CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Charlevoix Area Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $147
Cash Discount Price: $1,113
vs. Medicare Baseline: 1.38x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Charlevoix Area Hospital is $147. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,113. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.38x the Medicare baseline. Located in 14700 Lakeshore Drive, Charlevoix, MI.

Cash / Self-Pay

$1,113

Average discount available for prompt cash payment at this facility.

Insurance Median

$147

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: $1,113 (1042%)

Insurance Median: $147 (138%)

Cash: $1,113 (1042% of Medicare)

Ins. Median: $147 (138% 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
Blue Cross Blue Shield	$30 - $1,209	28%
Mclaren Health Plan	$30 - $1,219	28%
Meridian	$30 - $74	28%
Priority Health	$30 - $1,309	28%
UnitedHealthcare	$30 - $1,138	28%
Aetna	$46 - $1,182	43%
Blue Care Network	$46 - $615	43%
Hap (Health Alliance Plan)	$46 - $1,047	43%
Medicare (plans)	$46 - $615	43%
Michigan Amish Medical Board	$46 - $615	43%
Molina	$46 - $664	43%
Northern Michigan Mennonite Group	$46 - $615	43%
Asr Physicians Care Network	$69 - $1,047	65%
Cigna	$70 - $1,309	66%
Nomi Health	$73 - $1,217	68%
Employee Benefits Logistics	$78 - $1,046	73%
Provider Network Of America/Hma Group Health	$147 - $1,113	138%
Hospice Of Michigan	$785	735%
Enterprise Group Planning Employee Benefit Plan	$1,047	980%
First Health/Coventry Health/Community Care Network	$1,047	980%
Medical Cost Savings Solution	$1,047	980%
Three Rivers Provider Network	$1,113	1042%
Iba Health And Life Assurance Company	$1,204	1127%
Cofinity	$1,217	1139%
Preferred Medical Claim Solutions	$1,244	1165%

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 $1,113.
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 Charlevoix Area 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.