CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Washington County Hospital and Clinics

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $868
Cash Discount Price: $1,587
vs. Medicare Baseline: 8.13x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Washington County Hospital and Clinics is $868. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,587. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 8.13x the Medicare baseline. Located in 400 East Polk Street, Washington, IA.

Cash / Self-Pay

$1,587

Average discount available for prompt cash payment at this facility.

Insurance Median

$868

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: $1,587 (1486%)

Insurance Median: $868 (813%)

Cash: $1,587 (1486% of Medicare)

Ins. Median: $868 (813% 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 813% of the Medicare baseline (a markup of 713%). 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
Ambetter / Centene	$93	87%
Aetna	$144 - $1,862	135%
Midlands Choice - All Plans	$148	139%
Health Alliance Mcr Adv	$846	792%
Med Assoc Mcr Adv	$846	792%
Blue Cross Blue Shield	$855	800%
Healthpartners Mcr Adv	$863	808%
Humana	$863	808%
Ia Total Care Wellcare Mcr Adv	$872	816%
Molina Mcr Adv - All Other Plans	$872	816%
Wellpoint Mcr Adv Amerigrp - All Other Plans	$872	816%
Ia Total Care Mcaid	$889	832%
Medicaid / KanCare	$889	832%
Wellpoint Mcaid Amerigrp	$889	832%
Healthpartners - All Other Plans	$1,799	1684%
Health Alliance Comm - All Other Plans	$2,010	1882%

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 $1,587.
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 Washington County Hospital and Clinics 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.