CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: UPMC Pinnacle Hospitals

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $771
Cash Discount Price: $876
vs. Medicare Baseline: 7.22x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at UPMC Pinnacle Hospitals is $771. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $876. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 7.22x the Medicare baseline. Located in 409 South Second Street, Harrisburg, PA.

Cash / Self-Pay

$876

Average discount available for prompt cash payment at this facility.

Insurance Median

$771

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: $876 (820%)

Insurance Median: $771 (722%)

Cash: $876 (820% of Medicare)

Ins. Median: $771 (722% 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 722% of the Medicare baseline (a markup of 622%). 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	$104 - $1,420	97%
Humana	$108	101%
Aetna	$109 - $1,075	102%
Cigna	$110	103%
UnitedHealthcare	$112 - $115	105%
Pa Health & Wellness	$113 - $236	106%
Amerihealth Caritas	$176	165%
Health Partners Plans (Jefferson Health Plan)	$189	177%
Geisinger	$202	189%
Premier Comp Solutions	$280	262%
Keystone Health Plan	$292 - $931	273%
Prime Net	$353 - $1,098	330%
Upmc Work Partners	$681	638%
Intergroup	$949 - $1,241	888%
Upmc Health Plan	$1,029	963%
Wellspan Population Health	$1,241	1162%

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 $876.
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 Pinnacle Hospitals 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.