MRI lower back without contrast at Froedtert Holy Family Memorial Hospital. CPT 72148.
What Froedtert Holy Family Memorial Hospital publishes for this service, straight from its standard-charges file, last updated December 31, 2025.
Outpatient / ER
$1,650cash price (self-pay)
$3,000list price
$230–$2,640range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Anthem Blue Cross Blue Shield | Medicare Advantage | $230 |
| Community Care Incorporated | Medicare Advantage | $230 |
| Health Partners | Medicare Advantage | $230 |
| Humana | Medicare Advantage | $230 |
| ICare | Medicare Advantage | $230 |
| Molina | Medicare Advantage | $230 |
| Network Health Plan | Medicare Advantage | $230 |
| Security Health Plan | Medicare Advantage | $230 |
| United Healthcare | Medicare Advantage | $230 |
| Allwell | Medicare Advantage | $235 |
| Molina | Marketplace Plans | $248 |
| Medical College of Wisconsin | Employee Plan | $990 |
| Centivo | WI 2 Median | $1,200 |
| Centivo | WI 1 Broad | $1,380 |
| Dean Health Plan | All Plans | $1,500 |
| Health Payment Systems | All Contracted Commercial Plans | $1,551 |
| United Healthcare | Manitowoc Schools | $1,628 |
| Network Health Plan | ACA | $1,692 |
| United Healthcare | Nexus | $1,732 |
| Sheboygan Employers Health Network | All Contracted Commercial Plans | $1,800 |
| Network Health Plan | HMO | $1,880 |
| Chorus Community Health Plan | Marketplace Plans | $1,929 |
| Health Partners | All Contracted Commercial Plans | $1,950 |
| Trilogy | All Contracted Commercial Plans | $1,980 |
| United Healthcare Choice/Navigate | APA | $2,035 |
| Cigna | All Contracted Commercial Plans | $2,160 |
| WPS Health Plan | All Contracted Commercial Plans | $2,220 |
| Anthem Blue Cross Blue Shield (Healthlink) | HMO/PPO | $2,364 |
| Aspirus | Marketplace Plans | $2,400 |
| HealthEos | All Contracted Commercial Plans | $2,400 |
Inpatient
$1,650cash price (self-pay)
$3,000list price
$1,800–$2,640range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Sheboygan Employers Health Network | All Contracted Commercial Plans | $1,800 |
| Trilogy | All Contracted Commercial Plans | $1,980 |
| Cigna | All Contracted Commercial Plans | $2,160 |
| Aspirus | Marketplace Plans | $2,400 |
| HealthEos | All Contracted Commercial Plans | $2,400 |
| Multiplan/Private Healthcare Systems | All Contracted Commercial Plans | $2,400 |
| Preferred One | All Contracted Commercial Plans | $2,400 |
| Security Health Plan | All Contracted Commercial Plans | $2,400 |
| HealthSmart | All Contracted Commercial Plans | $2,490 |
| First Health Network | All Contracted Commercial Plans | $2,640 |
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All common services at Froedtert Holy Family Memorial Hospital