CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Othello Community Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $2,113
Cash Discount Price: $1,981
vs. Medicare Baseline: 19.78x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Othello Community Hospital is $2,113. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,981. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 19.78x the Medicare baseline. Located in 315 North 14Th Avenue, Othello, WA.

Cash / Self-Pay

$1,981

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,113

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: $1,981 (1855%)

Insurance Median: $2,113 (1978%)

Cash: $1,981 (1855% of Medicare)

Ins. Median: $2,113 (1978% 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 1978% of the Medicare baseline (a markup of 1878%). 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
Ambetter / Centene	$1,123 - $1,136	1051%
Amerigroup Mcaid	$1,123	1051%
Chp Mcaid	$1,123	1051%
Cocare - All Plans	$1,123	1051%
Gau - All Plans	$1,123	1051%
Kaiser - All Plans	$1,123	1051%
Molina Mcaid	$1,123	1051%
UnitedHealthcare	$1,123 - $2,641	1051%
Chp - All Other Plans	$1,136	1064%
Molina - All Other Plans	$1,136	1064%
Medicare (plans)	$1,321	1237%
Tricare	$1,717	1608%
Triwest - All Plans	$1,717	1608%
Asuris - All Plans	$2,113	1978%
Commercial Other - All Plans	$2,113	1978%
Hma - All Plans	$2,113	1978%
Hmso - All Plans	$2,113	1978%
Tpsc - All Plans	$2,113	1978%
Travelers - All Plans	$2,113	1978%
Veterans Admin - All Plans	$2,113	1978%
Blue Cross Blue Shield	$2,219	2078%
Cigna	$2,351	2201%
First Choice - All Plans	$2,377	2225%
Aetna	$2,483	2325%
Chp Mcr Adv	$2,641	2473%
Health Alliance Mcr Adv - All Plans	$2,641	2473%
Humana	$2,641	2473%
Molina Mcare	$2,641	2473%
Wellcare Mcr Adv - All Plans	$2,641	2473%

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 $1,981.
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 Othello 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.