CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: AHMC Seton Medical Center

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 72131
  • Insurance Median: $202
  • Cash Discount Price: $4,515
  • vs. Medicare Baseline: 1.89x Medicare
The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at AHMC Seton Medical Center is $202. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,515. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.89x the Medicare baseline. Located in 1900 Sullivan Avenue, Daly City, CA.
Cash / Self-Pay
$4,515

Average discount available for prompt cash payment at this facility.

Insurance Median
$202

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: $4,515 (4227%)
Insurance Median: $202 (189%)
Cash: $4,515 (4227% of Medicare)
Ins. Median: $202 (189% 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.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash 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
Blue Cross Blue Shield $39 - $4,287 37%
Veterans Administration (Va) $106 99%
Hill Physicians Medical Group Inc $121 - $334 113%
Medi-Cal $124 116%
Aetna $149 - $847 140%
Asian American Medical Group $149 - $401 140%
Blue Shield Of California $149 - $3,225 140%
Brand New Day $149 - $190 140%
Brown And Toland Medical Group $149 - $417 140%
Care Advantage $149 140%
Chinese Community Health Plan $149 - $2,822 140%
For Your Benefit $149 140%
Healthnet Seniority $149 140%
Humana $149 140%
Imperial Health Plan $149 140%
Jade Health Care Mg $149 - $187 140%
Medicare (plans) $149 140%
North East Medical Services $149 - $174 140%
Pacificare $149 140%
Tricare $151 141%
Apcmg $152 - $228 142%
Canopy Health $152 - $273 142%
Covid-19 Uninsured Program $152 142%
Kaiser $152 - $4,628 142%
UnitedHealthcare $152 - $178 142%
San Mateo County/San Mateo County General Hospital $153 143%
Easy Choice Hospital Services $155 145%
Central Health Plan $161 151%
San Francisco Health Plan $174 163%
Ahmc Health $190 178%
Knox-Keene Act $190 178%
Athens Administrators $202 189%
Corvel Healthcare $202 189%
Multiplan/Bce Emergis $202 - $4,233 189%
Work Comp Other $202 189%
Health Plan Of San Mateo Healthworx $304 285%
Cmac $334 313%
Health Plan Of San Mateo $346 324%
Workers Compensation Federal $496 464%
Self Pay $847 - $1,919 793%
Interplan Corporation $3,386 3170%
Cigna $3,951 3699%
Private Healthcare Sytems Inc $4,233 3963%
The First Health Network $4,233 3963%
Health Net $4,298 4024%
Beech Street Corporation $4,515 4227%
Healthcare Foundation Of San Mateo $4,515 4227%
Choicecare Network $4,797 4491%
Multiplan $4,797 4491%
Mills Peninsula Health Services $5,080 4756%
Indemnity $5,644 5284%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 1900 Sullivan Avenue, Daly City, CA 94015
  • CMS Rating: ★☆☆☆☆
  • Ownership Type: Voluntary non-profit - Church
  • Hospital Type: Acute Care Hospitals