CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Southcoast Hospitals Group

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $155
Cash Discount Price: $376
vs. Medicare Baseline: 1.45x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Southcoast Hospitals Group is $155. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $376. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.45x the Medicare baseline. Located in 363 Highland Avenue, Fall River, MA.

Cash / Self-Pay

$376

Average discount available for prompt cash payment at this facility.

Insurance Median

$155

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: $376 (352%)

Insurance Median: $155 (145%)

Cash: $376 (352% of Medicare)

Ins. Median: $155 (145% 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.

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
Wellsense Health Plan [1010202]	$96	90%
Tufts Health Public Plans [1010213]	$110 - $412	103%
Aetna	$126 - $572	118%
Blue Cross Blue Shield	$126 - $313	118%
Evercare [1010304]	$126	118%
Medicare (plans)	$126 - $155	118%
Tufts Senior Care Options [1010315]	$126	118%
UnitedHealthcare	$126 - $168	118%
Wellsense Health Plan Senior Care Options [1020208	$128	120%
Commonwealth Care Alliance [1080501]	$130 - $131	122%
Eternal Health [1010322]	$139	130%
Wellsense Health Plan Clarity Connectorcare & Meta	$161	151%
Fallon [1000114]	$177	166%
Harvard Pilgrim [1010602]	$214	200%
Tufts [1010701]	$314	294%
Mass General Brigham Health Plan Commercial [10122	$424	397%
Mass General Brigham Health Plan Connectorcare [10	$424	397%
Group Insurance Service Center [1013001]	$451	422%
Innovative Health Plan [1025001]	$451	422%
Priority Health [1015001]	$451	422%
PHCS [1000125]	$489	458%
Wellpoint [1000102]	$491	460%
First Health [1000130]	$572	536%
Cigna	$587	550%

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 $376.
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 Southcoast Hospitals Group 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.