CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: St Marys Good Samaritan Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $479
Cash Discount Price: $1,152
vs. Medicare Baseline: 4.48x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at St Marys Good Samaritan Hospital is $479. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,152. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 4.48x the Medicare baseline. Located in 5401 Lake Oconee Parkway, Greensboro, GA.

Cash / Self-Pay

$1,152

Average discount available for prompt cash payment at this facility.

Insurance Median

$479

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: $1,152 (1079%)

Insurance Median: $479 (448%)

Cash: $1,152 (1079% of Medicare)

Ins. Median: $479 (448% 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 448% of the Medicare baseline (a markup of 348%). 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
Peach State	$261	244%
Wellcare	$261 - $479	244%
Blue Cross Blue Shield	$343 - $1,281	321%
Aetna	$479 - $1,418	448%
Ambetter / Centene	$479	448%
Care Improvement Plus	$479	448%
Caresource	$479	448%
Cigna	$479 - $1,454	448%
Coventry	$479 - $1,330	448%
Eon Health Plan	$479	448%
Humana	$479 - $1,330	448%
Kaiser Permanente	$479	448%
Molina	$479	448%
Pruitthealth Premier	$479	448%
Todays Options Pffs	$479	448%
Todays Options Ppo	$479	448%
UnitedHealthcare	$479 - $2,632	448%
Vaccn United	$479	448%
First Health	$1,330	1245%
Phcs	$1,330	1245%
Meritain	$1,418	1328%
Multiplan	$1,507 - $1,543	1411%
Nova	$1,507 - $1,596	1411%
Three Rivers Provider Network	$1,596	1494%
Amerigroup	$1,773	1660%

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 $1,152.
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 St Marys Good Samaritan 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.