CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Excela Health - Frick Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $126
Cash Discount Price: $839
vs. Medicare Baseline: 1.18x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Excela Health - Frick Hospital is $126. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $839. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.18x the Medicare baseline. Located in 508 South Church Street, Mount Pleasant, PA.

Cash / Self-Pay

$839

Average discount available for prompt cash payment at this facility.

Insurance Median

$126

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: $839 (786%)

Insurance Median: $126 (118%)

Cash: $839 (786% of Medicare)

Ins. Median: $126 (118% 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 Advantage Community Blue	$99	93%
Senior Life	$107	100%
Va	$107	100%
Aetna	$110 - $246	103%
Health Partners Plan	$110	103%
Martin'S Point	$110	103%
Peak Health	$110 - $251	103%
The Health Plan Of West Virginia	$110 - $251	103%
Humana	$111	104%
United	$111	104%
Amerihealth Caritas	$112 - $180	105%
Cigna	$112 - $236	105%
Devoted	$112	105%
Geisinger	$112 - $166	105%
Pa Health And Wellness	$114 - $180	107%
Upmc	$115 - $176	108%
Highmark Wholecare	$116 - $170	109%
American Health Plan Of Pa	$117	110%
Provider Network Of America	$117 - $1,119	110%
Provider Plan Partners Plan	$117	110%
Upmc Health Plan	$124 - $809	116%
Highmark Children'S Health Insurance Program	$128	120%
Ambetter / Centene	$134	125%
Highmark	$145 - $236	136%
Velocity	$160	150%
Health Partners Plans	$166	155%
Upmc For Kids Chip	$184	172%
Community Blue	$212	198%
UnitedHealthcare	$272	255%

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 $839.
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 Excela Health - Frick 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.