CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Elizabethtown Community Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $191
Cash Discount Price: $1,200
vs. Medicare Baseline: 1.79x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Elizabethtown Community Hospital is $191. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,200. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.79x the Medicare baseline. Located in 75 Park Street, Elizabethtown, NY.

Cash / Self-Pay

$1,200

Average discount available for prompt cash payment at this facility.

Insurance Median

$191

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: $1,200 (1123%)

Insurance Median: $191 (179%)

Cash: $1,200 (1123% of Medicare)

Ins. Median: $191 (179% 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
Capital District Physicians' Health Plan	$83 - $1,858	78%
UnitedHealthcare	$86 - $2,081	81%
Humana	$101 - $116	95%
Fidelis Care	$104 - $859	97%
Mvp	$104 - $1,765	97%
Blue Cross Blue Shield	$110 - $1,699	103%
Harvard Pilgrim	$111 - $1,808	104%
Magnacare	$111 - $1,808	104%
Coventry	$118 - $1,921	110%
Aetna	$122 - $1,695	114%
Martins Point	$122 - $859	114%
Veterans Affairs Community Care Network	$122 - $859	114%
Multiplan	$125 - $2,034	117%
Choicecare	$134 - $1,808	125%
Highmark Blueshield	$164 - $1,842	154%
Wellpath	$171 - $1,288	160%
Emblem Health	$1,808	1693%

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 $1,200.
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 Elizabethtown Community 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.