CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Lehigh Valley Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $222
Cash Discount Price: Unavailable
vs. Medicare Baseline: 2.08x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Lehigh Valley Hospital is $222. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 2.08x the Medicare baseline. Located in 1200 South Cedar Crest Boulevard, Allentown, PA.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$222

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%)

Insurance Median: $222 (208%)

Ins. Median: $222 (208% 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 208% of the Medicare baseline (a markup of 108%). 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
Cigna	$94 - $465	88%
Amerihealth	$111 - $114	104%
Blue Cross Blue Shield	$111 - $1,065	104%
Ibc	$111 - $1,726	104%
UnitedHealthcare	$111 - $377	104%
Highmark Blue Shield	$113 - $359	106%
Geisinger	$114 - $488	107%
Aetna	$116 - $615	109%
Jefferson Health Partners	$116 - $222	109%
Devoted Health	$118	110%
Humana	$118	110%
Upmc	$118 - $540	110%
Gateway	$119	111%
Emblem	$120 - $495	112%
Pa Health & Wellness (Allwell)	$122	114%
Amerihealth Caritas	$152 - $249	142%
Highmark Wholecare/Gateway	$176	165%
Pa Health & Wellness	$187	175%
Keystone First	$201	188%
Ambetter / Centene	$336	315%
Valley Preferred	$647	606%

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 $X.
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 Lehigh Valley 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.