CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Adventist Health Vallejo

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $3,607
Cash Discount Price: $1,064
vs. Medicare Baseline: 33.77x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Adventist Health Vallejo is $3,607. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,064. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 33.77x the Medicare baseline. Located in 525 Oregon St, Vallejo, CA.

Cash / Self-Pay

$1,064

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,607

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: $1,064 (996%)

Insurance Median: $3,607 (3377%)

Cash: $1,064 (996% of Medicare)

Ins. Median: $3,607 (3377% 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 3377% of the Medicare baseline (a markup of 3277%). 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 - $6,778	24%
Blue Shield Mcr Adv	$46 - $106	43%
Medicare (plans)	$46 - $106	43%
Napa County Mcal Child	$46 - $106	43%
Tricare	$46 - $106	43%
Ah Employee Health Plan-All Plans	$51 - $191	48%
Interplan-All Plans	$56 - $5,450	52%
Kaiser-All Plans	$56 - $7,116	52%
Blue Shield Epn	$60 - $3,990	56%
Blue Shield Non-Epn-All Other Plans	$60 - $3,931	56%
UnitedHealthcare	$62 - $5,401	58%
Western Growers-All Plans	$68 - $4,490	64%
Aetna	$69 - $1,270	65%
Va Mcr-All Other Plans	$106	99%
Phcs-All Plans	$113 - $4,660	106%
Medi-Cal	$124 - $232	116%
Health Management Network-All Plans	$174 - $7,201	163%
Three Rivers-All Plans	$184 - $7,625	172%
Va Medi-Cal	$232	217%
Blue Cross Blue Shield	$1,005 - $1,205	941%
Healthnet-All Plans	$1,060	992%
Blue Shield Behav Hlth	$2,723 - $3,812	2549%
Choicecare-All Plans	$4,236 - $5,930	3966%
Beech Street-All Plans	$4,539 - $6,354	4250%
Galaxy Network-All Plans	$5,447 - $7,625	5100%

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 $1,064.
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 Vallejo 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.