CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Adventist Health Tillamook

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $920
Cash Discount Price: $928
vs. Medicare Baseline: 8.61x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Adventist Health Tillamook is $920. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $928. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 8.61x the Medicare baseline. Located in 1000 Third Street, Tillamook, OR.

Cash / Self-Pay

$928

Average discount available for prompt cash payment at this facility.

Insurance Median

$920

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: $928 (869%)

Insurance Median: $920 (861%)

Cash: $928 (869% of Medicare)

Ins. Median: $920 (861% 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 861% of the Medicare baseline (a markup of 761%). 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
UnitedHealthcare	$39 - $1,788	37%
Aetna	$46 - $1,750	43%
Moda Health Plan - All Plans	$47 - $885	44%
Medicare (plans)	$48 - $885	45%
Sterling Life - All Plans	$48 - $920	45%
Devoted Health	$49 - $955	46%
Blue Cross Blue Shield	$53 - $1,637	50%
Hvhs Mcare - All Plans	$55 - $893	51%
Ods Health Plan - All Other Plans	$106 - $1,826	99%
Pacificsource - All Plans	$118 - $1,807	110%
Lifewise - All Plans	$293 - $1,698	274%
Ah Employee Health Plan - All Plans	$306 - $1,769	286%
First Choice Health- All Plans	$306 - $1,769	286%
Health Net - All Plans	$306 - $1,769	286%
Providence Preferred - All Plans	$318 - $1,844	298%
Workers Comp	$325 - $1,882	304%
Cigna	$1,633 - $1,788	1529%
Phcs Preferred - All Plans	$1,633 - $1,788	1529%

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 $928.
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 Tillamook 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.