MRI lower back without contrast at Ascension SE Wisconsin Hospital - Franklin Campus. CPT 72148.
What Ascension SE Wisconsin Hospital - Franklin Campus publishes for this service, straight from its standard-charges file, last updated January 1, 2026.
Outpatient / ER
$1,342cash price (self-pay)
$2,532list price
$235–$1,975range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Medicare Replacement | 1205_medicare Replacement Outpatient 20250101 | $235 |
| Veterans Administration | 1208_veteran Administration Outpatient 20250 | $235 |
| Smart Health | 1206_smarthealth Outpatient 20250101 | $329 |
| Wps | 1272_wisconsin Physician Services PPO 20250701 | $487 |
| United Health Care | 1282_united Health Care 20250701 | $518 |
| Trilogy | 1271_trilogy 20250701 | $836 |
| Cigna | 1273_cigna 20250701 | $1,975 |
Inpatient
—cash price (self-pay)
—list price
$235–$329range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Medicare Replacement | 1321_medicare Replacement Inpatient 20251001 | $235 |
| Veterans Administration | 1323_veteran Administration Inpatient 202510 | $235 |
| Smart Health | 1317_smarthealth Inpatient 20251001 | $329 |
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All common services at Ascension SE Wisconsin Hospital - Franklin Campus