CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Virginia Gay Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $1,099
Cash Discount Price: $1,820
vs. Medicare Baseline: 10.29x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Virginia Gay Hospital is $1,099. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,820. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 10.29x the Medicare baseline. Located in 502 North 9Th Avenue, Vinton, IA.

Cash / Self-Pay

$1,820

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,099

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: $1,820 (1704%)

Insurance Median: $1,099 (1029%)

Cash: $1,820 (1704% of Medicare)

Ins. Median: $1,099 (1029% 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 1029% of the Medicare baseline (a markup of 929%). 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
Medicaid / KanCare	$107 - $989	100%
Aetna	$145	136%
Wellmark Hmo	$480	449%
Wellmark Ppo-All Other Plans	$529	495%
UnitedHealthcare	$762 - $1,099	713%
Va Ccn-All Plans	$829 - $854	776%
Health Alliance Mcr Adv	$874 - $900	818%
Medical Associates-All Plans	$1,681 - $1,731	1574%
Cedar Valley Community Healthcare-All Plans	$1,765 - $1,817	1652%
Humana	$1,793 - $1,846	1679%
Health Partners-All Plans	$1,905 - $1,962	1784%
Healthsmart-All Plans	$1,905 - $1,962	1784%
Corvel-All Plans	$2,084 - $2,146	1951%
Health Alliance-All Other Plans	$2,129 - $2,193	1993%

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 $1,820.
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 Virginia Gay 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.