CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Baylor Scott & White Medical Center - Round Rock

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $970
Cash Discount Price: $1,532
vs. Medicare Baseline: 9.08x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Baylor Scott & White Medical Center - Round Rock is $970. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,532. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 9.08x the Medicare baseline. Located in 300 University Blvd, Round Rock, TX.

Cash / Self-Pay

$1,532

Average discount available for prompt cash payment at this facility.

Insurance Median

$970

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: $1,532 (1434%)

Insurance Median: $970 (908%)

Cash: $1,532 (1434% of Medicare)

Ins. Median: $970 (908% 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 908% of the Medicare baseline (a markup of 808%). 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
Baylor Scott & White Health Plan	$93 - $1,586	87%
Humana	$98 - $1,788	92%
Superior Health Plan	$98 - $107	92%
Triwest	$98	92%
Aetna	$103 - $1,405	96%
American Health Plan	$103	96%
Blue Cross Blue Shield	$103 - $536	96%
Corvel	$103	96%
Healthspring	$103	96%
Prime Health Services	$103	96%
Procare Advantage	$103	96%
UnitedHealthcare	$113 - $1,939	106%
Injury Management Organization	$122	114%
Careworks Fka Rockport	$147	138%
Sedgwick	$147	138%
Midcoast	$1,405	1315%
Quiktrip	$1,405	1315%
Cigna	$1,466 - $1,725	1373%
Independent Medical System	$1,532	1434%
Curative	$1,660	1554%
University Of Mary Hardin-Baylor	$1,725	1615%
First Health	$1,788	1674%
Healthsmart	$1,788 - $1,916	1674%
Bluebell Creameries	$1,916	1794%
Private Health Care System	$1,916	1794%
Three Rivers	$2,299	2152%

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 $1,532.
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 Baylor Scott & White Medical Center - Round Rock 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.