CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: UPMC Wellsboro

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $2,078
Cash Discount Price: $2,266
vs. Medicare Baseline: 19.46x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at UPMC Wellsboro is $2,078. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,266. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 19.46x the Medicare baseline. Located in 32-36 Central Avenue, Wellsboro, PA.

Cash / Self-Pay

$2,266

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,078

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: $2,266 (2122%)

Insurance Median: $2,078 (1946%)

Cash: $2,266 (2122% of Medicare)

Ins. Median: $2,078 (1946% 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 1946% of the Medicare baseline (a markup of 1846%). 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	$113 - $2,906	106%
Amerihealth Caritas	$152	142%
Geisinger	$152 - $2,291	142%
Upmc Health Plan	$152 - $1,491	142%
Highmark Wholecare (Prev Gateway)	$155 - $684	145%
Health Partners Plans (Jefferson Health Plan)	$209	196%
Pa Health & Wellness	$236 - $738	221%
Aetna	$558 - $2,951	522%
Blue Cross Blue Shield	$620 - $1,729	580%
Upmc Work Partners	$641	600%
Cigna	$651 - $718	609%
Wirerope Works	$1,724 - $1,901	1614%
Multiplan	$2,419 - $3,248	2265%
America'S Choice	$2,791 - $3,077	2613%
Intergroup	$2,791 - $3,077	2613%

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 $2,266.
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 UPMC Wellsboro 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.