CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Adventist Health Mendocino Coast

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $232
Cash Discount Price: $1,020
vs. Medicare Baseline: 2.17x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Adventist Health Mendocino Coast is $232. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,020. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 2.17x the Medicare baseline. Located in 700 River Drive, Fort Bragg, CA.

Cash / Self-Pay

$1,020

Average discount available for prompt cash payment at this facility.

Insurance Median

$232

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: $1,020 (955%)

Insurance Median: $232 (217%)

Cash: $1,020 (955% of Medicare)

Ins. Median: $232 (217% 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 217% of the Medicare baseline (a markup of 117%). 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	$47 - $2,266	44%
Tricare	$47 - $1,423	44%
UnitedHealthcare	$47 - $2,351	44%
Ah Employee Health Plan - All Plans	$52 - $1,511	49%
Blue Cross Blue Shield	$52 - $1,526	49%
Healthnet - All Plans	$69 - $1,891	65%
Blue Shield Epn	$86 - $1,098	81%
Blue Shield - All Other Plans	$91 - $2,231	85%
Medi-Cal	$124 - $232	116%
Partnership Hp Mcal-All Plans	$180 - $696	169%
Ahcc - All Plans	$185 - $2,614	173%
Beech Street - All Plans	$185 - $2,614	173%
Great West Hmo/Pos/Epo/Oa	$185 - $1,888	173%
Great West Ppo - All Other Plans	$185 - $2,034	173%
Multiplan - All Plans	$185 - $2,034	173%

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 $1,020.
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 Adventist Health Mendocino Coast 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.