CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Carolina East Medical Center

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $1,123
Cash Discount Price: $1,134
vs. Medicare Baseline: 10.51x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Carolina East Medical Center is $1,123. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,134. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 10.51x the Medicare baseline. Located in 2000 Neuse Blvd, New Bern, NC.

Cash / Self-Pay

$1,134

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,123

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: $1,134 (1062%)

Insurance Median: $1,123 (1051%)

Cash: $1,134 (1062% of Medicare)

Ins. Median: $1,123 (1051% 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 1051% of the Medicare baseline (a markup of 951%). 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
Humana	$45 - $100	42%
Inclusive Health (Nchirp)-All Plans	$45 - $100	42%
Tricare	$45 - $2,512	42%
Pamlico Co Jail-All Plans	$338 - $668	316%
Craven Co. Jail Systems - All Plans	$440 - $847	412%
UnitedHealthcare	$444 - $1,786	416%
Medcost Ppo Employees And Retirees	$833 - $1,649	780%
Medcost Ppo Ultra (Employees)	$833 - $1,572	780%
Blue Cross Blue Shield	$886 - $1,723	830%
Medcost Ppo City Employees	$924 - $1,830	865%
Medcost Ppo County Employee	$961 - $1,903	900%
Benefit Mgmt, Svcs-All Plans	$1,079 - $2,135	1010%
Medcost Benefit Svc-All Other Plans	$1,122 - $2,220	1050%
Aetna	$1,124 - $2,226	1052%
Acs Consult Svc Inc-All Plans	$1,146 - $2,269	1073%
Medcost Ppo Standard	$1,146 - $2,269	1073%
Cigna	$1,155 - $2,286	1081%

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 $1,134.
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 Carolina East 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.