CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Clarion Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $230
Cash Discount Price: $526
vs. Medicare Baseline: 2.15x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Clarion Hospital is $230. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $526. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 2.15x the Medicare baseline. Located in One Hospital Drive, Clarion, PA.

Cash / Self-Pay

$526

Average discount available for prompt cash payment at this facility.

Insurance Median

$230

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: $526 (492%)

Insurance Median: $230 (215%)

Cash: $526 (492% of Medicare)

Ins. Median: $230 (215% 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 215% of the Medicare baseline (a markup of 115%). 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
Highmark	$101 - $320	95%
Amerihealth	$102 - $152	95%
Cigna	$102 - $470	95%
Highmark Community Blue	$102	95%
Martin'S Point - Usfhp	$102 - $329	95%
Medicare (plans)	$102	95%
Tricare	$102	95%
UnitedHealthcare	$102	95%
Aetna	$105 - $837	98%
Geisinger	$107 - $166	100%
Devoted Health Plan	$108 - $376	101%
The Health Plan	$108 - $240	101%
Gateway	$109 - $348	102%
Pa Health & Wellness	$109	102%
Upmc	$110 - $809	103%
American Health Plan	$113	106%
Medicaid / KanCare	$139	130%
Jefferson Health Plan	$152	142%
Highmark - Ind.& Managed Care	$230 - $320	215%
Peak Health	$240 - $658	225%
Workers Comp	$667	624%
Devon	$705	660%

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 $526.
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 Clarion 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.