MRI lower back without contrast at Gundersen Moundview Hospital and Clinics. CPT 72148.
What Gundersen Moundview Hospital and Clinics publishes for this service, straight from its standard-charges file, last updated June 27, 2026.
Outpatient / ER
$2,033cash price (self-pay)
$4,002list price
$107–$4,106range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Amerigroup | Medicaid HMO | $107 |
| Anthem | Medicaid | $672 |
| Group Health Eau Claire | Medicaid HMO | $672 |
| Group Health of South Central | Medicaid HMO | $672 |
| Iowa Total Care | Medicaid | $672 |
| Managed Health Service | Managed Medicaid | $672 |
| Quartz | Medicaid_Badgercare | $672 |
| Alliance | Premier/All Products | $975 |
| Dean Health Plan | ASO | $1,241 |
| Quartz | All Products | $1,693 |
| Quartz | All Other Self Funded | $1,761 |
| Security Health Plan | Medicare Advantage | $1,841 |
| Anthem | Medicare HMO/PPO | $1,841 |
| Health Partners | Medicare Advantage | $1,841 |
| Quartz | Medicare Advantage | $1,841 |
| Security Health Plan | Medicare + Choice | $1,841 |
| UCARE | Dually Eligible | $1,841 |
| Quartz | Self Funded | $1,881 |
| UCARE | MSHO/Minnesota Special Needs | $1,921 |
| UCARE | Non-Dually Eligible | $1,921 |
| Quartz | Level Funded | $1,941 |
| Health Partners | Medicaid HMO | $2,001 |
| Quartz | Fully Insured | $2,181 |
| Health Partners | Medicare Cost | $2,401 |
| Cigna | All Products | $3,086 |
| Anthem | State Specific | $3,123 |
| Alliance | Comprehensive/All Products | $3,202 |
| Group Health of South Central | All Products | $3,202 |
| Trilogy | All Products | $3,202 |
| UCARE | Qualified Health Plan | $3,202 |
Inpatient
$2,033cash price (self-pay)
$4,002list price
$1,693–$3,882range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Quartz | All Other Self Funded | $2,357 |
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All common services at Gundersen Moundview Hospital and Clinics