MRI lower back without contrast at HSHS St. Mary's Hospital Medical Center. CPT 72148.
What HSHS St. Mary's Hospital Medical Center 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
$53.34–$3,542range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Anthem | Antehm Medicaid | $107 |
| Community Care Family Care | Community Care Family Care Medicaid Manag | $107 |
| Continuus Medicaid Managed | Continuus Medicaid Managed | $107 |
| Managed Health Services | Managed Health Services Medicaid | $107 |
| Meridian Health Plan | Meridian HMO Mcd | $107 |
| Molina Healthcare | Molina Medicaid | $113 |
| Aetna | Aetna Medicare | $233 |
| Anthem | Anthem Medicare Advantage HMO | $233 |
| Humana | Humana Medicare Advantage | $233 |
| Medicare Managed | Managed Medicare No Sequestration | $233 |
| Molina Healthcare | Molina Medicare | $233 |
| Naphcare | All Commerical Naphcare | $524 |
| 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 |
| Humana | Humana Choice Care HMO | $2,383 |
| Humana | Humana Natiional POS HMO | $2,383 |
| Cigna | All Commercial Cigna | $2,479 |
| Health Eos | All Commercial Health Eos | $2,515 |
| Healthsmart | All Commercial Healthsmart | $2,586 |
| Interplan | All Commercial Interplan Health Group | $2,586 |
| Network Health Plan | All Commerical Network Health Plan | $2,657 |
| Health Care Alliance | The Alliance | $2,975 |
| Multiplan/Phcs | All Commercial Multiplan | $2,975 |
| Choicecare | All Commercial Choice Care | $3,011 |
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All common services at HSHS St. Mary's Hospital Medical Center