CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Reading Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $1,066
Cash Discount Price: $1,866
vs. Medicare Baseline: 9.98x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Reading Hospital is $1,066. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,866. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 9.98x the Medicare baseline. Located in 420 S 5Th Avenue, West Reading, PA.

Cash / Self-Pay

$1,866

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,066

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: $1,866 (1747%)

Insurance Median: $1,066 (998%)

Cash: $1,866 (1747% of Medicare)

Ins. Median: $1,066 (998% 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 998% of the Medicare baseline (a markup of 898%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance 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
Upmc	$97 - $1,439	91%
Geisinger	$106 - $1,687	99%
Keystone First	$106	99%
Pa Health & Wellness	$110	103%
UnitedHealthcare	$110 - $786	103%
Amerihealth Caritas	$112	105%
Health Partners	$112	105%
Gateway	$113	106%
Wernersville State Hospital	$115	108%
Blue Cross Blue Shield	$127 - $1,721	119%
Aetna	$220 - $1,839	206%
Pma	$1,066	998%
Lehigh Valley Health Network	$1,199	1123%
Cigna	$1,524	1427%
Berkshire	$1,999	1872%
First Health	$2,052	1921%
Blue Ridge	$2,532	2371%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $1,866.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 72131.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Reading Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 72131.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.