CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Punxsutawney Area Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $109
Cash Discount Price: $209
vs. Medicare Baseline: 1.02x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Punxsutawney Area Hospital is $109. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $209. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.02x the Medicare baseline. Located in 81 Hillcrest Drive, Punxsutawney, PA.

Cash / Self-Pay

$209

Average discount available for prompt cash payment at this facility.

Insurance Median

$109

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: $209 (196%)

Insurance Median: $109 (102%)

Cash: $209 (196% of Medicare)

Ins. Median: $109 (102% 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
Highmark Wholecare	$27 - $122	25%
UnitedHealthcare	$31 - $382	29%
Tricare	$40 - $108	37%
Aetna	$45 - $340	42%
Amerihealth Caritas	$45 - $120	42%
Highmark	$45 - $2,059	42%
United Mine Workers Of America	$45 - $122	42%
Upmc Health Plan	$45 - $908	42%
Cigna	$46 - $567	43%
Geisinger Health Plan	$46 - $122	43%
Ambetter / Centene	$48 - $128	45%
Pa Health And Wellness Commercial	$57 - $218	53%
Geisinger	$64 - $305	60%
Humana	$107	100%
Pa Workers Compensation	$184 - $954	172%

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 $209.
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 Punxsutawney Area 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.