CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Boston Children's Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $1,417
Cash Discount Price: $1,996
vs. Medicare Baseline: 13.27x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Boston Children's Hospital is $1,417. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,996. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 13.27x the Medicare baseline. Located in 300 Longwood Avenue, Boston, MA.

Cash / Self-Pay

$1,996

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,417

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: $1,996 (1869%)

Insurance Median: $1,417 (1327%)

Cash: $1,996 (1869% of Medicare)

Ins. Median: $1,417 (1327% 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 1327% of the Medicare baseline (a markup of 1227%). 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
Unicare	$623	583%
Blue Cross Blue Shield	$672 - $1,318	629%
Cdphp	$978 - $1,697	916%
Harvard Pilgrim	$1,014 - $1,349	949%
United	$1,194 - $1,668	1118%
Aetna	$1,198 - $1,673	1122%
Mgb/Allways	$1,214 - $1,476	1137%
Tufts Public Plan	$1,226 - $1,229	1148%
United Ri Nj Ny	$1,257	1177%
Ambetter / Centene	$1,261	1181%
Carelon Strategies/Bhs	$1,297	1214%
UnitedHealthcare	$1,297 - $1,697	1214%
Carelon/Beacon	$1,497	1402%
Fallon	$1,523 - $1,539	1426%
Health New England	$1,613	1510%
Cigna	$1,697 - $1,801	1589%
Ets/Lifetrac	$1,697	1589%
Interlink Transplant	$1,697	1589%
Community Health Options	$1,796	1681%
Humana	$1,796	1681%
Coventry/Hcvm/First Health	$1,836	1719%
Multiplan/Phcs	$1,836 - $1,896	1719%

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 $1,996.
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 Boston Children's 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.