CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Piedmont Rockdale Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $1,237
Cash Discount Price: $912
vs. Medicare Baseline: 11.58x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Piedmont Rockdale Hospital is $1,237. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $912. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 11.58x the Medicare baseline. Located in 1412 Milstead Avenue, Ne, Conyers, GA.

Cash / Self-Pay

$912

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,237

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: $912 (854%)

Insurance Median: $1,237 (1158%)

Cash: $912 (854% of Medicare)

Ins. Median: $1,237 (1158% 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 1158% of the Medicare baseline (a markup of 1058%). 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
UnitedHealthcare	$262	245%
Medicaid / KanCare	$366 - $373	343%
Cigna	$405 - $567	379%
Alliant Health Plans Of Georgia [10952]	$742	695%
Phcs [10601]	$1,732	1622%
Aetna	$2,082	1949%
Beechstreet [10800]	$2,128	1992%
First Health [10303]	$2,128	1992%
Multiplan [10600]	$2,128	1992%
Kaiser [10500]	$2,279	2134%
Novanet [10819]	$2,279	2134%

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 $912.
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 Piedmont Rockdale 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.