CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Pottstown Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $1,000
Cash Discount Price: $819
vs. Medicare Baseline: 9.36x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Pottstown Hospital is $1,000. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $819. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 9.36x the Medicare baseline. Located in 1600 East High Street, Pottstown, PA.

Cash / Self-Pay

$819

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,000

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: $819 (767%)

Insurance Median: $1,000 (936%)

Cash: $819 (767% of Medicare)

Ins. Median: $1,000 (936% 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 936% of the Medicare baseline (a markup of 836%). 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
Geisinger	$106	99%
Health Partners	$110	103%
Pa Health And Wellness	$110	103%
Gateway	$123	115%
Upmc	$123 - $2,456	115%
Aetna	$150 - $2,783	140%
Blue Cross Blue Shield	$877 - $1,122	821%
Keystone First	$1,170	1095%
First Health	$2,947	2759%
Devon	$3,209	3004%

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 $819.
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 Pottstown 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.