Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
CT Spine Thorac Lumb w/o Contrast
Suffern, NY
See all hospitals reporting CPT 72128 →Price type
Good Samaritan Hospital’s median price of $694 is 108% above the median hospital's median price ($334), higher than 65% of the 2,605 hospitals reporting CPT 72128. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 10 payers, 17 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.
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| # | ||||
|---|---|---|---|---|
| 1 | Medicare medicare facility · fee schedule · outpatient | $130.50 | $130.50 | $130.50 – $130.50 |
| 2 | Tricare tricare facility · fee schedule · outpatient | $130.50 | $130.50 | $130.50 – $130.50 |
| 3 | Molina affinity by molina mcr facility · fee schedule · outpatient | $136.35 | $136.35 | $136.35 – $136.35 |
| 4 | Aetna aetna hp network facility · fee schedule · outpatient | $281.76 | $281.76 | $281.76 – $281.76 |
| 5 | Aetna aetna employee facility · fee schedule · outpatient | $288.44 | $288.44 | $288.44 – $288.44 |
| 6 | Aetna aetna facility · fee schedule · outpatient | $313.50 | $313.50 | $313.50 – $313.50 |
| 7 | Cigna cigna ppo facility · fee schedule · outpatient | $336.99 | $336.99 | $336.99 – $336.99 |
| 8 | Blue Cross Blue Shield blue cross connection/exchange facility · fee schedule · outpatient | $1,346 | $1,346 | $1,346 – $1,346 |
| 9 | MultiPlan multiplan facility · percent of total billed charges · outpatientfrom % of charges | $1,567 | $1,567 | $1,567 – $1,567 |
| 10 | Phcs phcs facility · percent of total billed charges · outpatientfrom % of charges | $1,567 | $1,567 | $1,567 – $1,567 |
| 11 | Blue Cross Blue Shield blue cross small group facility · fee schedule · outpatient | $1,617 | $1,617 | $1,617 – $1,617 |
| 12 | Blue Cross Blue Shield blue cross hmo facility · fee schedule · outpatient | $1,661 | $1,661 | $1,661 – $1,661 |
| 13 | First Health first health facility · percent of total billed charges · outpatientfrom % of charges | $1,776 | $1,776 | $1,776 – $1,776 |
| 14 | UnitedHealthcare uhc exchange facility · fee schedule · outpatient | $2,532 | $2,532 | $2,532 – $2,532 |
| 15 | UnitedHealthcare uhc commercial facility · fee schedule · outpatient | $2,979 | $2,979 | $2,979 – $2,979 |
| 16 | UnitedHealthcare uhc empire facility · fee schedule · outpatient | $2,979 | $2,979 | $2,979 – $2,979 |
| 17 | Blue Cross Blue Shield blue cross access facility · fee schedule · outpatient | $8,313 | $8,313 | $8,313 – $8,313 |
Last updated: Jun 29, 2026
See CT scan of chest and spine without contrast dye pricing across every hospital in the network reporting it, or ask Claude or any MCP client directly — see how to connect.