CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Memorialcare Orange Coast Medical Center

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $231
Cash Discount Price: $6,934
vs. Medicare Baseline: 2.16x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Memorialcare Orange Coast Medical Center is $231. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $6,934. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 2.16x the Medicare baseline. Located in 9920 Talbert Avenue, Fountain Valley, CA.

Cash / Self-Pay

$6,934

Average discount available for prompt cash payment at this facility.

Insurance Median

$231

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: $6,934 (6492%)

Insurance Median: $231 (216%)

Cash: $6,934 (6492% of Medicare)

Ins. Median: $231 (216% 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 216% of the Medicare baseline (a markup of 116%). 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
Seoul Medical Group	$121	113%
Blue Shield	$132 - $2,326	124%
Blue Cross Blue Shield	$134 - $367	125%
UnitedHealthcare	$134	125%
Molina	$138	129%
Universal Care	$141	132%
Central Health	$148	139%
Clever Care	$161	151%
Healthcare Partners	$168 - $366	157%
Select Health	$182	170%
Monarch Health Plan	$216 - $336	202%
Centivo	$303	284%
Cigna	$308 - $447	288%

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 $6,934.
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 Memorialcare Orange Coast 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.