CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Adventist Health Twin Cities

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $3,952
Cash Discount Price: $715
vs. Medicare Baseline: 37.00x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Adventist Health Twin Cities is $3,952. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $715. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 37.00x the Medicare baseline. Located in 1100 Las Tablas Rd, Templeton, CA.

Cash / Self-Pay

$715

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,952

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: $715 (669%)

Insurance Median: $3,952 (3700%)

Cash: $715 (669% of Medicare)

Ins. Median: $3,952 (3700% 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 3700% of the Medicare baseline (a markup of 3600%). 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 - $3,439	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	$3,472	3251%
Blue Shield Epn	$3,676	3442%
Blue Shield Hmo/Pos	$4,228	3958%
Blue Shield Epo/Ppo - All Other Plans	$4,953	4637%
Chn-Community Hlth Ntwrk-All Plans	$5,617	5259%
Nbd-Ntwrks By Design Exlus-All Other Plans	$5,897	5521%
Nbd-Ntwrks By Design Non-Exlus	$5,897	5521%
Pacific Health Alliance-All Plans	$9,191	8605%
Medi-Cal	$10,212	9561%
Cencal Mcal	$11,642	10900%
Blue Shield Promise Mcal	$12,275	11492%
Ccah-Centrl Ca Allince Mcal-All Plans	$13,276	12430%
Coalinga-All Plans	$13,276	12430%

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 $715.
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 Twin Cities 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.