CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Ira Davenport Memorial Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $1,410
Cash Discount Price: $1,551
vs. Medicare Baseline: 13.20x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Ira Davenport Memorial Hospital is $1,410. 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 13.20x the Medicare baseline. Located in 7571 State Route 54, Bath, NY.

Cash / Self-Pay

$1,551

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,410

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: $1,410 (1320%)

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

Ins. Median: $1,410 (1320% 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 1320% of the Medicare baseline (a markup of 1220%). 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	$36 - $118	34%
Blue Cross Blue Shield	$112 - $7,778	105%
Fidelis	$112	105%
Humana	$126 - $2,307	118%
Tricare	$126	118%
Amerihealth Caritas Mcr Adv - All Plans	$127	119%
UnitedHealthcare	$1,217 - $2,692	1139%
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 - All Plans	$1,769	1656%
Pomco Inc - All Plans	$1,846	1728%
Aetna	$1,923 - $2,288	1800%
Emblem Health - All Plans	$2,256	2112%
Emblem/Ghi	$2,369	2218%
Martins Point - All Plans	$2,564	2401%
Healthnow - All Plans	$8,445	7907%

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 Ira Davenport Memorial 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.