CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Caribou Medical Center

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $1,884
Cash Discount Price: $1,388
vs. Medicare Baseline: 17.64x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Caribou Medical Center is $1,884. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,388. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 17.64x the Medicare baseline. Located in 300 South 3Rd West, Soda Springs, ID.

Cash / Self-Pay

$1,388

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,884

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: $1,388 (1300%)

Insurance Median: $1,884 (1764%)

Cash: $1,388 (1300% of Medicare)

Ins. Median: $1,884 (1764% 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 1764% of the Medicare baseline (a markup of 1664%). 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
Humana	$892	835%
Pacific Source Mcr Adv	$892	835%
Regence Blue Shield Mcr	$892	835%
Select Health Mcr Adv	$892	835%
Select Health/Bright Path Mcr Adv	$892	835%
Blue Cross Blue Shield	$901 - $1,943	844%
Aetna	$1,249 - $1,943	1169%
First Choice Health-All Plans	$1,785	1671%
Bc Qualified Hp (Qhp)	$1,844	1726%
Deseret Healthcare-All Plans	$1,884	1764%
Pacific Source-All Other Plans	$1,924	1801%
UnitedHealthcare	$1,924	1801%
Cigna	$1,943	1819%
Montana Health Co-Op-All Plans	$1,943	1819%
Regence Blue Shield-All Other Plans	$1,943	1819%
Select Health-All Other Plans	$1,943	1819%

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 $1,388.
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 Caribou Medical Center 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.