CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Vandalia Health Broaddus Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $1,629
Cash Discount Price: $1,556
vs. Medicare Baseline: 15.25x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Vandalia Health Broaddus Hospital is $1,629. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,556. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 15.25x the Medicare baseline. Located in 1 Healthcare Drive Mansfield Hill, Philippi, WV.

Cash / Self-Pay

$1,556

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,629

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: $1,556 (1457%)

Insurance Median: $1,629 (1525%)

Cash: $1,556 (1457% of Medicare)

Ins. Median: $1,629 (1525% 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 1525% of the Medicare baseline (a markup of 1425%). 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
Correctional Medical Systems	$34 - $88	32%
Aetna	$35 - $1,987	33%
The Health Plan	$35 - $2,001	33%
Unicare	$35 - $93	33%
Blue Cross Blue Shield	$86 - $1,577	81%
Peak Health	$383 - $708	359%
Highmark	$1,629	1525%
UnitedHealthcare	$1,645 - $2,159	1540%
Humana	$1,711	1602%
West Virginia Senior Advantage	$1,727	1617%
Cigna	$1,945	1821%
First Health	$1,987	1860%
Geisenger Health Plan	$2,067	1935%
Health Network America	$2,067 - $2,112	1935%
Multiplan/Phcs	$2,090	1957%
Geha	$2,112	1977%
Selectnet	$2,179	2040%

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 $1,556.
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 Vandalia Health Broaddus 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.