CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Boone County Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $1,022
Cash Discount Price: $1,818
vs. Medicare Baseline: 9.57x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Boone County Hospital is $1,022. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,818. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 9.57x the Medicare baseline. Located in 1015 Union Street, Boone, IA.

Cash / Self-Pay

$1,818

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,022

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: $1,818 (1702%)

Insurance Median: $1,022 (957%)

Cash: $1,818 (1702% of Medicare)

Ins. Median: $1,022 (957% 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 957% of the Medicare baseline (a markup of 857%). 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
Tricare	$107	100%
Wellmark Hmo	$406	380%
Wellmark Ppo - All Other Plans	$446	418%
Choice Care Mcr Adv - All Plans	$932	873%
Humana	$932 - $2,045	873%
Iowa Hlth Adv - All Plans	$932	873%
Mt Carmel Hp - All Plans	$932	873%
UnitedHealthcare	$932 - $1,334	873%
Va Ccn-All Plans	$932	873%
Amerigroup Mcr Adv - All Other Plans	$941	881%
Aetna	$952 - $1,772	891%
Meridian Mcaid - All Plans	$1,022	957%
Iowa Total Care Mcaid - All Plans	$1,043	977%
Medicaid / KanCare	$1,053	986%
Healthsmart Accell Network	$1,590	1489%
Medical Associates Hp-All Plans	$1,704	1595%
Healthsmart Ppo - All Other Plans	$1,818	1702%
Health Alliance-All Plans	$2,045	1915%
Midlands Choice-All Plans	$2,090	1957%
Mutually Preferred-All Plans	$2,158	2020%

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 $1,818.
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 Boone County 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.