CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Atrium Health Navicent the Medical Center

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $158
Cash Discount Price: $1,495
vs. Medicare Baseline: 1.48x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Atrium Health Navicent the Medical Center is $158. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,495. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.48x the Medicare baseline. Located in 777 Hemlock Street, Macon, GA.

Cash / Self-Pay

$1,495

Average discount available for prompt cash payment at this facility.

Insurance Median

$158

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: $1,495 (1400%)

Insurance Median: $158 (148%)

Cash: $1,495 (1400% of Medicare)

Ins. Median: $158 (148% 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
Aetna	$44 - $2,063	41%
Blue Cross Blue Shield	$44 - $177	41%
Georgia Health Advantage	$44 - $117	41%
Humana	$44 - $2,054	41%
UnitedHealthcare	$44 - $1,422	41%
Care Source	$45 - $119	42%
Clover	$45 - $119	42%
Eon Health	$45 - $119	42%
Pruitt Health	$46 - $123	43%
Alliant	$53 - $140	50%
Ambetter / Centene	$60 - $1,525	56%
Securehealth	$137 - $1,046	128%
Cigna	$175 - $524	164%
Kaiser	$234 - $1,944	219%
Multiplan	$1,944 - $2,392	1820%
Ibg	$2,114	1979%
Novanet	$2,392	2239%
Three Rivers Provider Network	$2,542	2380%
Beechstreet	$2,781	2604%

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 $1,495.
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 Atrium Health Navicent the 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.