CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Mary Washington Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $181
Cash Discount Price: $1,114
vs. Medicare Baseline: 1.69x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Mary Washington Hospital is $181. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,114. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.69x the Medicare baseline. Located in 1001 Sam Perry Boulevard, Fredericksburg, VA.

Cash / Self-Pay

$1,114

Average discount available for prompt cash payment at this facility.

Insurance Median

$181

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: $1,114 (1043%)

Insurance Median: $181 (169%)

Cash: $1,114 (1043% of Medicare)

Ins. Median: $181 (169% 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.

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
Humana	$105 - $147	98%
Molina	$109 - $153	102%
Kaiser	$112 - $157	105%
Aetna	$147 - $2,641	138%
Blue Cross Blue Shield	$147 - $248	138%
Sentara	$147 - $234	138%
UnitedHealthcare	$147 - $180	138%
Medcost	$310	290%
PHCS	$317	297%
Cf	$905 - $992	847%
Innovation	$1,789 - $1,968	1675%

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 $1,114.
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 Mary Washington 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.