CMS Price Transparency Data
CT scan, lower back (lumbar spine)
Facility: Saint Joseph Regional Medical Center - Plymouth
Billing Code: 72131 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 72131
- Insurance Median: $1,901
- Cash Discount Price: $2,060
- vs. Medicare Baseline: 17.80x Medicare
The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Saint Joseph Regional Medical Center - Plymouth is $1,901. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,060. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 17.80x the Medicare baseline. Located in 1915 Lake Ave, Plymouth, IN.
Cash / Self-Pay
$2,060
Average discount available for prompt cash payment at this facility.
Insurance Median
$1,901
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: $2,060 (1929%)
Insurance Median: $1,901 (1780%)
Cash: $2,060 (1929% of Medicare)
Ins. Median: $1,901 (1780% 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 1780% of the Medicare baseline (a markup of 1680%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Aetna | $57 - $2,060 | 53% |
| Blue Cross Blue Shield | $57 - $391 | 53% |
| Medicaid / KanCare | $57 - $382 | 53% |
| UnitedHealthcare | $57 - $878 | 53% |
| Medicare (plans) | $111 - $113 | 104% |
| Meridian Complete | $111 | 104% |
| Pace-Trinity Health | $111 | 104% |
| County Coroner | $115 | 108% |
| Provider Partners Health Plan Of Indiana | $122 | 114% |
| Auxiant | $166 - $2,630 | 155% |
| Physicians Health Plan Northern Indiana Health Insurance | $166 - $334 | 155% |
| St Joseph County Hlth Dpt | $166 | 155% |
| Caresource | $171 | 160% |
| Siho Insurance Services | $177 | 166% |
| Key Benefit Administrator | $199 - $2,222 | 186% |
| Allied Benefit Systems | $210 - $2,060 | 197% |
| Custom Design Benefits | $238 | 223% |
| Managed Health Services - Indiana | $382 | 358% |
| Mdwise | $382 | 358% |
| Blue Benefit Administrators Of Massachusetts | $391 | 366% |
| Blue Care Network | $391 | 366% |
| Blue Distinction Transplant | $391 | 366% |
| Blue Shield - Ca | $391 | 366% |
| Blue Shield - Id (Regence) | $391 | 366% |
| Blue Shield - Ny Highmark Northeastern | $391 | 366% |
| Blue Shield - Ny Highmark Western | $391 | 366% |
| Blue Shield - Pa (Highmark) | $391 | 366% |
| Blue Shield - Wa (Regence) | $391 | 366% |
| Plain Church Group | $856 | 801% |
| Geha | $878 | 822% |
| Healthscope | $878 | 822% |
| Student Insurance Cma | $878 | 822% |
| Notre Dame Athletic Association | $1,743 | 1632% |
| Wc Notre Dame | $1,743 | 1632% |
| Luminare Health (Detroit) | $1,806 - $1,901 | 1691% |
| Ameriben | $1,901 | 1780% |
| Asr Health Benefits | $2,060 | 1929% |
| Christian Brother Services | $2,060 | 1929% |
| Employee Benefit Management | $2,060 | 1929% |
| Medical Mutual | $2,060 | 1929% |
| Meritain | $2,060 | 1929% |
| Preferred One | $2,060 | 1929% |
| Rural Carrier Health Benefit Plan | $2,060 | 1929% |
| Webtpa | $2,060 | 1929% |
| Encore Health | $2,222 | 2080% |
| Indiana Criminal Justice Inst | $2,222 | 2080% |
| Western & Southern Financial Group | $2,222 | 2080% |
| Cigna | $2,282 | 2137% |
| Group Administrators | $2,282 | 2137% |
| Health Partners | $2,282 | 2137% |
| Mvp | $2,282 | 2137% |
| Prairie States | $2,282 | 2137% |
| Priority Health | $2,282 | 2137% |
| Professional Benefit Administrators | $2,282 | 2137% |
| Sagamore Health Network | $2,282 - $2,440 | 2137% |
| Sisco Benefits | $2,282 | 2137% |
| Unified Group Services | $2,282 | 2137% |
| Goshen Preferred Network | $2,440 - $2,725 | 2284% |
| Signature Care | $2,630 | 2462% |
| Allied National Global Care | $2,852 | 2670% |
| Asrm - Reliance Standard Life Insurance | $2,852 | 2670% |
| Avmed Health Plan | $2,852 | 2670% |
| Christian Care Ministry | $2,852 | 2670% |
| Dean Health | $2,852 | 2670% |
| Fallon Health | $2,852 | 2670% |
| Family Life Insurance Company | $2,852 | 2670% |
| Freedom Life Insurance Company | $2,852 | 2670% |
| Ghc Scw | $2,852 | 2670% |
| International Benefit Administrators | $2,852 | 2670% |
| Lifetime Benefit Solutions | $2,852 | 2670% |
| Manhattan Life | $2,852 | 2670% |
| Medi Share | $2,852 | 2670% |
| Multiplan | $2,852 | 2670% |
| Pai | $2,852 | 2670% |
| Pan-American Life | $2,852 | 2670% |
| Paramount Hmo | $2,852 | 2670% |
| Phcs | $2,852 | 2670% |
| Philadelphia American Life Insurance | $2,852 | 2670% |
| Trinity Health Share | $2,852 | 2670% |
| Bankers Life Casualty | $3,169 | 2967% |
| Bureau Of Disability | $3,169 | 2967% |
| Wc Align Network | $3,169 | 2967% |