CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: City of Hope National Medical Center

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $1,504
Cash Discount Price: $2,148
vs. Medicare Baseline: 14.08x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at City of Hope National Medical Center is $1,504. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,148. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 14.08x the Medicare baseline. Located in 1500 Duarte Rd, Duarte, CA.

Cash / Self-Pay

$2,148

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,504

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: $2,148 (2011%)

Insurance Median: $1,504 (1408%)

Cash: $2,148 (2011% of Medicare)

Ins. Median: $1,504 (1408% 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 1408% of the Medicare baseline (a markup of 1308%). 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
Health Net	$92 - $2,084	86%
Cal Optima	$98 - $174	92%
Heritage Provider Network	$122 - $1,504	114%
Inland Empire	$122 - $1,718	114%
Prime Healthcare Keenan	$171 - $2,062	160%
Healthcare Partners	$285	267%
UnitedHealthcare	$480 - $1,203	449%
Aetna	$715	669%
Blue Cross Blue Shield	$1,074 - $1,677	1006%
Blue Shield	$1,272 - $2,560	1191%
Blue Shield Covca	$1,306	1223%
Blue Shield Promise	$1,504	1408%
Cencal	$1,718	1608%
La Care Health	$1,718	1608%
Kaiser	$1,933	1810%
Gold Coast	$2,148	2011%
Molina	$2,148 - $2,792	2011%
Cigna	$2,307	2160%
Facey	$2,363	2212%
St. Joseph Heritage	$2,578	2414%
Primecare Medical Network	$2,792	2614%
First Health	$3,308	3097%
Phcs Multiplan	$3,866	3620%

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 $2,148.
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 City of Hope National Medical Center 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.