CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Cook Childrens Medical Center Prosper

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $1,611
Cash Discount Price: $3,265
vs. Medicare Baseline: 15.08x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Cook Childrens Medical Center Prosper is $1,611. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,265. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 15.08x the Medicare baseline. Located in 4100 W University Drive, Prosper, TX.

Cash / Self-Pay

$3,265

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,611

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: $3,265 (3057%)

Insurance Median: $1,611 (1508%)

Cash: $3,265 (3057% of Medicare)

Ins. Median: $1,611 (1508% 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 1508% of the Medicare baseline (a markup of 1408%). 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	$126 - $3,700	118%
Beacon	$135 - $2,351	126%
El Paso Health First	$135 - $2,351	126%
Health Plan W. Uhrip	$135	126%
Health Plan W/O Uhrip	$135 - $2,351	126%
Tx Children Health	$135 - $2,351	126%
Wellpoint	$141	132%
Blue Cross Blue Shield	$145 - $3,918	136%
Superior Health	$145	136%
Firstcare	$148 - $3,483	139%
United Community	$148 - $1,611	139%
UnitedHealthcare	$1,916 - $3,700	1794%
S&W Health	$3,657	3424%
Cigna	$3,700	3464%
Healthscope	$3,700	3464%
Imagine Health	$3,700	3464%
Humana	$3,787 - $3,831	3546%
Multiplan	$3,787	3546%
First Health	$3,831	3587%
Galaxy Health	$3,918	3668%
Healthsmart	$3,918	3668%
Usamco	$4,005	3750%

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 $3,265.
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 Cook Childrens Medical Center Prosper 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.