CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: McLaren Bay Region

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $67
Cash Discount Price: $474
vs. Medicare Baseline: 0.63x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at McLaren Bay Region is $67. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $474. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 0.63x the Medicare baseline. Located in 1900 Columbus Ave, Bay City, MI.

Cash / Self-Pay

$474

Average discount available for prompt cash payment at this facility.

Insurance Median

$67

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: $474 (444%)

Insurance Median: $67 (63%)

Cash: $474 (444% of Medicare)

Ins. Median: $67 (63% 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.

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
Medicaid / KanCare	$30 - $60	28%
Humana	$46 - $104	43%
Medicare (plans)	$46 - $166	43%
U Of M Health Plan	$53	50%
UnitedHealthcare	$58 - $1,235	54%
Aetna	$60 - $1,441	56%
Mclaren Commercial Ins	$67	63%
Priority Health	$68 - $934	64%
Blue Cross Blue Shield	$75 - $358	70%
Mi Amish Medical Board	$104	97%
Tricare	$104	97%
Cofinity Auto	$197	184%
Workers Compensation	$550	515%

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 $474.
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 McLaren Bay Region 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.