CMS Price Transparency Data
CT scan, lower back (lumbar spine)
Facility: Saint Alphonsus Medical Center Ontario
Billing Code: 72131 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 72131
- Insurance Median: $599
- Cash Discount Price: $1,299
- vs. Medicare Baseline: 5.61x Medicare
The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Saint Alphonsus Medical Center Ontario is $599. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,299. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 5.61x the Medicare baseline. Located in 351 Sw 9Th Street, Ontario, OR.
Cash / Self-Pay
$1,299
Average discount available for prompt cash payment at this facility.
Insurance Median
$599
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: $1,299 (1216%)
Insurance Median: $599 (561%)
Cash: $1,299 (1216% of Medicare)
Ins. Median: $599 (561% 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 561% of the Medicare baseline (a markup of 461%). 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 | $102 - $599 | 95% |
| Blue Cross Blue Shield | $122 - $1,698 | 114% |
| Medicare (plans) | $122 - $131 | 114% |
| UnitedHealthcare | $122 - $1,918 | 114% |
| Aetna | $126 - $1,892 | 118% |
| American Health Advantage Of Idaho | $127 | 119% |
| Moda Health | $242 - $1,938 | 227% |
| Blue Benefit Administrators Of Massachusetts | $312 | 292% |
| Blue Care Network | $312 | 292% |
| Blue Distinction Transplant | $312 | 292% |
| Blue Shield - Ca | $312 | 292% |
| Blue Shield - Id (Regence) | $312 | 292% |
| Blue Shield - Ny Highmark Northeastern | $312 | 292% |
| Blue Shield - Ny Highmark Western | $312 | 292% |
| Blue Shield - Pa (Highmark) | $312 | 292% |
| Blue Shield - Wa (Regence) | $312 | 292% |
| Healthcare Management Admin | $321 | 301% |
| Webtpa | $329 - $1,798 | 308% |
| Pacificsource Health Plans | $386 - $1,878 | 361% |
| Selecthealth | $410 - $1,798 | 384% |
| Ada County Jail Inmate Ins | $599 | 561% |
| Ambetter / Centene | $599 | 561% |
| Amish Mennonite | $599 | 561% |
| Bcccp-Michigan | $599 | 561% |
| Bccp | $599 | 561% |
| Bmc Healthnet | $599 | 561% |
| Breast Grant-Connecticut | $599 | 561% |
| California Health And Wellness | $599 | 561% |
| Cardinal Innovations Lme | $599 | 561% |
| Care Oregon Ohp | $599 | 561% |
| Cencal Health Plan | $599 | 561% |
| Cenpatico | $599 | 561% |
| Centurion Of Idaho | $599 | 561% |
| Chhuny | $599 | 561% |
| Childrens Comm Health Plan | $599 | 561% |
| Childrens Medical Services Title 19 | $599 | 561% |
| Cigna | $599 - $1,878 | 561% |
| Community Benefit Health | $599 | 561% |
| Community Care Behavorial Health | $599 | 561% |
| Community Health Choice | $599 | 561% |
| Covid19 Hrsa Uninsured Testing And Treatment Fund | $599 | 561% |
| Dean Wi Badgercare | $599 | 561% |
| Delaware First Health | $599 | 561% |
| Delta Dental Nj | $599 | 561% |
| Dph Tb Program | $599 | 561% |
| Dscc | $599 | 561% |
| Eastpointe Lme | $599 | 561% |
| Family Health Network | $599 | 561% |
| Freedom First Healthcare | $599 | 561% |
| Ghc Scw Wi Badgercare | $599 | 561% |
| Harbor Health | $599 | 561% |
| Health Safety Net | $599 | 561% |
| Healthy Blue Ne | $599 | 561% |
| Hennepin Health | $599 | 561% |
| Humana | $599 - $1,758 | 561% |
| Id County Ada | $599 | 561% |
| Id County Canyon | $599 | 561% |
| Id County Cat Fund | $599 | 561% |
| Id County Payette | $599 | 561% |
| Idaho Womens Health Check | $599 | 561% |
| Indiana Breast Cervical Cancer | $599 | 561% |
| Inland Empire Health Plan | $599 | 561% |
| Intercommunity Health Ohp | $599 | 561% |
| Iowa Total Care | $599 | 561% |
| Jai Medical System | $599 | 561% |
| Kern Family Health Plan | $599 | 561% |
| Keystone First | $599 | 561% |
| Keystone First Chip | $599 | 561% |
| La Care Health Plan | $599 | 561% |
| Lakeland Care Inc | $599 | 561% |
| Managed Health Services - Indiana | $599 | 561% |
| Maryland Breast & Cervical Program | $599 | 561% |
| Maryland Healthy Smiles - Scion Dental | $599 | 561% |
| Maryland Physicians Care | $599 | 561% |
| Massachusetts Behavioral Health Partnership | $599 | 561% |
| Mdwise | $599 | 561% |
| Medi-Cal | $599 | 561% |
| Medi-Cal Healthnet | $599 | 561% |
| Medstar Dc Healthy Family | $599 | 561% |
| Medstar Md Health Choice | $599 | 561% |
| Mo Home State Health Plan | $599 | 561% |
| Molina Centennial Care | $599 | 561% |
| Nascentia Health Options | $599 | 561% |
| Nebraska Total Care | $599 | 561% |
| New York Cancer Services Program | $599 | 561% |
| Nextlevel Health | $599 | 561% |
| Oregon Screenwise | $599 | 561% |
| Pace Of Southwest Michigan | $599 | 561% |
| Paramount Advantage | $599 | 561% |
| Parkland Community Health Plan | $599 | 561% |
| Partners Behavioral Lme | $599 | 561% |
| Peach State Healthplan | $599 | 561% |
| Presbyterian Centennial Care | $599 | 561% |
| Prestige Health Choice | $599 | 561% |
| Priority Partners | $599 | 561% |
| Rx 340B Pass Along | $599 | 561% |
| Rx Assistance/Rx Manufacturer Assistance 0 Copay | $599 | 561% |
| Rx Medi-Cal | $599 | 561% |
| Rx Meridian Rx | $599 | 561% |
| Sandhills Center Lme | $599 | 561% |
| Screening For Life | $599 | 561% |
| Sunshine State Health Plan | $599 | 561% |
| Superior Health | $599 | 561% |
| Tenncare | $599 | 561% |
| Texas Children'S Health Plan | $599 | 561% |
| Trillium Community Ohp | $599 | 561% |
| Tufts Health Public Plans | $599 | 561% |
| Vaya Health Lme | $599 | 561% |
| Wellsense Health Plan | $599 | 561% |
| Wi Womens Wellness | $599 | 561% |
| Mountain Health Co-Op | $1,199 | 1123% |
| Allegiance | $1,518 | 1421% |
| Correctional Health Partners | $1,558 | 1459% |
| Columbia Health Network | $1,598 | 1496% |
| Healthnet | $1,678 | 1571% |
| Allied National Global Care | $1,798 | 1683% |
| Asrm - Reliance Standard Life Insurance | $1,798 | 1683% |
| Christian Care Ministry | $1,798 | 1683% |
| Dean Health | $1,798 | 1683% |
| Fallon Health | $1,798 | 1683% |
| Family Life Insurance Company | $1,798 | 1683% |
| First Choice Health | $1,798 | 1683% |
| Ghc Scw | $1,798 | 1683% |
| International Benefit Administrators | $1,798 | 1683% |
| Lifetime Benefit Solutions | $1,798 | 1683% |
| Manhattan Life | $1,798 | 1683% |
| Pai | $1,798 | 1683% |
| Pan-American Life | $1,798 | 1683% |
| Paramount Hmo | $1,798 | 1683% |
| Phcs | $1,798 | 1683% |
| Trinity Health Share | $1,798 | 1683% |
| Lifewise | $1,858 | 1740% |
| Priority Health | $1,878 | 1758% |
| Allied Benefit Systems | $1,892 | 1771% |
| Ameriben | $1,892 | 1771% |
| Asr Health Benefits | $1,892 | 1771% |
| Christian Brother Services | $1,892 | 1771% |
| Geha | $1,892 - $1,918 | 1771% |
| Healthez | $1,892 | 1771% |
| Luminare Health (Detroit) | $1,892 | 1771% |
| Rural Carrier Health Benefit Plan | $1,892 | 1771% |
| First Health | $1,898 | 1777% |
| Medi Share | $1,898 | 1777% |
| Providence | $1,898 | 1777% |