CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Hospital for Special Surgery

Billing Code: 72131 (CPT)

The BaseRate · fair price low confidence

A fair price for this

$160

about 1.5× the $107 Medicare rate · typically $103–$859

modeled estimate · not a bill or quote

What this hospital charges insurers

$857

Well above the fair price

about $697 over the fair price · 8.0× Medicare

Medicare pays $107 Fair price $160 This hospital $857 Cash price $1,266 Hospital's list price $1,613

How we calculate the fair BaseRate →

How this hospital compares to other NY hospitals

Highest price of the 9 NY hospitals we have prices for — worth calling around.

Cheapest $48 Priciest $857

Black dot = this hospital, among the 9 NY hospitals with a price for this procedure. Full list below.

A fair price for a CT scan, lower back (lumbar spine) is about $160 (about 1.5× the $107 Medicare rate). Hospital for Special Surgery charges insurers about $857, or about $1,266 in cash — well above the fair price. Located in New York, NY.

This price is above the fair BaseRate — you may be able to pay less

Ask the hospital for the cash / self-pay price, check whether you qualify for financial assistance, or negotiate the bill down toward the fair price of about $160. Many patients pay well below the first number they’re quoted — the checklists below walk you through it.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

4 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna HumanaKaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$36 - $1,183	34%
Blue Cross Blue Shieldmajor	$80 - $2,063	75%
Aetnamajor	$140 - $857	131%
Cignamajor	$105 - $1,709	98%
Fidelis Care	$38 - $318	36%
GEHA	$1,030	964%
Harvard Pilgrim	$857 - $1,183	802%
Molina	$857 - $1,124	802%
+ 13 smaller / regional plans	$50 - $2,006

Government programs also on file: Medicare.

Excludes 2 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 1,266), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 72131.

Insurance Before you use insurance

Call your insurance company to confirm Hospital for Special Surgery is in-network.
Ask your insurer whether prior approval is required for CPT code 72131.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Hospital for Special Surgery

Compare: CT scan, lower back (lumbar spine) at other NY hospitals

Insurance negotiated median for the same procedure, sorted lowest first.