MRI lower back without contrast at Froedtert West Bend Hospital. CPT 72148.
What Froedtert West Bend Hospital publishes for this service, straight from its standard-charges file, last updated December 31, 2025.
Outpatient / ER
$2,604cash price (self-pay)
$4,734list price
$235–$4,497range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Allwell | Medicare Advantage | $235 |
| Anthem Blue Cross Blue Shield | Medicare Advantage | $235 |
| Community Care | Medicare Advantage | $235 |
| Health Partners | Medicare Advantage | $235 |
| Humana | Medicare Advantage | $235 |
| ICare | Medicare Advantage | $235 |
| Molina | Medicare Advantage | $235 |
| Network Health Plan | Medicare Advantage | $235 |
| Security Health Plan Secure Savers | Medicare Advantage | $235 |
| United Healthcare | Medicare Advantage | $235 |
| Aetna | Medicare Advantage | $239 |
| Care Wisconsin | Medicare Advantage | $242 |
| Centivo | WI 2 Median | $1,420 |
| Centivo | WI 1 Broad | $1,562 |
| UMR | MCW Employees | $1,562 |
| Network Health Plan | ACA | $1,692 |
| United Healthcare | Nexus | $1,732 |
| Network Health Plan | All Contracted Commercial Payers | $1,880 |
| Froedtert South | All Contracted Commercial Plans | $1,988 |
| United Healthcare | Choice Plus/Navigate | $2,035 |
| Chorus Community Health Plan | All Contracted Commercial Plans | $2,036 |
| Anthem Blue Cross Blue Shield | HMO | $2,188 |
| United Healthcare | Options PPO | $2,440 |
| Common Ground | All Contracted Commercial Plans | $2,840 |
| Sheboygan Employers Health Network | All Contracted Commercial Payers | $2,854 |
| Health Payment Systems | Group Specific | $2,981 |
| Health Partners | All Contracted Commercial Plans | $3,077 |
| Aetna | All Contracted Commercial Plans | $3,314 |
| Wisconsin Physician Services | All Contracted Commercial Plans | $3,787 |
| Health Payment Systems | Other Commercial Plans | $3,827 |
Inpatient
$2,604cash price (self-pay)
$4,734list price
$2,840–$4,497range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Common Ground | All Contracted Commercial Plans | $2,840 |
| Health Payment Systems | Group Specific | $2,981 |
| Aetna | All Contracted Commercial Plans | $3,314 |
| Health Payment Systems | Other Commercial Plans | $3,827 |
| Trilogy | All Contracted Commercial Plans | $3,882 |
| Americas Choice | PPO | $4,119 |
| HealthEos | All Contracted Commercial Plans | $4,119 |
| Multiplan/Private Healthcare Systems | All Contracted Commercial Plans | $4,119 |
| First Health Network | All Contracted Commercial Plans | $4,166 |
| Hfn | PPO | $4,261 |
| IBSI Passport | All Contracted Commercial Plans | $4,261 |
| Cigna | All Contracted Commercial Plans | $4,497 |
| HealthSmart | All Contracted Commercial Plans | $4,497 |
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