CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: West Penn Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $106
Cash Discount Price: $1,126
vs. Medicare Baseline: 0.99x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at West Penn Hospital is $106. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,126. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 0.99x the Medicare baseline. Located in 4800 Friendship Avenue, Pittsburgh, PA.

Cash / Self-Pay

$1,126

Average discount available for prompt cash payment at this facility.

Insurance Median

$106

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: $1,126 (1054%)

Insurance Median: $106 (99%)

Cash: $1,126 (1054% of Medicare)

Ins. Median: $106 (99% 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.

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
Amerihealth	$53 - $229	50%
Highmark	$55 - $260	51%
Pennsylvania Health And Wellness	$67 - $208	63%
Geisinger	$73 - $222	68%
UnitedHealthcare	$73 - $359	68%
Cigna	$75 - $211	70%
University Of Pittsburgh Medical Center	$97 - $152	91%
American Health Plans	$102	95%
Life Pittsburgh	$102	95%
Martin'S Point	$102	95%
Medicare (plans)	$105	98%
Aetna	$106 - $339	99%
Highmark Wholecare	$108 - $191	101%
Humana	$108	101%
Molina	$112	105%
Medical Mutual	$339	317%

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 $1,126.
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 West Penn 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.