CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Sweeny Community Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $1,228
Cash Discount Price: $1,271
vs. Medicare Baseline: 11.50x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Sweeny Community Hospital is $1,228. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,271. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 11.50x the Medicare baseline. Located in 305 North McKinney, Sweeny, TX.

Cash / Self-Pay

$1,271

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,228

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: $1,271 (1190%)

Insurance Median: $1,228 (1150%)

Cash: $1,271 (1190% of Medicare)

Ins. Median: $1,228 (1150% 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 1150% of the Medicare baseline (a markup of 1050%). 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
Humana	$500 - $618	468%
UnitedHealthcare	$500 - $1,694	468%
Aetna	$515 - $1,228	482%
Blue Cross Blue Shield	$635 - $1,059	595%
Cigna	$750	702%
Evercare Mcaid	$1,059	991%
Amerigroup Mcr Adv - All Other Plans	$1,228	1150%
Community Hlth Choice Him - All Other Plans	$1,228	1150%
Coventry Mcr Adv	$1,228	1150%
Molina Mcr Adv - All Other Plans	$1,228	1150%
Superior Hp Mcr Adv-All Other Plans	$1,228	1150%
Wellcare Mcare - All Plans	$1,228	1150%
Care Improvement Mcr - All Plans	$1,240	1161%
Choicecare Mcr Adv - All Plans	$1,240	1161%
Community Hlth Choice Star	$1,495	1400%
Molina Mcaid	$1,495	1400%
Superior Hp Mcaid	$1,495	1400%
Tx Chlidrens Hp Mcaid - All Plans	$1,495	1400%
Tx True Choice Mcaid - All Plans	$1,495	1400%
Beech Street - All Plans	$1,588	1487%
Community Care Network - All Plans	$1,694	1586%
Galaxy Health Network - All Plans	$1,906	1784%
Multiplan - All Plans	$1,906	1784%
Evercare Mcr Adv - All Other Plans	$2,054	1923%
Amerigroup Mcaid	$2,118	1983%

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 $1,271.
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 Sweeny Community 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.