CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Jefferson Healthcare

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $659
Cash Discount Price: $885
vs. Medicare Baseline: 6.17x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Jefferson Healthcare is $659. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $885. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 6.17x the Medicare baseline. Located in 834 Sheridan Street, Port Townsend, WA.

Cash / Self-Pay

$885

Average discount available for prompt cash payment at this facility.

Insurance Median

$659

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: $885 (829%)

Insurance Median: $659 (617%)

Cash: $885 (829% of Medicare)

Ins. Median: $659 (617% 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 617% of the Medicare baseline (a markup of 517%). 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
Tricare	$47 - $723	44%
Chpw Mcr Adv	$51 - $781	48%
Aetna	$54 - $1,859	51%
Medicare (plans)	$54 - $738	51%
Molina Mcr Adv	$54 - $723	51%
Molina Marketplace-All Other Plans	$59 - $904	55%
Chpw Commercial-All Other Plans	$70 - $1,756	66%
Coord Care Comm/Exchge-All Other Plans	$75 - $1,859	70%
Chpw Mcaid	$81 - $645	76%
Molina Mcaid	$81 - $659	76%
Amerigroup Mcaid-All Plans	$83 - $679	78%
Regence-All Other Plans	$109 - $1,550	102%
Premera-All Plans	$124 - $1,756	116%
Cigna	$131 - $1,859	123%
Coord Care Mcaid Ip/Op Only	$691	647%
UnitedHealthcare	$1,157	1083%
Coord Care Cascade Ip/Op Only	$1,859	1740%

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 $885.
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 Jefferson Healthcare 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.