CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Bethesda Hospital East

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $734
Cash Discount Price: $3,283
vs. Medicare Baseline: 6.87x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Bethesda Hospital East is $734. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,283. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 6.87x the Medicare baseline. Located in 2815 S Seacrest Blvd, Boynton Beach, FL.

Cash / Self-Pay

$3,283

Average discount available for prompt cash payment at this facility.

Insurance Median

$734

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: $3,283 (3074%)

Insurance Median: $734 (687%)

Cash: $3,283 (3074% of Medicare)

Ins. Median: $734 (687% 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 687% of the Medicare baseline (a markup of 587%). 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
Amerigroup	$67	63%
Medicaid / KanCare	$67 - $74	63%
Sunshine State	$67	63%
UnitedHealthcare	$67 - $5,050	63%
Wellcare	$67	63%
Aetna	$71 - $2,697	66%
Vista	$71	66%
Blue Cross Blue Shield	$109 - $1,352	102%
Leon Medical	$109	102%
Medica Health Plan	$109	102%
Medicare (plans)	$109 - $147	102%
Humana	$114	107%
Cigna	$115 - $594	108%
Avmed	$120 - $2,495	112%
Non Contracted	$1,853	1735%
Amerihealth	$2,272	2127%
Affordable	$3,282	3073%
International	$3,282	3073%
Dimension Health Plan	$4,545	4255%
Phcs	$4,545	4255%
Quality Health	$4,545	4255%

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 $3,283.
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 Bethesda Hospital East 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.