont | Vermont Health Plan | $1,400 |
| Cigna | Commercial | $1,400 |
| Harvard Pilgrim Health Care | HMO | $1,400 |
| Harvard Pilgrim Health Care | PPO | $1,400 |
| Blue Cross Blue Shield of Vermont | Managed Care | $1,470 |
| Blue Cross Blue Shield of Vermont | Commercial | $1,487 |
| MVP Health Care of NY | Commercial | $1,487 |
| Multiplan | Commercial | $1,627 |
| Aetna of VT | Commercial | $1,662 |
| United Healthcare | Commercial | $1,662 |
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