CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Shriners Hospitals for Children Northern Calif

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $156
Cash Discount Price: $3,834
vs. Medicare Baseline: 1.46x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Shriners Hospitals for Children Northern Calif is $156. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,834. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.46x the Medicare baseline. Located in 2425 Stockton Boulevard, Sacramento, CA.

Cash / Self-Pay

$3,834

Average discount available for prompt cash payment at this facility.

Insurance Median

$156

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: $3,834 (3590%)

Insurance Median: $156 (146%)

Cash: $3,834 (3590% of Medicare)

Ins. Median: $156 (146% 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.

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	$91 - $202	85%
Medicaid / KanCare	$91	85%
Kaiser Permanente	$100 - $178	94%
Ambetter / Centene	$102 - $202	95%
Molina Healthcare Of Ms	$102	95%
Soonercare	$110	103%
UnitedHealthcare	$112	105%
Amerihealth Caritas Nc	$118	110%
Amerihealth Caritas Sc	$118	110%
Caresource Of Oh	$118	110%
Northbay Healthcare	$136	127%
Cigna	$139	130%
Gateway Health Plan	$139	130%
Sana Benefits	$143 - $190	134%
Sutter Medical Foundation	$149	140%
Health Net Of Ca	$156	146%
Blue Cross Blue Shield	$178 - $249	167%
Central California Alliance For Health	$178	167%
Health Plan Of San Joaquin	$178	167%
Molina Healthcare Of Ca	$178	167%
Partnership Healthplan Of Ca	$178	167%
Amerigroup Nv	$181	169%
Health Plan Of Nv	$202	189%
Healthchoice Of Oklahoma	$213	199%
Providence Health Plan	$261	244%

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 $3,834.
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 Shriners Hospitals for Children Northern Calif 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.