CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: UMass Memorial Healthalliance Hospitals

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $249
Cash Discount Price: $2,386
vs. Medicare Baseline: 2.33x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at UMass Memorial Healthalliance Hospitals is $249. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,386. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 2.33x the Medicare baseline. Located in 60 Hospital Road, Leominster, MA.

Cash / Self-Pay

$2,386

Average discount available for prompt cash payment at this facility.

Insurance Median

$249

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: $2,386 (2234%)

Insurance Median: $249 (233%)

Cash: $2,386 (2234% of Medicare)

Ins. Median: $249 (233% 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 233% of the Medicare baseline (a markup of 133%). 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
Champva [11001]	$114	107%
Cigna	$127 - $1,050	119%
Correctional Care [11003]	$127	119%
Institution [10406]	$127 - $1,265	119%
Medicaid / KanCare	$127 - $1,241	119%
Medicare (plans)	$127	119%
Tufts Dual [10111]	$127	119%
Tufts Us Family [11203]	$127	119%
Blue Cross Blue Shield	$131 - $312	123%
Aetna	$133	125%
Commonwealth Care Mcr [10115]	$133	125%
Fallon Mcr Supp [20202]	$133	125%
Harvard Pilgrim Mcr [10106]	$133	125%
Mgb Mcr [10124]	$133	125%
Tufts Mcr [10112]	$133	125%
UnitedHealthcare	$133 - $2,386	125%
Senior Whole Health [10110]	$136	127%
Tufts Connectorcare [10507]	$216	202%
Tufts [11201]	$282	264%
Workers Compensation [20501]	$284	266%
Hsno/Free Care [10801]	$294	275%
Wellpoint [11112]	$413	387%
Hne [11108]	$1,331	1246%
First Health Network [11120]	$1,790	1676%
Multiplan [11109]	$1,790	1676%
Connecticare [11105]	$2,386	2234%
Fallon Carelon Hlth [28]	$2,386	2234%
Fallon Mcaid Carelon Hlth [29]	$2,386	2234%
Grants [20507]	$2,386	2234%

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 $2,386.
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 UMass Memorial Healthalliance Hospitals 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.