CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: West Valley Medical Center

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $1,518
Cash Discount Price: $3,272
vs. Medicare Baseline: 14.21x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at West Valley Medical Center is $1,518. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,272. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 14.21x the Medicare baseline. Located in 1717 Arlington Street, Caldwell, ID.

Cash / Self-Pay

$3,272

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,518

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: $3,272 (3063%)

Insurance Median: $1,518 (1421%)

Cash: $3,272 (3063% of Medicare)

Ins. Median: $1,518 (1421% 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 1421% of the Medicare baseline (a markup of 1321%). 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
Blue Cross Blue Shield	$38 - $4,614	36%
Molina	$38 - $64	36%
Regence	$219	205%
United	$245 - $2,900	229%
Select Health Idaho (Eirmc Only)	$538 - $1,549	504%
Corizon Health	$624 - $1,797	584%
True Blue	$666 - $1,919	624%
Cigna	$945 - $2,720	885%
Pacificsource Health	$1,007 - $2,900	943%
Moda	$1,051 - $3,026	984%
St Luke'S Health Partners	$1,096 - $3,157	1026%
Aetna	$1,334 - $3,842	1249%
Four Rivers Hospice	$1,349 - $3,886	1263%
Multiplan	$1,349 - $3,886	1263%
Humana	$1,417 - $4,080	1327%
Geha Ppo Usa	$1,434 - $4,128	1343%
Coventry First Health	$1,518 - $4,371	1421%
St Alphonsus Health	$1,518 - $4,371	1421%

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 $3,272.
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 West Valley Medical Center 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.