CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Portsmouth Regional Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $653
Cash Discount Price: $7,983
vs. Medicare Baseline: 6.11x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Portsmouth Regional Hospital is $653. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $7,983. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 6.11x the Medicare baseline. Located in 333 Borthwick Ave, Portsmouth, NH.

Cash / Self-Pay

$7,983

Average discount available for prompt cash payment at this facility.

Insurance Median

$653

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: $7,983 (7474%)

Insurance Median: $653 (611%)

Cash: $7,983 (7474% of Medicare)

Ins. Median: $653 (611% 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 611% of the Medicare baseline (a markup of 511%). 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	$202 - $3,536	189%
Amerihealth Caritas	$329	308%
Harvard Pilgrim	$387 - $484	362%
Well Sense Health Plan	$653	611%
United	$2,052 - $5,269	1921%
Maine Community Health	$2,496 - $4,230	2337%
Tufts Health Plan	$3,002 - $4,566	2811%
Aetna	$5,053	4731%
Corvel	$5,748	5382%
Evernorth	$6,386	5979%
Mutual Of Omaha	$6,386	5979%
Multiplan	$6,466	6054%
First Health	$7,265	6802%
Healthcare Value Mgmt	$7,265	6802%
Oxford Health Plans	$7,584	7100%

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 $7,983.
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 Portsmouth Regional 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.