CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Medstar Georgetown University Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $770
Cash Discount Price: $1,788
vs. Medicare Baseline: 7.21x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Medstar Georgetown University Hospital is $770. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,788. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 7.21x the Medicare baseline. Located in 3800 Reservoir Rd, Washington, DC.

Cash / Self-Pay

$1,788

Average discount available for prompt cash payment at this facility.

Insurance Median

$770

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: $1,788 (1674%)

Insurance Median: $770 (721%)

Cash: $1,788 (1674% of Medicare)

Ins. Median: $770 (721% 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 721% of the Medicare baseline (a markup of 621%). 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
Carefirst Advantage Inc	$124	116%
Tricare	$124	116%
UnitedHealthcare	$124 - $963	116%
Aetna	$127 - $811	119%
Health Care Service Corporation	$130	122%
Humana	$130	122%
Blue Cross Blue Shield	$169	158%
Amerigroup	$230	215%
Amerihealth Caritas District Of Columbia	$230	215%
Hscsn	$230	215%
Medstar Family Choice Inc	$230 - $770	215%
Carefirst Blue Choice Inc	$1,126	1054%
Cigna	$1,243	1164%
Pfc	$1,788	1674%
Private Healthcare Systems (Phcs)	$2,200	2060%
First Health	$2,338	2189%
Beech Street	$2,475	2317%

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 $1,788.
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 Medstar Georgetown University 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.