MRI lower back without contrast at Gundersen TriCounty Hospital and Clinics. CPT 72148.
What Gundersen TriCounty Hospital and Clinics publishes for this service, straight from its standard-charges file, last updated June 27, 2026.
Outpatient / ER
$1,984cash price (self-pay)
$3,129list price
$107–$4,106range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Amerigroup | Medicaid HMO | $107 |
| Anthem | Medicaid | $525 |
| Group Health Eau Claire | Medicaid HMO | $525 |
| Group Health of South Central | Medicaid HMO | $525 |
| Iowa Total Care | Medicaid | $525 |
| Managed Health Service | Managed Medicaid | $525 |
| Quartz | Medicaid_Badgercare | $525 |
| Quartz | All Products | $1,324 |
| Quartz | All Other Self Funded | $1,377 |
| Quartz | Self Funded | $1,471 |
| Quartz | Level Funded | $1,518 |
| UCARE | Non-Dually Eligible | $1,627 |
| UCARE | MSHO/Minnesota Special Needs | $1,627 |
| UCARE | Dually Eligible | $1,627 |
| Quartz | Fully Insured | $1,705 |
| Anthem | Medicare HMO/PPO | $1,846 |
| Humana | Medicare Advantage | $1,846 |
| Quartz | Medicare Advantage | $1,846 |
| UHC | Medicare Advantage | $1,846 |
| UHC | All Payer Appendix | $2,253 |
| Cigna | All Products | $2,412 |
| Alliance | Premier/All Products | $2,503 |
| Group Health of South Central | All Products | $2,503 |
| Trilogy | All Products | $2,503 |
| UCARE | Qualified Health Plan | $2,503 |
| Aspirus Arise Health | All Products | $2,597 |
| Allied National | Core Value Programs | $2,660 |
| Sana | All Products | $2,691 |
| Group Health Eau Claire | All Products | $2,816 |
| Alliance | Comprehensive/All Products | $2,973 |
Inpatient
$1,984cash price (self-pay)
$3,129list price
$1,324–$2,973range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Quartz | All Other Self Funded | $1,843 |
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All common services at Gundersen TriCounty Hospital and Clinics