CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Childrens Hospital of the Kings Daughters Inc

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $2,417
Cash Discount Price: $2,873
vs. Medicare Baseline: 22.63x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Childrens Hospital of the Kings Daughters Inc is $2,417. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,873. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 22.63x the Medicare baseline. Located in 601 Children's Lane, Norfolk, VA.

Cash / Self-Pay

$2,873

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,417

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: $2,873 (2690%)

Insurance Median: $2,417 (2263%)

Cash: $2,873 (2690% of Medicare)

Ins. Median: $2,417 (2263% 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 2263% of the Medicare baseline (a markup of 2163%). 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	$159 - $359	149%
UnitedHealthcare	$160 - $2,624	150%
Sentara Community Plan	$187	175%
Aetna	$196 - $2,624	184%
Humana	$196	184%
Amerihealth Caritas	$734	687%
Healthy Blue	$734	687%
Carolina Complete Health	$749	701%
Wellcare	$756	708%
Sentara Health Plans	$1,171	1096%
Cigna	$2,120	1985%
Virginia Health Network	$2,235 - $2,554	2093%
Medcost	$2,714 - $2,937	2541%
First Health	$2,873	2690%
Multiplan	$2,937	2750%
Phcs	$2,937 - $3,033	2750%
Vhn	$2,937 - $3,033	2750%
Johns Hopkins Healthcare	$3,033	2840%

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 $2,873.
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 Childrens Hospital of the Kings Daughters Inc 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.