CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Colleton Medical Center

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $1,209
Cash Discount Price: $5,511
vs. Medicare Baseline: 11.32x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Colleton Medical Center is $1,209. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $5,511. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 11.32x the Medicare baseline. Located in 501 Robertson Boulevard, Walterboro, SC.

Cash / Self-Pay

$5,511

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,209

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: $5,511 (5160%)

Insurance Median: $1,209 (1132%)

Cash: $5,511 (5160% of Medicare)

Ins. Median: $1,209 (1132% 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 1132% of the Medicare baseline (a markup of 1032%). 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
Select Health	$147	138%
Absolute Total Care	$186 - $1,032	174%
United	$245 - $3,044	229%
Blue Choice	$383	359%
Sc State Employees	$497 - $527	465%
Blue Choice Health Plan	$633 - $662	593%
Blue Cross Blue Shield	$633 - $5,445	593%
Nhc Advantage	$1,089	1020%
Pruitt Health	$1,089	1020%
Employers Health Network	$2,579	2415%
Value Option	$2,866	2683%
Vocational Rehab	$3,095	2898%
Medcost	$3,233 - $4,184	3027%
Aetna	$3,319	3107%
Cigna	$3,703	3467%
Humana	$3,726 - $5,159	3488%
Evernorth	$4,586	4294%
Multiplan	$4,872	4561%
North American Administrators	$4,872	4561%
Prime Health	$4,872	4561%
First Health	$5,159	4830%
Novanet	$5,159	4830%

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 $5,511.
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 Colleton 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.