CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Children's Hospital of Philadelphia

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $1,761
Cash Discount Price: $4,874
vs. Medicare Baseline: 16.49x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Children's Hospital of Philadelphia is $1,761. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,874. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 16.49x the Medicare baseline. Located in 3401 Civic Center Blvd, Philadelphia, PA.

Cash / Self-Pay

$4,874

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,761

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: $4,874 (4563%)

Insurance Median: $1,761 (1649%)

Cash: $4,874 (4563% of Medicare)

Ins. Median: $1,761 (1649% 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 1649% of the Medicare baseline (a markup of 1549%). 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 Medical Assistance	$119	111%
Highmark Wholecare	$132	124%
Horizon Nj Health	$527	493%
Medicaid / KanCare	$804	753%
UnitedHealthcare	$809 - $1,299	757%
Health Partners	$919	860%
Aetna	$1,283 - $2,437	1201%
Upmc Medical Assistance	$1,330	1245%
Keystone First Chip	$1,511	1415%
Keystone Health Plan East	$1,541	1443%
Blue Cross Blue Shield	$1,720 - $1,952	1610%
Geisinger Health Plan Commercial	$1,802	1687%
Jefferson Health Plans	$2,305	2158%
Cigna	$2,437	2282%
Highmark	$2,437	2282%
Qualcare	$2,680	2509%
First Health Network	$3,168	2966%
Devon Health, Intergroup, Multiplan, Valley Preferred/Populytics	$3,899	3650%
Private Health Care Systems	$3,899	3650%
Choice Care Network	$4,386	4106%

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 $4,874.
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 Children's Hospital of Philadelphia 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.