CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Alice Peck Day Memorial Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $1,466
Cash Discount Price: $1,142
vs. Medicare Baseline: 13.73x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Alice Peck Day Memorial Hospital is $1,466. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,142. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 13.73x the Medicare baseline. Located in 10 Alice Peck Day Drive, Lebanon, NH.

Cash / Self-Pay

$1,142

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,466

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: $1,142 (1069%)

Insurance Median: $1,466 (1373%)

Cash: $1,142 (1069% of Medicare)

Ins. Median: $1,466 (1373% 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 1373% of the Medicare baseline (a markup of 1273%). 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
Ambetter / Centene	$43	40%
Nh Healthy Families	$44	41%
Blue Cross Blue Shield	$690 - $1,885	646%
Wellpoint	$690	646%
Cigna	$784 - $1,733	734%
Klais	$784	734%
Commercial Generic	$832	779%
Connecticut General	$832	779%
Medicaid / KanCare	$972	910%
Harvard Pilgrim	$1,317 - $1,836	1233%
UnitedHealthcare	$1,525	1428%
Tufts	$1,553	1454%
Aetna	$1,906	1784%
Mvp	$1,927	1804%
Coventry Health	$2,012	1884%
Coventry Health Wc	$2,012	1884%
Humana	$2,203	2063%

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 $1,142.
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 Alice Peck Day Memorial Hospital 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.