CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Memorial Hospital and Manor

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $1,255
Cash Discount Price: $1,329
vs. Medicare Baseline: 11.75x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Memorial Hospital and Manor is $1,255. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,329. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 11.75x the Medicare baseline. Located in 1500 E Shotwell Street, Bainbridge, GA.

Cash / Self-Pay

$1,329

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,255

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: $1,329 (1244%)

Insurance Median: $1,255 (1175%)

Cash: $1,329 (1244% of Medicare)

Ins. Median: $1,255 (1175% 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 1175% of the Medicare baseline (a markup of 1075%). 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
Tricare	$85	80%
Aetna	$92 - $1,708	86%
Humana	$92 - $1,518	86%
Medicare (plans)	$92	86%
Wellcare_Plan	$92	86%
Ambetter / Centene	$120	112%
Alliant_Plan	$147	138%
Tnga_Plan	$450	421%
Amerigroup_Plan	$1,196	1120%
Medicaid / KanCare	$1,196	1120%
Peach_State_Health_Plan_Plan	$1,196	1120%
Caresource_Plan	$1,255	1175%
Blue Cross Blue Shield	$1,466	1373%
Uhc_Plan	$1,499	1403%
Novanet_Plan	$1,518	1421%
Cigna	$1,575	1475%
Private_Healthcare_Systems_Plan	$1,613	1510%
Multiplan_Plan	$1,708	1599%
Corvel_Plan	$1,803	1688%

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 $1,329.
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 Memorial Hospital and Manor 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.