CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Bellevue Hospital Center

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $245
Cash Discount Price: $127
vs. Medicare Baseline: 2.29x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Bellevue Hospital Center is $245. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $127. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 2.29x the Medicare baseline. Located in 462 First Avenue, New York, NY.

Cash / Self-Pay

$127

Average discount available for prompt cash payment at this facility.

Insurance Median

$245

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: $127 (119%)

Insurance Median: $245 (229%)

Cash: $127 (119% of Medicare)

Ins. Median: $245 (229% 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 229% of the Medicare baseline (a markup of 129%). 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
Healthfirst	$40 - $872	37%
Amidacare	$50 - $388	47%
Emblem	$50 - $523	47%
Aetna	$51 - $1,131	48%
Wellcare	$54 - $186	51%
Metroplus	$64 - $872	60%
Fidelis	$72 - $872	67%
Oscar	$75 - $1,228	70%
Hamaspik	$101 - $153	95%
Blue Cross Blue Shield	$126 - $1,230	118%
Centerlight	$126 - $769	118%
Vaccn	$126	118%
Vnsny	$126 - $1,307	118%
Affinity	$129 - $872	121%
Centers Plan For Healthy Living	$131 - $152	123%
Oxford	$132 - $923	124%
United	$132 - $1,230	124%
Elderplan	$146 - $999	137%
Villagecare Max	$191 - $1,307	179%
Local 1199	$374 - $1,307	350%
Carelon	$388 - $999	363%
Senior Whole Health	$388	363%
United Behavioral Health	$388 - $426	363%
Carelon (Amida Care)	$395	370%
Cigna	$1,056	989%
Magnacare	$1,153	1079%
Multiplan	$1,230	1152%

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 $127.
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 Bellevue Hospital 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.