CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: HCA Healthone Presbyterian St Luke's

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $421
Cash Discount Price: $2,604
vs. Medicare Baseline: 3.94x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at HCA Healthone Presbyterian St Luke's is $421. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,604. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 3.94x the Medicare baseline. Located in 1719 E 19Th Ave, Denver, CO.

Cash / Self-Pay

$2,604

Average discount available for prompt cash payment at this facility.

Insurance Median

$421

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$106.81

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $106.81 (100%)

Cash / Self-Pay: $2,604 (2438%)

Insurance Median: $421 (394%)

Cash: $2,604 (2438% of Medicare)

Ins. Median: $421 (394% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $106.81 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 394% of the Medicare baseline (a markup of 294%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Vail Health	$79 - $712	74%
United	$108 - $2,109	101%
Blue Cross Blue Shield	$115 - $3,468	108%
Cigna	$151 - $2,999	141%
Aetna	$156 - $1,763	146%
Bright Health	$156 - $1,406	146%
Pinnacol Workers Comp	$169	158%
Multiplan	$176 - $4,218	165%
Rocky Mountain Health Plan	$245	229%
Emerging Therapy Solutions	$250 - $2,999	234%
Kaiser National Transplant	$250 - $2,249	234%
Colorado Program For Children With Special Needs	$266 - $2,390	249%
Western Plains Community Health	$339 - $3,046	317%
Northcare	$365 - $3,280	342%
Physician Health Partners	$365 - $3,280	342%
Medical Development International	$417 - $3,749	390%
Prime Health	$469 - $4,218	439%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $2,604.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 72131.

Insurance In-Network Protection Plan

Contact your insurance company to confirm HCA Healthone Presbyterian St Luke's is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 72131.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.