CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Novant Health Forsyth Medical Center

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $1,265
Cash Discount Price: $1,213
vs. Medicare Baseline: 11.84x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Novant Health Forsyth Medical Center is $1,265. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,213. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 11.84x the Medicare baseline. Located in 3333 Silas Creek Parkway, Winston-Salem, NC.

Cash / Self-Pay

$1,213

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,265

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: $1,213 (1136%)

Insurance Median: $1,265 (1184%)

Cash: $1,213 (1136% of Medicare)

Ins. Median: $1,265 (1184% 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 1184% of the Medicare baseline (a markup of 1084%). 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
Blue Cross Blue Shield	$101 - $1,693	95%
Humana	$101 - $1,919	95%
Pace Of The Southern Piedmont	$101	95%
UnitedHealthcare	$101 - $1,658	95%
Aetna	$104 - $1,971	97%
Cigna	$104 - $1,464	97%
Liberty Health	$106	99%
Nc Department Of Public Safety	$203 - $458	190%
Carolina Complete	$367 - $458	344%
Amerihealth	$374 - $467	350%
Wellcare	$374 - $467	350%
Caresource North Carolina	$790 - $986	740%
Atlantic Corporation Dba Atlantic Packaging	$1,116 - $1,392	1045%
Plotkin Health	$1,186 - $1,478	1110%
Amps	$1,284 - $1,602	1202%
Medcost	$1,680 - $2,316	1573%
Primary Physician Care	$1,739 - $2,168	1628%
Beechstreet	$1,778 - $2,218	1665%
Multiplan	$1,778 - $2,218	1665%
Phcs	$1,778 - $2,218	1665%
Employers Choice Network	$1,917 - $2,390	1795%
Three Rivers Provider Network	$1,917 - $2,390	1795%

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 $1,213.
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 Novant Health Forsyth 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.