CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Pocahontas Memorial Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $1,055
Cash Discount Price: $974
vs. Medicare Baseline: 9.88x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Pocahontas Memorial Hospital is $1,055. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $974. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 9.88x the Medicare baseline. Located in 150 Duncan Road, Buckeye, WV.

Cash / Self-Pay

$974

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,055

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: $974 (912%)

Insurance Median: $1,055 (988%)

Cash: $974 (912% of Medicare)

Ins. Median: $1,055 (988% 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 988% of the Medicare baseline (a markup of 888%). 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
Medicaid / KanCare	$974	912%
Unicare Health Plan of Wv, Inc. - Commercial-Hmo	$974	912%
Wellpoint West Virginia, Inc. - Commercial-Hmo	$974	912%
Aetna	$974 - $1,244	912%
Medicare (plans)	$1,028 - $1,055	962%
Wv Treasury Peia - Commercial-Ppo	$1,071	1003%
UnitedHealthcare	$1,085 - $1,296	1016%
Blue Cross Blue Shield	$1,208	1131%
Humana	$1,363	1276%

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 $974.
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 Pocahontas Memorial 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.