CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Grossmont Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $2,052
Cash Discount Price: $2,412
vs. Medicare Baseline: 19.21x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Grossmont Hospital is $2,052. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,412. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 19.21x the Medicare baseline. Located in 5555 Grossmont Center Drive Box 58, La Mesa, CA.

Cash / Self-Pay

$2,412

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,052

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: $2,412 (2258%)

Insurance Median: $2,052 (1921%)

Cash: $2,412 (2258% of Medicare)

Ins. Median: $2,052 (1921% 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 1921% of the Medicare baseline (a markup of 1821%). 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
Managed Health Network	$24	22%
Molina	$24 - $2,052	22%
Aetna	$482 - $2,251	451%
Health Net	$900 - $3,152	843%
Medi-Cal	$955 - $4,366	894%
Cigna	$965 - $2,219	903%
Blue Shield	$981 - $2,894	918%
San Diego Pace	$1,286	1204%
Indian Health Council	$1,769 - $2,052	1656%
Interplan	$1,817	1701%
County Medical Services	$2,010	1882%
California Health And Wellness	$2,042 - $2,412	1912%
Kaiser	$2,052	1921%
Blue Cross Blue Shield	$2,155 - $2,637	2018%
Medicare (plans)	$2,573	2409%
Community Health Group	$2,894	2709%
Allianz Global Assistance	$3,152	2951%
Multiplan	$3,152	2951%
Epic Americas	$23,240	21758%

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 $2,412.
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 Grossmont 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.