CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Lexington Memorial Hospital Inc

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $593
Cash Discount Price: $666
vs. Medicare Baseline: 5.55x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Lexington Memorial Hospital Inc is $593. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $666. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 5.55x the Medicare baseline. Located in 250 Hospital Drive Po Box 1817, Lexington, NC.

Cash / Self-Pay

$666

Average discount available for prompt cash payment at this facility.

Insurance Median

$593

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: $666 (624%)

Insurance Median: $593 (555%)

Cash: $666 (624% of Medicare)

Ins. Median: $593 (555% 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 555% of the Medicare baseline (a markup of 455%). 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
Amerihealth	$251 - $366	235%
Carolina Complete	$251	235%
Healthy Blue	$251	235%
Partners	$251	235%
UnitedHealthcare	$253 - $597	237%
Vaya	$253	237%
Wellcare	$253	237%
Alliance	$256	240%
Trillium	$259	242%
Medcost	$292 - $891	273%
Blue Cross Blue Shield	$372 - $596	348%
Aetna	$378 - $1,231	354%
Ambetter / Centene	$382	358%
Oscar	$426 - $586	399%
Cigna	$579 - $590	542%
Directnet	$787	737%
Healthgram Lexington Home Brands	$959	898%
Healthgram	$1,066	998%
Private Healthcare Systems	$1,092	1022%
Beechstreet	$1,172	1097%
Humana	$1,172	1097%
Multiplan	$1,199	1123%
National Provider Network	$1,199	1123%

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 $666.
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 Lexington Memorial Hospital Inc 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.