CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: UPMC Jameson

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 72131
  • Insurance Median: $186
  • Cash Discount Price: $750
  • vs. Medicare Baseline: 1.74x Medicare
The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at UPMC Jameson is $186. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $750. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.74x the Medicare baseline. Located in 1211 Wilmington Avenue, New Castle, PA.
Cash / Self-Pay
$750

Average discount available for prompt cash payment at this facility.

Insurance Median
$186

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: $750 (702%)
Insurance Median: $186 (174%)
Cash: $750 (702% of Medicare)
Ins. Median: $186 (174% 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.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash 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
Aetna $101 - $157 95%
Humana $101 - $1,000 95%
UnitedHealthcare $101 - $763 95%
Upmc Health Plan $106 - $1,029 99%
Amerihealth Caritas $109 - $180 102%
Cigna $109 - $670 102%
Highmark Wholecare (Prev Gateway) $109 - $625 102%
Pa Health & Wellness $109 - $236 102%
Occunet $127 119%
Geisinger $193 181%
Blue Cross Blue Shield $329 308%
Upmc Work Partners $651 609%
Multiplan $938 - $1,000 878%
National Provider Network $1,100 1030%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 1211 Wilmington Avenue, New Castle, PA 16105
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Other
  • Hospital Type: Acute Care Hospitals