MRI lower back without contrast at HSHS St. Clare Memorial Hospital. CPT 72148.
What HSHS St. Clare Memorial Hospital publishes for this service, straight from its standard-charges file, last updated March 24, 2026.
Outpatient / ER
$2,338cash price (self-pay)
$3,542list price
$122–$3,542range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Anthem | Antehm Medicaid | $392 |
| Community Care Family Care | Community Care Family Care Medicaid Manag | $392 |
| Continuus Medicaid Managed | Continuus Medicaid Managed | $392 |
| Managed Health Services | Managed Health Services Medicaid | $392 |
| Meridian Health Plan | Meridian HMO Mcd | $392 |
| Molina Healthcare | Molina Medicaid | $415 |
| Aetna | Aetna Medicare | $850 |
| Anthem | Anthem Medicare Advantage HMO | $850 |
| Humana | Humana Medicare Advantage | $850 |
| Molina Healthcare | Molina Medicare | $850 |
| Security Health Plan | Medicare Advantage Security Health Plan Of Wi | $859 |
| Anthem | Anthem POS/HMO | $1,430 |
| Anthem | Anthem PPO | $1,430 |
| P360 Small Group | Prevea 360 Small Group Commercial Plan | $1,444 |
| Prevea Health Network | Prevea Employees | $1,444 |
| Prevea Health Network | Prevea360 | $1,444 |
| Prevea Health Network | Prevea360 - Network | $1,444 |
| Hshs Employees | Hshs Employees | $1,721 |
| Molina Healthcare Of Wi | All Commerical Molina Marketplace | $1,771 |
| Naphcare | All Commerical Naphcare | $1,913 |
| Cigna | All Commercial Cigna | $2,214 |
| Security Health Plan | All Commercial Security Health Plan Broad Netwo | $2,261 |
| Triology | All Commercial Triology | $2,798 |
| Arise Health Plan | All Commercial Arise Health Plan | $2,834 |
| Health Care Alliance | The Alliance | $2,975 |
| Choicecare | All Commercial Choice Care | $3,011 |
| Humana | All Commercial Humana Hpn Choicecare | $3,011 |
| Humana | Humana Choice Care PPO | $3,011 |
| Humana | Humana Natiional POS HMO | $3,011 |
| Health Eos | All Commercial Health Eos | $3,152 |
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