CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Atrium Health Pineville

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $534
Cash Discount Price: $1,504
vs. Medicare Baseline: 5.00x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Atrium Health Pineville is $534. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,504. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 5.00x the Medicare baseline. Located in 10628 Park Rd, Charlotte, NC.

Cash / Self-Pay

$1,504

Average discount available for prompt cash payment at this facility.

Insurance Median

$534

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: $1,504 (1408%)

Insurance Median: $534 (500%)

Cash: $1,504 (1408% of Medicare)

Ins. Median: $534 (500% 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 500% of the Medicare baseline (a markup of 400%). 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
Cigna	$44 - $2,030	41%
Humana	$45 - $122	42%
Aetna	$46 - $2,497	43%
UnitedHealthcare	$46 - $1,417	43%
Trillium	$48 - $320	45%
Alliance	$49 - $319	46%
Amerihealth Caritas	$49 - $305	46%
Carolina Complete Health	$49 - $311	46%
Healthy Blue	$49 - $311	46%
Partners	$49 - $301	46%
Vaya	$49 - $314	46%
Wellcare	$49 - $311	46%
Ortho Carolina	$55 - $150	51%
Blue Cross Blue Shield	$534 - $782	500%
Ambetter / Centene	$874 - $1,092	818%
Employers Health Network	$1,330	1245%
Physician Reach Out	$1,504	1408%
Medcost	$1,618 - $1,799	1515%
Magellan	$1,805	1690%
Gmmi	$1,955	1830%
Quik Trip	$1,955	1830%
Choicecare	$2,166 - $2,226	2028%
Healthgram	$2,406	2253%
Provider Select	$2,437 - $2,707	2282%
Private Health Care Systems	$2,467	2310%
First Health	$2,497	2338%
Beechstreet	$2,707	2534%
Multiplan	$2,767	2591%

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 $1,504.
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 Pineville 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.