CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Astria Sunnyside Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $1,454
Cash Discount Price: $2,020
vs. Medicare Baseline: 13.61x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Astria Sunnyside Hospital is $1,454. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,020. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 13.61x the Medicare baseline. Located in 1016 Tacoma Avenue, Sunnyside, WA.

Cash / Self-Pay

$2,020

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,454

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: $2,020 (1891%)

Insurance Median: $1,454 (1361%)

Cash: $2,020 (1891% of Medicare)

Ins. Median: $1,454 (1361% 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 1361% of the Medicare baseline (a markup of 1261%). 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
Medicare (plans)	$156 - $895	146%
Medicaid / KanCare	$677 - $1,086	634%
Aetna	$869 - $3,119	814%
Healthcomp_Ihs	$869	814%
Humana	$869 - $3,190	814%
Molina	$869	814%
Va	$869	814%
Tricare	$878	822%
Regence	$1,822	1706%
Cigna	$2,126	1990%
Li	$2,176	2037%
First_Choice	$2,658	2489%
Tpsc	$2,764	2588%
Kaiser	$2,783	2606%
Premera	$2,885	2701%
UnitedHealthcare	$3,012	2820%
Fhpw	$3,119	2920%
Healthcomp	$3,190	2987%
Bcchp	$3,544	3318%
Great_Rivers	$3,544	3318%
Zenith	$3,544	3318%

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 $2,020.
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 Astria Sunnyside 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.