CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Vidant Chowan Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $2,238
Cash Discount Price: $1,980
vs. Medicare Baseline: 20.95x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Vidant Chowan Hospital is $2,238. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,980. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 20.95x the Medicare baseline. Located in 211 Virginia Rd, Edenton, NC.

Cash / Self-Pay

$1,980

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,238

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: $1,980 (1854%)

Insurance Median: $2,238 (2095%)

Cash: $1,980 (1854% of Medicare)

Ins. Median: $2,238 (2095% 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 2095% of the Medicare baseline (a markup of 1995%). 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	$1,062 - $2,146	994%
Carolina Complete Health [1317]	$1,072	1004%
Wellcare [1320]	$1,077	1008%
Amerihealth McAid Adv [1316]	$1,083	1014%
Humana	$1,096	1026%
UnitedHealthcare	$1,192 - $2,178	1116%
Liberty Advantage [1313]	$1,227	1149%
Aetna	$1,262 - $2,892	1182%
Longevity Health [1411]	$1,517	1420%
Nc Dept of Public Safety [1095]	$1,980	1854%
Medcost [1067]	$2,238 - $2,359	2095%
Cigna	$3,006 - $3,359	2814%
Multiplan [1031]	$3,359	3145%

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 $1,980.
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 Vidant Chowan 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.