CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Medical Center Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $417
Cash Discount Price: $1,381
vs. Medicare Baseline: 3.90x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Medical Center Hospital is $417. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,381. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 3.90x the Medicare baseline. Located in 500 W 4Th Street, Odessa, TX.

Cash / Self-Pay

$1,381

Average discount available for prompt cash payment at this facility.

Insurance Median

$417

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: $1,381 (1293%)

Insurance Median: $417 (390%)

Cash: $1,381 (1293% of Medicare)

Ins. Median: $417 (390% 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 390% of the Medicare baseline (a markup of 290%). 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	$100 - $1,424	94%
Corvel Wc	$100 - $107	94%
Humana	$100	94%
UnitedHealthcare	$100 - $2,158	94%
Novitas Solutions	$103	96%
Triwest Va Ccn	$103	96%
Care Improvement Plus	$105	98%
Medicaid / KanCare	$105 - $110	98%
Superior Chips	$105	98%
Ambetter / Centene	$109 - $118	102%
Wellcare By Allwell	$109	102%
Amerigroup	$118	110%
Blue Cross Blue Shield	$118 - $928	110%
Community Health Choice	$118	110%
First Care Health Plan	$118	110%
Superior Health Plan	$118	110%
Group Resources	$126	118%
Workers Comp	$210	197%
Caprock	$381 - $1,036	357%
Health Select	$391 - $928	366%
Healthsmart Preferred Care	$417 - $1,295	390%
Geha	$700	655%
Firstcare	$850 - $1,511	796%
90 Degree Benefits	$1,036	970%
State Comptroller	$1,079	1010%
Cigna	$1,082 - $1,092	1013%
Texas Mutual Wc	$1,424	1333%

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 $1,381.
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 Medical Center 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.