CMS Price Transparency Data
CT scan, lower back (lumbar spine)
Facility: Trinity Health Oakland Hospital
Billing Code: 72131 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 72131
- Insurance Median: $1,765
- Cash Discount Price: $1,687
- vs. Medicare Baseline: 16.52x Medicare
The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Trinity Health Oakland Hospital is $1,765. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,687. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 16.52x the Medicare baseline. Located in 44405 Woodward Ave, Pontiac, MI.
Cash / Self-Pay
$1,687
Average discount available for prompt cash payment at this facility.
Insurance Median
$1,765
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: $1,687 (1579%)
Insurance Median: $1,765 (1652%)
Cash: $1,687 (1579% of Medicare)
Ins. Median: $1,765 (1652% 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 1652% of the Medicare baseline (a markup of 1552%). 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 |
|---|---|---|
| Medicaid / KanCare | $57 - $58 | 53% |
| Blue Cross Blue Shield | $58 - $135 | 54% |
| Aetna | $102 - $1,176 | 95% |
| Blue Care Network Advantage | $102 | 95% |
| Medicare (plans) | $102 - $104 | 95% |
| Align Senior Care | $104 | 97% |
| Geha | $104 - $1,947 | 97% |
| Hospice Advantage | $104 | 97% |
| Medical Mutual | $104 | 97% |
| Meritain | $104 | 97% |
| UnitedHealthcare | $107 - $1,947 | 100% |
| Cca - Zing Health | $110 | 103% |
| Longevity Ipa Of Michigan Llc Health Plan Isnp | $117 | 110% |
| Bcn Domestic | $135 | 126% |
| Blue Benefit Administrators Of Massachusetts | $135 | 126% |
| Blue Care Network | $135 | 126% |
| Blue Distinction Transplant | $135 | 126% |
| Blue Shield - Ca | $135 | 126% |
| Blue Shield - Id (Regence) | $135 | 126% |
| Blue Shield - Ny Highmark Northeastern | $135 | 126% |
| Blue Shield - Ny Highmark Western | $135 | 126% |
| Blue Shield - Pa (Highmark) | $135 | 126% |
| Blue Shield - Wa (Regence) | $135 | 126% |
| Health Choices | $135 - $1,905 | 126% |
| Kaiser Domestic | $135 | 126% |
| Molina Marketplace | $135 | 126% |
| Health Cost Solutions | $161 | 151% |
| Vitalcore | $161 | 151% |
| Wellpath | $161 | 151% |
| Employee Benefit Logistic | $240 | 225% |
| U Of M Health Plan | $288 | 270% |
| Asr Health Benefits | $361 | 338% |
| Caresource | $361 | 338% |
| Hap | $361 - $1,890 | 338% |
| Varipro | $361 | 338% |
| Priority Health | $421 - $468 | 394% |
| Wc Accident Fund | $788 | 738% |
| Wc Advantage | $788 | 738% |
| Wc Aig | $788 | 738% |
| Wc Allied | $788 | 738% |
| Wc Amerisure | $788 | 738% |
| Wc Amtrust | $788 | 738% |
| Wc Asu Risk Mgt | $788 | 738% |
| Wc Berkley Admin | $788 | 738% |
| Wc Broadspire | $788 | 738% |
| Wc Bunch & Associates | $788 | 738% |
| Wc Ccmsi | $788 | 738% |
| Wc Emc Insurance Company | $788 | 738% |
| Wc Esis | $788 | 738% |
| Wc Fcci | $788 | 738% |
| Wc Federated | $788 | 738% |
| Wc Gallagher Bassett | $788 | 738% |
| Wc Genex Care For Ohio | $788 | 738% |
| Wc Guard Insurance Company | $788 | 738% |
| Wc Hartford | $788 | 738% |
| Wc Liberty Mutual | $788 | 738% |
| Wc Meijers | $788 | 738% |
| Wc Michigan | $788 | 738% |
| Wc Mitchell Frankenmuth | $788 | 738% |
| Wc Pma | $788 | 738% |
| Wc Sedgwick | $788 | 738% |
| Wc Sentry | $788 | 738% |
| Wc Travelers | $788 | 738% |
| Wc Tristar | $788 | 738% |
| Wc Walmart | $788 | 738% |
| Wc Zurich | $788 | 738% |
| Acs Benefit Services | $1,142 | 1069% |
| Allied Benefit Systems | $1,142 | 1069% |
| Claimchoice Adminstrators | $1,142 | 1069% |
| Consociate | $1,142 | 1069% |
| Cypress Benefit Administrators | $1,142 | 1069% |
| Forest County Potawatomi | $1,142 | 1069% |
| Health Smart | $1,142 | 1069% |
| Healthgram | $1,142 | 1069% |
| Healthscope | $1,142 | 1069% |
| Secureone Preferred United Plans | $1,142 | 1069% |
| Sisco Benefits | $1,142 | 1069% |
| The Health Plan | $1,142 | 1069% |
| Trustmark Small Business Benefits | $1,142 | 1069% |
| Unified Group Services | $1,142 | 1069% |
| Webtpa | $1,142 | 1069% |
| Mclaren Health | $1,248 - $1,361 | 1168% |
| Carelon Behavioral Health | $1,298 | 1215% |
| Magellan Behavioral Health | $1,558 | 1459% |
| 1199 National Benefit Fund | $1,765 | 1652% |
| Allied National Global Care | $1,765 | 1652% |
| Asrm - Reliance Standard Life Insurance | $1,765 | 1652% |
| Christian Care Ministry | $1,765 | 1652% |
| Dean Health | $1,765 | 1652% |
| Fallon Health | $1,765 | 1652% |
| Family Life Insurance Company | $1,765 | 1652% |
| Ghc Scw | $1,765 | 1652% |
| Group Pension Administrators | $1,765 | 1652% |
| International Benefit Administrators | $1,765 | 1652% |
| Lifetime Benefit Solutions | $1,765 | 1652% |
| Manhattan Life | $1,765 | 1652% |
| Medi Share | $1,765 | 1652% |
| Multiplan | $1,765 | 1652% |
| Mvp | $1,765 | 1652% |
| Pai | $1,765 | 1652% |
| Pan-American Life | $1,765 | 1652% |
| Paramount Hmo | $1,765 | 1652% |
| Phcs | $1,765 | 1652% |
| Trinity Health Share | $1,765 | 1652% |
| Health Partners | $1,890 | 1769% |
| Tufts Health Plan | $1,890 | 1769% |
| Access Health | $1,905 | 1784% |
| Acclaim | $1,905 | 1784% |
| Administrative Concepts | $1,905 | 1784% |
| Allegeant | $1,905 | 1784% |
| Ameriben | $1,905 | 1784% |
| American Family | $1,905 | 1784% |
| American Healthcare Alliance | $1,905 | 1784% |
| American National | $1,905 | 1784% |
| American Republic | $1,905 | 1784% |
| Amerihealth | $1,905 | 1784% |
| Aultcare | $1,905 | 1784% |
| Automated Benefit Services | $1,905 | 1784% |
| Auxiant | $1,905 | 1784% |
| Benefit Administrative Systems,Llc | $1,905 | 1784% |
| Boon Chapman | $1,905 | 1784% |
| Cam Administrative Services | $1,905 | 1784% |
| Christian Brother Services | $1,905 | 1784% |
| Christian Brothers Holy Cross | $1,905 | 1784% |
| Comprehensive Benefits | $1,905 | 1784% |
| Continental Life Insurance | $1,905 | 1784% |
| Custom Benefit Administrators | $1,905 | 1784% |
| Employee Benefit Concepts | $1,905 | 1784% |
| Employee Benefit Management | $1,905 | 1784% |
| Enterprise Group Planning | $1,905 | 1784% |
| Freedom Life Insurance Company | $1,905 | 1784% |
| Group Administrators | $1,905 | 1784% |
| Group Marketing Services | $1,905 | 1784% |
| Guardian | $1,905 | 1784% |
| Health America | $1,905 | 1784% |
| Healthcare Management Admin | $1,905 | 1784% |
| Healthez | $1,905 | 1784% |
| Humana | $1,905 | 1784% |
| Insight | $1,905 | 1784% |
| Intercare | $1,905 | 1784% |
| Jfp Benefit Management | $1,905 | 1784% |
| Jp Farley Corporation | $1,905 | 1784% |
| Key Benefit Administrator | $1,905 | 1784% |
| Liberty Union Life Assurance Co | $1,905 | 1784% |
| Lucent Health | $1,905 | 1784% |
| Luminare Health | $1,905 | 1784% |
| Luminare Health (Detroit) | $1,905 | 1784% |
| Magnacare | $1,905 | 1784% |
| Medben | $1,905 | 1784% |
| Medcost | $1,905 | 1784% |
| Mutual Health Services | $1,905 | 1784% |
| Mutual Of Omaha | $1,905 | 1784% |
| Ncas | $1,905 | 1784% |
| Nippon Life Ins | $1,905 | 1784% |
| Nova | $1,905 | 1784% |
| Painters Union Insurance Fund | $1,905 | 1784% |
| Physicians Mutual | $1,905 | 1784% |
| Plumbers Local 98 Insurance Fund | $1,905 | 1784% |
| Prairie States | $1,905 | 1784% |
| Preferred One | $1,905 | 1784% |
| Primary Physician Care | $1,905 | 1784% |
| Professional Benefit Administrators | $1,905 | 1784% |
| Siho Insurance Services | $1,905 | 1784% |
| The Loomis Company | $1,905 | 1784% |
| Unicare | $1,905 | 1784% |
| Us Health And Life | $1,905 | 1784% |
| Valenz | $1,905 | 1784% |
| Western & Southern Financial Group | $1,905 | 1784% |
| Wps | $1,905 | 1784% |
| Cigna | $1,924 | 1801% |
| Coventry | $1,957 | 1832% |
| First Health | $1,957 | 1832% |
| Prime Health Services | $2,077 | 1945% |
| Three Rivers Provider Network | $2,336 | 2187% |
| Cmh Detroit Wayne Integrated Health Network | $2,596 | 2430% |
| Cmh Lenawee County | $2,596 | 2430% |
| Cmh Livingston County | $2,596 | 2430% |
| Cmh Misc | $2,596 | 2430% |
| Cmh Monroe County | $2,596 | 2430% |
| Cmh Oakland County | $2,596 | 2430% |
| Cmh Washtenaw County | $2,596 | 2430% |