CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Ellenville Regional Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $544
Cash Discount Price: $585
vs. Medicare Baseline: 5.09x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Ellenville Regional Hospital is $544. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $585. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 5.09x the Medicare baseline. Located in 10 Healthy Way, Ellenville, NY.

Cash / Self-Pay

$585

Average discount available for prompt cash payment at this facility.

Insurance Median

$544

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: $585 (548%)

Insurance Median: $544 (509%)

Cash: $585 (548% of Medicare)

Ins. Median: $544 (509% 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 509% of the Medicare baseline (a markup of 409%). 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
UnitedHealthcare	$22 - $798	21%
Emblemhealth	$50 - $1,130	47%
Cdphp	$54 - $523	51%
Blue Cross Blue Shield	$58 - $565	54%
Fidelis	$58 - $565	54%
Hamaspik Choice	$58 - $565	54%
Humana	$58 - $565	54%
Mvp Health Care Of Ny	$61 - $1,060	57%
Aetna	$67 - $1,076	63%
Local 1199Seiu	$67 - $1,076	63%
Wellcare	$80 - $777	75%
Galaxy Health	$95 - $918	89%
Oxford Health Plans	$798	747%

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 $585.
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 Ellenville Regional 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.