CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Oak Valley Hospital District

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $1,904
Cash Discount Price: $2,462
vs. Medicare Baseline: 17.83x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Oak Valley Hospital District is $1,904. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,462. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 17.83x the Medicare baseline. Located in 350 S Oak Ave, Oakdale, CA.

Cash / Self-Pay

$2,462

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,904

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: $2,462 (2305%)

Insurance Median: $1,904 (1783%)

Cash: $2,462 (2305% of Medicare)

Ins. Median: $1,904 (1783% 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 1783% of the Medicare baseline (a markup of 1683%). 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
Alignment Op Only Ip/Op Only-All Plans	$134	125%
Humana	$134	125%
Kaiser Mcr Adv Ip/Op Only	$134	125%
Scan Health Plan Ip/Op Only-All Plans	$137	128%
Imperial Health Ip/Op Only-All Plans	$148	139%
Blue Cross Blue Shield	$232 - $2,954	217%
Healthnet Medi-Cal Ip/Op Only	$232	217%
Kaiser Medi-Cal Ip/Op Only	$232	217%
Medi-Cal Ip/Op Only	$232	217%
Hp Of San Joaquin Ip/Op Only-All Plans	$278	260%
Blue Shield Epn Ip/Op Only	$1,776	1663%
Healthnet Comm Op Only Ip/Op Only-All Other Plans	$1,904	1783%
Kaiser Comm Ip/Op Only-All Other Plans	$2,035	1905%
Blue Shield/Bcout Ip/Op Only-All Other Plans	$2,166	2028%
Cigna	$2,199	2059%
UnitedHealthcare	$2,297	2151%
Aetna	$2,793	2615%

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 $2,462.
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 Oak Valley Hospital District 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.