CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Carilion Stonewall Jackson Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $1,506
Cash Discount Price: $1,027
vs. Medicare Baseline: 14.10x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Carilion Stonewall Jackson Hospital is $1,506. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,027. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 14.10x the Medicare baseline. Located in 1 Health Circle, Lexington, VA.

Cash / Self-Pay

$1,027

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,506

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: $1,027 (962%)

Insurance Median: $1,506 (1410%)

Cash: $1,027 (962% of Medicare)

Ins. Median: $1,506 (1410% 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 1410% of the Medicare baseline (a markup of 1310%). 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
Aetna	$92 - $1,948	86%
Humana	$94 - $124	88%
Blue Cross Blue Shield	$100 - $488	94%
UnitedHealthcare	$101 - $2,397	95%
Sentara Health Plan	$103 - $1,818	96%
Abh of VA (Formerly Coventry)	$124	116%
Abh of Wva (Formerly Coventry)	$124	116%
Gateway - Tier 3	$1,613	1510%
Vhn - Ultra	$1,818	1702%
Connecticare	$2,053	1922%
Gateway - Tier 2	$2,346	2196%
Vhn - Plus	$2,346	2196%
Cigna	$2,349	2199%
Vhn	$2,493	2334%
Integrated Health Plan	$2,493	2334%
Vhn - Link	$2,640	2472%
Beech Street	$2,698	2526%
Gateway - Tier 1	$2,786	2608%
Vhn - Secondary Payors	$2,786	2608%

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 $1,027.
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 Carilion Stonewall Jackson 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.