CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Graham Regional Medical Center

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $850
Cash Discount Price: $1,184
vs. Medicare Baseline: 7.96x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Graham Regional Medical Center is $850. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,184. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 7.96x the Medicare baseline. Located in 1301 Montgomery Road, Graham, TX.

Cash / Self-Pay

$1,184

Average discount available for prompt cash payment at this facility.

Insurance Median

$850

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: $1,184 (1109%)

Insurance Median: $850 (796%)

Cash: $1,184 (1109% of Medicare)

Ins. Median: $850 (796% 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 796% of the Medicare baseline (a markup of 696%). 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
Amerigroup	$343 - $411	321%
Choicecare Network	$343 - $411	321%
Superior Healthplan	$343 - $411	321%
Wellpoint	$463 - $555	433%
Aetna	$744 - $891	697%
Cigna	$744 - $891	697%
Blue Cross Blue Shield	$778 - $1,028	728%
Three Rivers Provider Network	$972 - $1,165	910%
Health Advantage Network	$1,030 - $1,234	964%
Healthsmart Preferred Care	$1,030 - $1,234	964%
UnitedHealthcare	$1,405	1315%
Curative	$2,860 - $3,428	2678%

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 $1,184.
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 Graham Regional Medical Center 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.