CMS Price Transparency Data
CT scan, lower back (lumbar spine)
Facility: Garfield Medical Center
Billing Code: 72131 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 72131
- Insurance Median: $334
- Cash Discount Price: $6,274
- vs. Medicare Baseline: 3.13x Medicare
The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Garfield Medical Center is $334. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $6,274. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 3.13x the Medicare baseline. Located in 525 N Garfield Ave, Monterey Park, CA.
Cash / Self-Pay
$6,274
Average discount available for prompt cash payment at this facility.
Insurance Median
$334
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: $6,274 (5874%)
Insurance Median: $334 (313%)
Cash: $6,274 (5874% of Medicare)
Ins. Median: $334 (313% 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 313% of the Medicare baseline (a markup of 213%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
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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 | $39 - $6,274 | 37% |
| Veterans Administration | $94 | 88% |
| Advantage Care Ipa | $102 - $6,274 | 95% |
| Physicians Healthways Medical Corporation | $102 - $6,274 | 95% |
| Ahmc Healthcare Inc | $124 - $1,882 | 116% |
| Allied Physicians | $124 - $202 | 116% |
| Beverly Hospital | $124 - $148 | 116% |
| Brand New Day | $124 - $168 | 116% |
| Care 1St Mcl/Gar Cap Reciprocity | $124 | 116% |
| Community Health Plan | $124 | 116% |
| Emanate Health | $124 - $168 | 116% |
| Health Net | $124 - $5,270 | 116% |
| Healthy Way La | $124 | 116% |
| La Care Health Plan | $124 - $3,451 | 116% |
| Other Non-Contracting Medi-Cal | $124 | 116% |
| Physicians Healthways Medi-Cal | $124 - $6,274 | 116% |
| Aetna | $132 - $6,172 | 124% |
| Aids Health Foundation | $132 - $334 | 124% |
| Apa Aco Inc | $132 | 124% |
| Avanti | $132 - $334 | 124% |
| Blue Shield | $132 - $2,528 | 124% |
| Central Health Plan | $132 - $1,200 | 124% |
| Cms | $132 | 124% |
| Easy Choice Health Plan | $132 | 124% |
| Humana | $132 | 124% |
| Non-Contract Medi-Care | $132 | 124% |
| Pacific Alliance Medical Center Comm/Sr | $132 | 124% |
| UnitedHealthcare | $132 - $2,900 | 124% |
| Blue Shield Of California | $134 - $3,137 | 125% |
| Cv-19 Hrsa Uninsured Testing And Tx | $134 | 125% |
| First Health Network | $134 - $3,300 | 125% |
| La Care Covered Direct | $134 | 125% |
| Scan Health Plan Sr Hmo | $134 | 125% |
| Self-Pay | $134 | 125% |
| Ucla Impact Dept Of Uncology | $134 | 125% |
| Alignment Health Plan | $139 | 130% |
| Molina Healthcare | $139 | 130% |
| Molina Healthcare Of California | $139 - $168 | 130% |
| Inter Valley Health Plan | $141 | 132% |
| National Disaster Medical System | $148 | 139% |
| San Miguel Health Plan | $148 | 139% |
| Chinatown Service Center Pace | $161 | 151% |
| Ahmc Health Epo | $168 | 157% |
| Knox-Keene Act | $168 | 157% |
| Preferred Health Network | $170 | 159% |
| Interplan | $173 - $4,706 | 162% |
| Pacificare Of California Inc | $178 | 167% |
| Pacificare Ppo | $178 | 167% |
| Athens Administrators | $179 | 168% |
| Multiplan | $179 - $5,333 | 168% |
| Other Non-Contracted Workers Compensation | $179 | 168% |
| Health Net Comm/Hmo | $214 - $3,451 | 200% |
| Health Net Inc | $218 | 204% |
| Hollywood Presbyterian Advanced Med Mgmt Mcal | $334 | 313% |
| Hollywood Presbyterian Medpoint Mcal | $334 | 313% |
| State Of California Medi-Cal | $334 | 313% |
| Physician Healthways Medical Corporation | $384 | 360% |
| Molina Medical Group | $478 - $1,350 | 448% |
| Caloptima Direct | $491 | 460% |
| Access Ipa Ancillary | $500 - $2,510 | 468% |
| Family Health Alliance | $500 | 468% |
| Pacific Independent Physician Association | $502 - $2,510 | 470% |
| Associated Hispanic Phys Of So Cal | $627 - $1,255 | 587% |
| Care First Health Plan | $627 | 587% |
| Allied Physicians Med Grp | $1,100 | 1030% |
| Cigna | $1,301 - $3,576 | 1218% |
| Employee Health Systems Mg | $2,000 | 1872% |
| Healthnet Medi Cal Cap | $2,000 | 1872% |
| Allied Physicians Risk Pool | $2,072 | 1940% |
| Allied Physicians Risk Pool Agreement | $2,196 | 2056% |
| Pipa Risk Pool Agreement | $2,196 | 2056% |
| Health Net Foundation Comm/Sr (Family Health Alliance) | $2,510 | 2350% |
| Health Net Foundation M Cal (Family Health Alliance) | $2,510 | 2350% |
| One Health Plan | $2,510 - $4,392 | 2350% |
| Phys Assoc Of San Gab Valley | $2,510 | 2350% |
| Alhambra Hospital | $3,764 | 3524% |
| Care 1St Health Plan | $3,764 | 3524% |
| Corvel Corporation | $4,392 - $5,019 | 4112% |
| Fmc Los Angeles Co Epo | $4,706 | 4406% |
| Americas Health Plan | $5,333 | 4993% |
| Health Payors Organization | $5,647 | 5287% |
| East La Reg Ctr | $6,274 | 5874% |
| Non Contract Commercial | $6,274 | 5874% |
| One Legacy | $6,274 | 5874% |
| Private Pay | $6,274 | 5874% |