CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Adventist Health Howard Memorial

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $925
Cash Discount Price: $722
vs. Medicare Baseline: 8.66x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Adventist Health Howard Memorial is $925. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $722. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 8.66x the Medicare baseline. Located in 1 Marcela Dr, Willits, CA.

Cash / Self-Pay

$722

Average discount available for prompt cash payment at this facility.

Insurance Median

$925

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: $722 (676%)

Insurance Median: $925 (866%)

Cash: $722 (676% of Medicare)

Ins. Median: $925 (866% 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 866% of the Medicare baseline (a markup of 766%). 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
Cigna	$26 - $3,932	24%
Blue Shield Mcare	$47 - $925	44%
Medicare (plans)	$47 - $934	44%
Tricare	$47 - $925	44%
UnitedHealthcare	$47 - $3,580	44%
Ah Employee Health Plan - All Plans	$52 - $2,406	49%
Healthnet - All Plans	$69 - $3,793	65%
Western Growers/Pinnacle - All Plans	$72 - $3,470	67%
Blue Shield - All Other Plans	$91 - $2,312	85%
Medi-Cal	$124 - $232	116%
Brms - All Plans	$157 - $3,932	147%
Aetna	$178 - $3,104	167%
Blue Cross Blue Shield	$941 - $1,129	881%
Blue Shield Epn	$2,317	2169%
First Health Ppo - All Plans	$3,701	3465%
Ghn Ppo - All Plans	$3,701	3465%

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 $722.
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 Adventist Health Howard Memorial 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.