CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: UPMC Hamot

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $701
Cash Discount Price: $1,907
vs. Medicare Baseline: 6.56x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at UPMC Hamot is $701. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,907. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 6.56x the Medicare baseline. Located in 201 State Street, Erie, PA.

Cash / Self-Pay

$1,907

Average discount available for prompt cash payment at this facility.

Insurance Median

$701

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: $1,907 (1785%)

Insurance Median: $701 (656%)

Cash: $1,907 (1785% of Medicare)

Ins. Median: $701 (656% 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 656% of the Medicare baseline (a markup of 556%). 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
Blue Cross Blue Shield	$116 - $1,562	109%
Fidelis	$117	110%
Aetna	$119 - $2,225	111%
Upmc Health Plan	$119 - $514	111%
Wellcare	$121	113%
UnitedHealthcare	$125 - $693	117%
Amerihealth Caritas	$126 - $216	118%
Cigna	$126 - $1,271	118%
Highmark Wholecare (Prev Gateway)	$126 - $1,589	118%
Pa Health & Wellness	$126 - $236	118%
Independent Health	$166 - $222	155%
Geisinger	$193	181%
Health Partners Plans (Jefferson Health Plan)	$209	196%
Univera	$477 - $1,398	447%
Upmc Work Partners	$701	656%
Intergroup	$2,066 - $2,542	1934%
Multiplan	$2,225 - $2,542	2083%

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 $1,907.
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 UPMC Hamot 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.