CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Novant Health Presbyterian Medical Center

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $1,085
Cash Discount Price: $1,240
vs. Medicare Baseline: 10.16x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Novant Health Presbyterian Medical Center is $1,085. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,240. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 10.16x the Medicare baseline. Located in 200 Hawthorne Lane Box 33549, Charlotte, NC.

Cash / Self-Pay

$1,240

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,085

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: $1,240 (1161%)

Insurance Median: $1,085 (1016%)

Cash: $1,240 (1161% of Medicare)

Ins. Median: $1,085 (1016% 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 1016% of the Medicare baseline (a markup of 916%). 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	$102 - $1,633	95%
Humana	$102 - $1,993	95%
Pace Of The Southern Piedmont	$102	95%
UnitedHealthcare	$102 - $1,617	95%
Aetna	$104 - $2,214	97%
Cigna	$105 - $1,426	98%
Liberty Health	$107	100%
Nc Department Of Public Safety	$203 - $482	190%
Carolina Complete	$381 - $482	357%
Amerihealth	$389 - $492	364%
Wellcare	$389 - $492	364%
Caresource North Carolina	$723 - $913	677%
Atlantic Corporation Dba Atlantic Packaging	$1,007 - $1,273	943%
Amps	$1,204 - $1,522	1127%
Plotkin Health	$1,314 - $1,661	1230%
Medcost	$1,555 - $2,076	1456%
Primary Physician Care	$1,621 - $2,048	1518%
Multiplan	$1,642 - $2,076	1537%
Phcs	$1,642 - $2,076	1537%
Employers Choice Network	$2,124 - $2,685	1989%
Three Rivers Provider Network	$2,124 - $2,685	1989%

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 $1,240.
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 Presbyterian 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.