CT scan, lower back (lumbar spine)
Facility: North Adams Regional Hospital Corporation
Billing Code: 72131 (CPT)
- CPT Billing Code: 72131
- Insurance Median: $938
- Cash Discount Price: $1,979
- vs. Medicare Baseline: 8.78x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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 878% of the Medicare baseline (a markup of 778%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Mcd New York | $90 - $104 | 84% |
| Mcd Masshealth | $104 - $181 | 97% |
| Mcd Out Of State | $104 - $181 | 97% |
| Mcdmanaged Cdphp | $104 - $181 | 97% |
| Mcdmanaged Hne Mcdaco | $104 - $181 | 97% |
| Medicaid / KanCare | $104 - $916 | 97% |
| Comm Network Qhpsub | $115 - $1,177 | 108% |
| Mcdmanaged Network | $115 - $1,177 | 108% |
| Mcdmanaged Bmchnp | $120 - $189 | 112% |
| Medicare (plans) | $133 - $484 | 125% |
| Tricare | $133 - $783 | 125% |
| Comm Hospice | $135 - $479 | 126% |
| Mcr Miscellaneous | $135 - $479 | 126% |
| Mcrmanaged Usa Family | $135 - $479 | 126% |
| Mcrmanaged Va | $135 - $479 | 126% |
| Oth United Vaccn | $135 - $479 | 126% |
| Blue Cross Blue Shield | $153 - $1,770 | 143% |
| Mcrmanaged Cca One Care | $153 - $474 | 143% |
| Aetna | $159 - $1,573 | 149% |
| Comm Fallon Qhp | $200 - $1,179 | 187% |
| Comm Hne Hmo | $253 - $1,372 | 237% |
| Comm Hne | $269 - $1,452 | 252% |
| Comm Hne Ppo | $269 - $1,458 | 252% |
| Wc Workers Comp | $284 - $1,263 | 266% |
| Comm Unicare | $392 - $1,351 | 367% |
| Comm Network Qhpnonsub | $911 - $1,498 | 853% |
| Comm Nhp | $921 - $1,348 | 862% |
| Comm Tufts | $1,127 - $1,650 | 1055% |
| UnitedHealthcare | $1,224 - $1,791 | 1146% |
| Cigna | $1,281 - $1,937 | 1199% |
| Comm Cdphp | $1,281 - $1,875 | 1199% |
| Comm Mvp | $1,281 - $1,875 | 1199% |
| Comm Oxford | $1,281 - $1,875 | 1199% |
| Comm First Health | $1,324 - $1,979 | 1240% |
| Comm Connecticare | $1,352 - $1,979 | 1266% |
| Comm Consolidated Health | $1,352 - $1,979 | 1266% |
| Comm Harvard | $1,352 - $1,979 | 1266% |
| Comm Other | $1,352 - $1,979 | 1266% |
| Comm Phcs | $1,352 - $1,979 | 1266% |
| Comm Self Pay | $1,352 - $1,979 | 1266% |