CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Prosser Memorial Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $100
Cash Discount Price: $939
vs. Medicare Baseline: 0.94x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Prosser Memorial Hospital is $100. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $939. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 0.94x the Medicare baseline. Located in 723 Memorial Street, Prosser, WA.

Cash / Self-Pay

$939

Average discount available for prompt cash payment at this facility.

Insurance Median

$100

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: $939 (879%)

Insurance Median: $100 (94%)

Cash: $939 (879% of Medicare)

Ins. Median: $100 (94% 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.

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
Community Health Plan Of Washington	$27 - $1,277	25%
Coordinated Care	$27 - $1,277	25%
Kaiser Permanente	$27 - $2,870	25%
UnitedHealthcare	$27 - $1,355	25%
Amerigroup	$28 - $1,354	26%
Molina	$28 - $1,277	26%
Health Alliance Northwest	$53 - $788	50%
Humana	$53 - $2,681	50%
Wellcare	$53 - $788	50%
Aetna	$54 - $2,681	51%
Cigna	$59 - $2,586	55%
Premera	$64 - $2,523	60%
Asuris	$72 - $2,839	67%
Health Management Adminstrators	$72 - $2,839	67%
Regence	$72 - $2,839	67%
Ambetter / Centene	$95 - $2,429	89%
Multiplan	$223 - $2,839	209%
First Choice	$2,681	2510%

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 $939.
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 Prosser Memorial 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.