CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Kootenai Health

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $121
Cash Discount Price: $881
vs. Medicare Baseline: 1.13x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Kootenai Health is $121. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $881. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.13x the Medicare baseline. Located in 2003 Kootenai Health Way, Coeur D'Alene, ID.

Cash / Self-Pay

$881

Average discount available for prompt cash payment at this facility.

Insurance Median

$121

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: $881 (825%)

Insurance Median: $121 (113%)

Cash: $881 (825% of Medicare)

Ins. Median: $121 (113% 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
Coordinated Care Of Washington	$29 - $91	27%
Molina Healthcare Of Idaho	$29 - $435	27%
Molina Healthcare Of Washington	$29 - $91	27%
Blue Cross Blue Shield	$44 - $1,058	41%
Humana	$44 - $121	41%
Premera	$44 - $726	41%
Regence Blue Shield Of Idaho	$44 - $121	41%
UnitedHealthcare	$44 - $1,058	41%
Pacificsource	$45 - $962	42%
Aetna	$47 - $975	44%
Group Health/Kaiser	$63 - $389	59%
Magellan	$93 - $137	87%
Wellpoint	$93 - $137	87%
Mountain Health Co-Op	$911	853%
Cigna	$962 - $976	901%
Interwest Health	$999	935%
First Choice Health (Ameriben)	$1,002 - $1,018	938%

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 $881.
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 Kootenai Health 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.