CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Mayers Memorial Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $971
Cash Discount Price: $813
vs. Medicare Baseline: 9.09x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Mayers Memorial Hospital is $971. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $813. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 9.09x the Medicare baseline. Located in 43563 Hwy 299 East, Fall River Mills, CA.

Cash / Self-Pay

$813

Average discount available for prompt cash payment at this facility.

Insurance Median

$971

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: $813 (761%)

Insurance Median: $971 (909%)

Cash: $813 (761% of Medicare)

Ins. Median: $971 (909% 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 909% of the Medicare baseline (a markup of 809%). 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 Shield Ca Va	$45 - $922	42%
Blue Shield Mcr Adv	$45 - $922	42%
Tricare	$45 - $971	42%
Health Net Mcr Adv	$47 - $971	44%
Arcadian Health Services-All Plans	$50 - $971	47%
Imperial Health Plan-All Plans	$53 - $1,097	50%
Medi-Cal	$124 - $232	116%
Cigna	$147 - $1,398	138%
Corvel Ppo-All Plans	$147 - $1,398	138%
Coventry/First Health-All Plans	$147 - $1,398	138%
Integrated Hp-All Plans	$147 - $1,398	138%
Interplan-All Plans	$147 - $1,398	138%
Partnership Hp-All Plans	$928	869%
Blue Cross Blue Shield	$981 - $1,258	918%
Health Net Prison	$1,058	991%
Blue Shield Ca Exchange	$1,258	1178%
Blue Shield-All Other Plans	$1,398	1309%
Hmn-All Plans	$1,398	1309%
Multiplan Phcs-All Plans	$1,398	1309%
Pfmc-All Plans	$1,398	1309%
Superior Ca-All Plans	$1,398	1309%
Health Net-All Other Plans	$1,464	1371%
Pacificare-All Plans	$1,471	1377%

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 $813.
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 Mayers 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.