CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Memorial Hospital, The

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $1,297
Cash Discount Price: $991
vs. Medicare Baseline: 12.14x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Memorial Hospital, The is $1,297. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $991. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 12.14x the Medicare baseline. Located in 750 Hospital Loop, Craig, CO.

Cash / Self-Pay

$991

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,297

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: $991 (928%)

Insurance Median: $1,297 (1214%)

Cash: $991 (928% of Medicare)

Ins. Median: $1,297 (1214% 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 1214% of the Medicare baseline (a markup of 1114%). 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	$564 - $1,524	528%
Blue Cross Blue Shield	$564 - $1,524	528%
Care Advantage	$564 - $1,524	528%
Cvs Caremark-Part D	$564 - $1,524	528%
Denver Health	$564 - $1,524	528%
Kaiser	$564 - $1,524	528%
Rmhp Dualcare	$564 - $1,524	528%
Golden Rule Ins	$1,295	1212%
UnitedHealthcare	$1,295 - $1,524	1212%
Allegiance	$1,297	1214%
Cigna	$1,297	1214%
Geha	$1,297	1214%
Great West Hlthcare	$1,297	1214%
Health Partners	$1,297	1214%
Multiplan Inc Ppo	$1,402 - $1,448	1313%
First Health Other	$1,448	1356%
Humana	$1,524	1427%

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 $991.
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 Memorial Hospital, The 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.