CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Valley Presbyterian Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $676
Cash Discount Price: $4,502
vs. Medicare Baseline: 6.33x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Valley Presbyterian Hospital is $676. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,502. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 6.33x the Medicare baseline. Located in 15107 Vanowen St, Van Nuys, CA.

Cash / Self-Pay

$4,502

Average discount available for prompt cash payment at this facility.

Insurance Median

$676

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: $4,502 (4215%)

Insurance Median: $676 (633%)

Cash: $4,502 (4215% of Medicare)

Ins. Median: $676 (633% 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 633% of the Medicare baseline (a markup of 533%). 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
Blue Shield Senior	$132	124%
Aetna	$135 - $2,573	126%
Blue Cross Blue Shield	$135 - $523	126%
Health Net Senior	$135	126%
La Care Covered California	$135	126%
Medicare (plans)	$135 - $142	126%
Ambetter / Centene	$191	179%
Heritage Provider Network (Regal & Lakeside)	$209	196%
Health Net	$267 - $676	250%
UnitedHealthcare	$491 - $3,503	460%
Blue Shield Ifp	$841	787%
Cigna	$859	804%
Blue Shield	$999	935%
Blue Shield Promise Medi-Cal	$1,126	1054%
La Care Medi-Cal	$2,701	2529%
Phcs	$2,701	2529%
Coventry Health Care (Ccn)	$3,151	2950%
Beech Street	$3,376	3161%
Multiplan	$4,052	3794%

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 $4,502.
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 Valley Presbyterian 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.