CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Kohala Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $157
Cash Discount Price: $684
vs. Medicare Baseline: 1.47x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Kohala Hospital is $157. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $684. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.47x the Medicare baseline. Located in 54-383 Hospital Road, Kapaau, HI.

Cash / Self-Pay

$684

Average discount available for prompt cash payment at this facility.

Insurance Median

$157

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: $684 (640%)

Insurance Median: $157 (147%)

Cash: $684 (640% of Medicare)

Ins. Median: $157 (147% 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.

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
Uha	$45 - $362	42%
Alohacare	$60 - $157	56%
Kaiser	$60 - $947	56%
Ohana	$60 - $157	56%
Hmsa	$120 - $372	112%
Humana	$120	112%
UnitedHealthcare	$120 - $178	112%
#	$247 - $278	231%
Hmaa	$323 - $501	302%
Hma	$369	345%
Dmba	$842	788%
Mdx	$1,020	955%

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 $684.
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 Kohala Hospital 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.