MRI lower back without contrast at Bellin Memorial Hospital. CPT 72148.
What Bellin Memorial Hospital publishes for this service, straight from its standard-charges file, last updated June 27, 2026.
Outpatient / ER
$608cash price (self-pay)
$1,961list price
$102–$2,348range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Chorus Community Health Plan | Managed Medicaid | $102 |
| Anthem | Managed Medicaid | $102 |
| COMMUNITY CARE | Managed Medicaid | $102 |
| ICARE | Managed Medicaid | $102 |
| Managed Health Service | Managed Medicaid | $102 |
| My Choice | SSI Managed Medicaid | $102 |
| Molina Health | Managed Medicaid | $105 |
| My Choice | BadgerChoice Plus Managed Medicaid | $107 |
| Healthpartners | Select | $119 |
| AETNA | Medicare | $232 |
| ANTHEM | Managed Medicare | $232 |
| COMMUNITY CARE | Medicare Advantage | $232 |
| HUMANA | Medicare Advantage | $232 |
| ICARE | Managed Medicare | $232 |
| Managed Health Service | Medicare Advantage | $232 |
| My Choice | Medicare Advantage | $232 |
| Network Health | Medicare Advantage | $232 |
| Security Health Plan | Medicare Advantage | $232 |
| Healthpartners | Focus | $236 |
| Healthpartners | Broad | $255 |
| Anthem | Priority | $709 |
| Anthem | HMO/POS | $771 |
| United Health Care | HMO | $838 |
| Anthem | PPO | $933 |
| Chorus Community Health Plan | ALL PRODUCTS | $1,261 |
| Cigna Health and Life Insurance Company | ALL PRODUCTS | $1,369 |
| HPS/Paymedix | Medical Rental Network Tier 1 | $1,412 |
| Security Health Plan | All Products | $1,490 |
| WPS Insurance | BROAD | $1,523 |
| HPS/PayMedix | Medical Rental Network Tier 2 | $1,530 |
Inpatient
$608cash price (self-pay)
$1,961list price
$844–$2,348range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Cigna Health and Life Insurance Company | ALL PRODUCTS | $1,384 |
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