CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Franklin General Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $832
Cash Discount Price: $1,774
vs. Medicare Baseline: 7.79x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Franklin General Hospital is $832. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,774. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 7.79x the Medicare baseline. Located in 1720 Central Avenue East, Hampton, IA.

Cash / Self-Pay

$1,774

Average discount available for prompt cash payment at this facility.

Insurance Median

$832

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: $1,774 (1661%)

Insurance Median: $832 (779%)

Cash: $1,774 (1661% of Medicare)

Ins. Median: $832 (779% 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 779% of the Medicare baseline (a markup of 679%). 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
Wellmark Hmo	$480	449%
Wellmark Ppo - All Other Plans	$529	495%
Medical Associates Mcare	$788	738%
Mount Carmel Hp-All Plans	$788	738%
Tricare	$788	738%
UnitedHealthcare	$788 - $1,638	738%
Amerigroup Mcare	$796	745%
Wellmark Mcr Adv	$796	745%
Molina Mcare	$820	768%
Ambetter / Centene	$824 - $1,261	771%
American Hp Iowa - All Plans	$828	775%
Amerigroup Mcaid - All Other Plans	$832	779%
Molina Mcaid - All Other Plans	$836	783%
Centivo - All Plans	$1,183	1108%
Medical Ass Hosp Employer Group	$1,183	1108%
Oscar - All Plans	$1,183	1108%
Midlands Choice-All Plans	$1,380	1292%
Medical Associates Hp-All Other Plans	$1,675	1568%
Preferred Health Choices-All Plans	$1,675	1568%
Splashlight Llc-All Plans	$1,675	1568%
Aetna	$1,833 - $1,872	1716%
Multiplan-All Plans	$1,872	1753%

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 $1,774.
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 Franklin General 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.