CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Adventist Health Sierra Vista

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $3,848
Cash Discount Price: $941
vs. Medicare Baseline: 36.03x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Adventist Health Sierra Vista is $3,848. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $941. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 36.03x the Medicare baseline. Located in 1010 Murray St, San Luis Obispo, CA.

Cash / Self-Pay

$941

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,848

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: $941 (881%)

Insurance Median: $3,848 (3603%)

Cash: $941 (881% of Medicare)

Ins. Median: $3,848 (3603% 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 3603% of the Medicare baseline (a markup of 3503%). 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
Aetna	$134	125%
Cencal Mcr Adv - All Other Plans	$134	125%
Tricare	$134	125%
UnitedHealthcare	$134 - $3,597	125%
Cfmg-Ca Forensic Med Grp Op/Profee Only-All Plans	$174	163%
Ah Employee Health Plan - All Plans	$242	227%
Hpn-Heritage Prov Ntwrk-All Plans	$3,555	3328%
Blue Shield Epn	$4,099	3838%
Blue Shield Hmo/Pos	$5,103	4778%
Blue Shield Epo/Ppo-All Other Plans	$5,625	5266%
Nbd-Ntwrks By Design Exclus-All Other Plans	$6,038	5653%
Nbd-Ntwrks By Design Non-Exclus	$6,038	5653%
Medi-Cal	$10,456	9789%
Cencal Mcal	$11,920	11160%
Blue Shield Promise Mcal	$12,568	11767%
Ccah-Centrl Ca Allince Mcal-All Plans	$13,593	12726%
Coalinga-All Plans	$13,593	12726%

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 $941.
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 Adventist Health Sierra Vista 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.