CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Arnot Ogden Medical Center

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $1,350
Cash Discount Price: $1,551
vs. Medicare Baseline: 12.64x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Arnot Ogden Medical Center is $1,350. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,551. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 12.64x the Medicare baseline. Located in 600 Roe Avenue, Elmira, NY.

Cash / Self-Pay

$1,551

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,350

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: $1,551 (1452%)

Insurance Median: $1,350 (1264%)

Cash: $1,551 (1452% of Medicare)

Ins. Median: $1,350 (1264% 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 1264% of the Medicare baseline (a markup of 1164%). 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
Empire	$38 - $124	36%
Amerihealth	$88 - $139	82%
Aetna	$107 - $1,965	100%
Blue Cross Blue Shield	$107 - $7,778	100%
Geisinger	$109 - $1,566	102%
Fidelis	$117 - $247	110%
Humana	$122 - $2,423	114%
Tricare	$122	114%
Amerihealth Mcr Adv - All Plans	$123	115%
Fidelis Care-Exchange - All Plans	$1,410	1320%
Geisinger - All Plans	$1,492	1397%
Cigna	$1,597	1495%
Mvp Health Plan - All Plans	$1,597	1495%
Independent Health - All Plans	$1,666	1560%
Upmc Health Plan - All Plans	$1,769	1656%
Pomco Inc - All Plans	$1,846	1728%
UnitedHealthcare	$1,938 - $3,471	1814%
Emblem Health - All Plans	$2,256	2112%
Emblem/Ghi	$2,369	2218%
Martins Point Mcr Adv - All Plans	$2,564	2401%
Healthnow - All Plans	$7,724	7232%

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 $1,551.
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 Arnot Ogden Medical Center 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.