CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Samaritan Medical Center

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $131
Cash Discount Price: $1,004
vs. Medicare Baseline: 1.23x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Samaritan Medical Center is $131. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,004. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.23x the Medicare baseline. Located in 830 Washington Street, Watertown, NY.

Cash / Self-Pay

$1,004

Average discount available for prompt cash payment at this facility.

Insurance Median

$131

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: $1,004 (940%)

Insurance Median: $131 (123%)

Cash: $1,004 (940% of Medicare)

Ins. Median: $131 (123% 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
Empire	$43 - $118	40%
Fidelis	$45 - $150	42%
Wellcare	$45 - $130	42%
Capital District Physician'S Health Plan, Inc (Cdphp)	$130 - $803	122%
Excellus	$130 - $599	122%
Aetna	$133 - $853	125%
UnitedHealthcare	$134 - $853	125%
Mvp	$137 - $763	128%
Ghi Emblem	$833	780%

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 $1,004.
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 Samaritan 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.