MRI lower back without contrast at Gundersen Lutheran Medical Center. CPT 72148.
What Gundersen Lutheran Medical Center publishes for this service, straight from its standard-charges file, last updated June 27, 2026.
Outpatient / ER
—cash price (self-pay)
—list price
$103–$4,095range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| ICare | Medicaid HMO | $103 |
| Bcbsmn | Mhcp | $106 |
| Amerigroup | Medicaid HMO | $107 |
| Anthem | Medicaid | $107 |
| Group Health Eau Claire | Medicaid HMO | $107 |
| Group Health of South Central | Medicaid HMO | $107 |
| Iowa Total Care | Medicaid | $107 |
| Managed Health Service | Managed Medicaid | $107 |
| Molina Health | Managed Medicaid | $107 |
| Quartz | Medicaid_Badgercare | $107 |
| UHC | Medicaid | $107 |
| UCARE | Dually Eligible | $233 |
| UCARE | Non-Dually Eligible | $233 |
| UCARE | MSHO/Minnesota Special Needs | $245 |
| Aetna | Medicare Advantage | $253 |
| Amerigroup | Medicare Advantage | $253 |
| Anthem | Medicare HMO/PPO | $253 |
| Health Partners | Medicare Advantage | $253 |
| iCare | Medicare Advantage | $253 |
| Medical Associates | Medicare Advantage | $253 |
| Quartz | Medicare Advantage | $253 |
| UHC | Medicare Advantage | $253 |
| BCBSMN | All Products | $510 |
| Alliance | Premier/All Products | $3,900 |
| Alliance | Comprehensive/All Products | $4,095 |
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