CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Loma Linda University Children's Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $952
Cash Discount Price: $1,644
vs. Medicare Baseline: 8.91x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Loma Linda University Children's Hospital is $952. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,644. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 8.91x the Medicare baseline. Located in 11234 Anderson Street Suite A, Loma Linda, CA.

Cash / Self-Pay

$1,644

Average discount available for prompt cash payment at this facility.

Insurance Median

$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: $1,644 (1539%)

Insurance Median: $952 (891%)

Cash: $1,644 (1539% of Medicare)

Ins. Median: $952 (891% 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 891% of the Medicare baseline (a markup of 791%). 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
Alpha Care Medical Group	$135 - $203	126%
Dignity Health	$135 - $203	126%
Epic Health Plan	$135 - $1,903	126%
Inland Empire Health Plan (Iehp)	$135 - $209	126%
Kaiser Foundation Hospitals	$135 - $3,174	126%
Upland Medical Group	$135	126%
Vantage Medical Group	$135 - $203	126%
Molina Healthcare Of Ca	$170 - $181	159%
Heritage Provider Network	$222	208%
UnitedHealthcare	$491	460%
Adventist Health	$510 - $952	477%
Lluh Dept Of Risk Management	$612 - $1,142	573%
Blue Shield Of California	$1,030 - $1,561	964%
Global Benefits Group	$1,530 - $2,855	1432%
Temecula Valley Physicians Medical Group	$1,530	1432%
Trivalley Medical Group	$1,530	1432%
Blue Cross Blue Shield	$1,566	1466%
Cigna	$1,632 - $1,887	1528%
Networks By Design	$1,658 - $3,093	1552%
Multiplan	$2,040 - $3,806	1910%
Galaxy Health	$2,168 - $4,044	2030%
Prime Health Services	$2,168 - $4,044	2030%
Aetna	$2,754	2578%

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 $1,644.
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 Loma Linda University Children's Hospital 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.