CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: HCA Houston Healthcare Tomball

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $841
Cash Discount Price: $14,018
vs. Medicare Baseline: 7.87x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at HCA Houston Healthcare Tomball is $841. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $14,018. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 7.87x the Medicare baseline. Located in 605 Holderrieth, Tomball, TX.

Cash / Self-Pay

$14,018

Average discount available for prompt cash payment at this facility.

Insurance Median

$841

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: $14,018 (13124%)

Insurance Median: $841 (787%)

Cash: $14,018 (13124% of Medicare)

Ins. Median: $841 (787% 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 787% of the Medicare baseline (a markup of 687%). 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
Texas Childrens Healthplans	$105	98%
Community Health Choice Mcd	$107	100%
United	$109 - $6,308	102%
Aetna	$115 - $1,301	108%
Molina Healthcare	$115	108%
Humana	$131 - $2,273	123%
Blue Cross Blue Shield	$241 - $4,906	226%
Superior Health Plan	$841	787%
Cigna	$1,635 - $2,106	1531%
Coventry National First Health	$5,103	4778%
Christus (Usfhp)	$5,607	5250%

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 $14,018.
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 HCA Houston Healthcare Tomball 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.