CMS Price Transparency Data
CT scan, lower back (lumbar spine)
Facility: St Charles Madras
Billing Code: 72131 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 72131
- Insurance Median: $613
- Cash Discount Price: $2,042
- vs. Medicare Baseline: 5.74x Medicare
The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at St Charles Madras is $613. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,042. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 5.74x the Medicare baseline. Located in 470 Ne A Street, Madras, OR.
Cash / Self-Pay
$2,042
Average discount available for prompt cash payment at this facility.
Insurance Median
$613
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: $2,042 (1912%)
Insurance Median: $613 (574%)
Cash: $2,042 (1912% of Medicare)
Ins. Median: $613 (574% 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 574% of the Medicare baseline (a markup of 474%). 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 | $106 - $1,047 | 99% |
| Auto Allstate Insurance [602] | $195 | 183% |
| Auto American Family Insurance [603] | $195 | 183% |
| Auto Country Insurance Claims [604] | $195 | 183% |
| Auto Dairyland Insurance [617] | $195 | 183% |
| Auto Farmers [605] | $195 | 183% |
| Auto Geico Claims Oregon [606] | $195 | 183% |
| Auto Hartford [612] | $195 | 183% |
| Auto Liberty Mutual Auto Ins [613] | $195 | 183% |
| Auto Mutual Of Enumclaw [610] | $195 | 183% |
| Auto Nationwide Allied Insuranc [601] | $195 | 183% |
| Auto Oregon Mutual [614] | $195 | 183% |
| Auto Progressive [608] | $195 | 183% |
| Auto Safeco Concentra [600] | $195 | 183% |
| Auto State Farm Claims [609] | $195 | 183% |
| Auto Sublimity Insurance [616] | $195 | 183% |
| Auto Travelers Insurance [615] | $195 | 183% |
| Auto Usaa [611] | $195 | 183% |
| Generic Auto [649] | $195 | 183% |
| Generic Workers Comp [699] | $195 | 183% |
| Otj Broadspire Services [670] | $195 | 183% |
| Otj Ccmsi [618] | $195 | 183% |
| Otj Chartis Claims [650] | $195 | 183% |
| Otj City County Ins Services [662] | $195 | 183% |
| Otj Corvel [676] | $195 | 183% |
| Otj Esis West Wc Claims [653] | $195 | 183% |
| Otj Gallagher Bassett [654] | $195 | 183% |
| Otj Hartford [655] | $195 | 183% |
| Otj Intermountain Claims Inc [666] | $195 | 183% |
| Otj Liberty Mutual Wausau Underwriters [671] | $195 | 183% |
| Otj Penser No American [663] | $195 | 183% |
| Otj Pinnacle Risk Mgmt [661] | $195 | 183% |
| Otj Saif [667] | $195 | 183% |
| Otj Sedgwick Cms [660] | $195 | 183% |
| Otj Sedgwick [668] | $195 | 183% |
| Otj Travelers Insurance [672] | $195 | 183% |
| Otj Tristar [673] | $195 | 183% |
| Blue Cross Blue Shield | $325 - $674 | 304% |
| Bridgespan [342] | $325 | 304% |
| Asuris Northwest Health [202] | $383 | 359% |
| Healthcare Management Admin [201] | $383 | 359% |
| Regence Group Administrators [203] | $383 | 359% |
| Aetna | $613 - $2,221 | 574% |
| Ageright Advantage [142] | $613 | 574% |
| Champ Va [700] | $613 | 574% |
| Cigna | $613 - $1,608 | 574% |
| Covid19 Hrsa Uninsured Testing And Treatment Fund | $613 | 574% |
| Devoted Health Inc [145] | $613 | 574% |
| Health Market Care Assured [134] | $613 | 574% |
| Health Net Med Adv [135] | $613 | 574% |
| Humana | $613 | 574% |
| Indian Health [704] | $613 | 574% |
| Kaiser Permanente Med Adv [136] | $613 | 574% |
| Law Enforcement [701] | $613 - $1,266 | 574% |
| Medicare (plans) | $613 - $711 | 574% |
| Samaritan Health Plan Med Adv [141] | $613 | 574% |
| Unicare [133] | $613 | 574% |
| UnitedHealthcare | $613 - $2,359 | 574% |
| Veterans [706] | $613 | 574% |
| Wellcare [132] | $613 | 574% |
| Tricare | $797 | 746% |
| Pacificsource [345] | $1,021 - $1,396 | 956% |
| Advanced Health [534] | $1,047 | 980% |
| Allcare Health Plan [538] | $1,047 | 980% |
| Cascade Health Alliance [532] | $1,047 | 980% |
| Columbia Pacific Coordinated Care Llc [539] | $1,047 | 980% |
| Health Share Care Oregon [526] | $1,047 | 980% |
| Health Share Kaiser [543] | $1,047 | 980% |
| Health Share Ohsu Ohp [552] | $1,047 | 980% |
| Health Share Providence [548] | $1,047 | 980% |
| Health Share [537] | $1,047 | 980% |
| Intercommunity Health [530] | $1,047 | 980% |
| Jackson Care Connect [542] | $1,047 | 980% |
| Primary Health Of Jospehine County Llc [547] | $1,047 | 980% |
| Umpqua Health [533] | $1,047 | 980% |
| Willamette Valley Community Health [536] | $1,047 | 980% |
| Yamhill County Coordinated Care Org [550] | $1,047 | 980% |
| Us Benefits [326] | $1,608 | 1505% |
| Providence Health Plan [347] | $1,787 - $2,234 | 1673% |
| Rocky Mountain Administrators [405] | $2,042 | 1912% |
| Rx Internal [4100003] | $2,086 | 1953% |
| Moda [310] | $2,196 | 2056% |
| First Choice Health [317] | $2,211 | 2070% |
| Kaiser Permanente [334] | $2,211 | 2070% |
| Samaritan [376] | $2,211 | 2070% |
| Meritain Health [300] | $2,221 | 2079% |
| Health Net [340] | $2,400 | 2247% |
| Administrative Concepts Inc [402] | $2,502 | 2342% |
| First Health [339] | $2,502 | 2342% |
| Manhattan Life Insurance Company [379] | $2,502 | 2342% |
| Philadelphia American Life Insurance Company [395] | $2,502 | 2342% |
| Planned Administrators Inc [375] | $2,502 | 2342% |