CMS Price Transparency Data
CT scan, lower back (lumbar spine)
Facility: Mount Carmel St Ann's
Billing Code: 72131 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 72131
- Insurance Median: $949
- Cash Discount Price: $1,321
- vs. Medicare Baseline: 8.88x Medicare
The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Mount Carmel St Ann's is $949. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,321. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 8.88x the Medicare baseline. Located in 500 South Cleveland Avenue, Westerville, OH.
Cash / Self-Pay
$1,321
Average discount available for prompt cash payment at this facility.
Insurance Median
$949
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: $1,321 (1237%)
Insurance Median: $949 (888%)
Cash: $1,321 (1237% of Medicare)
Ins. Median: $949 (888% 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 888% of the Medicare baseline (a markup of 788%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Medicare (plans) | $89 - $106 | 83% |
| Aetna | $99 - $2,033 | 93% |
| Blue Cross Blue Shield | $99 - $2,033 | 93% |
| Hospice Mount Carmel | $101 | 95% |
| Oscar | $101 | 95% |
| UnitedHealthcare | $101 - $1,182 | 95% |
| The Health Plan | $103 - $1,336 | 96% |
| Enterprise Group Planning | $195 | 183% |
| Custom Design Benefits | $211 | 198% |
| Quality Care Partners | $228 | 213% |
| Medical Mutual | $248 - $1,613 | 232% |
| Western & Southern Financial Group | $359 | 336% |
| Blue Benefit Administrators Of Massachusetts | $376 | 352% |
| Blue Care Network | $376 | 352% |
| Blue Distinction Transplant | $376 | 352% |
| Blue Shield - Ca | $376 | 352% |
| Blue Shield - Id (Regence) | $376 | 352% |
| Blue Shield - Ny Highmark Northeastern | $376 | 352% |
| Blue Shield - Ny Highmark Western | $376 | 352% |
| Blue Shield - Pa (Highmark) | $376 | 352% |
| Blue Shield - Wa (Regence) | $376 | 352% |
| Crime Victim Assistance | $632 | 592% |
| Ohio Safe Program | $632 | 592% |
| Geha | $913 - $1,182 | 855% |
| Gravie Admin Services | $913 | 855% |
| Healthez | $913 | 855% |
| Meritain | $913 | 855% |
| Webtpa | $913 | 855% |
| Access Health | $949 | 888% |
| Acclaim | $949 | 888% |
| Administrative Concepts | $949 | 888% |
| Allegeant | $949 | 888% |
| Allied Benefit Systems | $949 | 888% |
| American Family | $949 | 888% |
| American Healthcare Alliance | $949 | 888% |
| American National | $949 | 888% |
| American Republic | $949 | 888% |
| Amerihealth | $949 | 888% |
| Aultcare | $949 | 888% |
| Automated Benefit Services | $949 | 888% |
| Auxiant | $949 | 888% |
| Benefit Administrative Systems,Llc | $949 | 888% |
| Boon Chapman | $949 | 888% |
| Cam Administrative Services | $949 | 888% |
| Christian Brother Services | $949 | 888% |
| Christian Brothers Holy Cross | $949 | 888% |
| Claimchoice Adminstrators | $949 | 888% |
| Comprehensive Benefits | $949 | 888% |
| Continental Life Insurance | $949 | 888% |
| Coventry | $949 | 888% |
| Custom Benefit Administrators | $949 | 888% |
| Cypress Benefit Administrators | $949 | 888% |
| Employee Benefit Concepts | $949 | 888% |
| Employee Benefit Management | $949 | 888% |
| Forest County Potawatomi | $949 | 888% |
| Freedom Life Insurance Company | $949 | 888% |
| Group Administrators | $949 | 888% |
| Group Marketing Services | $949 | 888% |
| Group Pension Administrators | $949 | 888% |
| Guardian | $949 | 888% |
| Health America | $949 | 888% |
| Health Choices | $949 | 888% |
| Healthcare Management Admin | $949 | 888% |
| Insight | $949 | 888% |
| Intercare | $949 | 888% |
| Jfp Benefit Management | $949 | 888% |
| Jp Farley Corporation | $949 | 888% |
| Key Benefit Administrator | $949 | 888% |
| Liberty Union Life Assurance Co | $949 | 888% |
| Lucent Health | $949 | 888% |
| Luminare Health | $949 | 888% |
| Magnacare | $949 | 888% |
| Medcost | $949 | 888% |
| Mutual Health Services | $949 | 888% |
| Mutual Of Omaha | $949 | 888% |
| Ncas | $949 | 888% |
| Nippon Life Ins | $949 | 888% |
| Nova | $949 | 888% |
| Painters Union Insurance Fund | $949 | 888% |
| Physicians Mutual | $949 | 888% |
| Plumbers Local 98 Insurance Fund | $949 | 888% |
| Prairie States | $949 | 888% |
| Preferred One | $949 | 888% |
| Primary Physician Care | $949 | 888% |
| Professional Benefit Administrators | $949 | 888% |
| Secureone Preferred United Plans | $949 | 888% |
| Siho Insurance Services | $949 | 888% |
| Sisco Benefits | $949 | 888% |
| The Loomis Company | $949 | 888% |
| Trustmark Small Business Benefits | $949 | 888% |
| U Of M Health Plan | $949 | 888% |
| Unicare | $949 | 888% |
| Unified Group Services | $949 | 888% |
| Us Health And Life | $949 | 888% |
| Valenz | $949 | 888% |
| Varipro | $949 | 888% |
| Wps | $949 | 888% |
| Humana | $1,039 - $2,033 | 973% |
| First Health | $1,071 | 1003% |
| Paramount Hmo | $1,071 | 1003% |
| American Postal Workers Secondary | $1,126 | 1054% |
| Cigna | $1,126 | 1054% |
| Health Partners | $1,126 | 1054% |
| Healthgram | $1,126 | 1054% |
| Mvp | $1,126 | 1054% |
| Priority Health | $1,126 | 1054% |
| Medben | $1,220 - $1,525 | 1142% |
| Consociate | $1,242 | 1163% |
| Health Ohio Network | $1,242 | 1163% |
| Rural Carrier Health Benefit Plan | $1,370 | 1283% |
| Caresource | $1,484 | 1389% |
| Healthlink Inc | $1,525 | 1428% |
| Medical Benefits Mutual | $1,525 | 1428% |
| Ohio Health Choice | $1,525 | 1428% |
| Ohio Ppo Connect | $1,525 | 1428% |
| Medi Share | $1,624 | 1520% |
| Multiplan | $1,624 | 1520% |
| Phcs | $1,624 | 1520% |
| Philadelphia American Life Insurance | $1,624 | 1520% |
| Ameriben | $1,626 | 1522% |
| Luminare Health (Detroit) | $1,626 | 1522% |
| Ohiohealthy | $1,626 | 1522% |
| Osu Not Independent Choice | $1,626 | 1522% |
| Twin Valley Psychiatric | $1,626 | 1522% |
| Health Smart | $1,728 | 1618% |
| Bccp | $2,033 | 1903% |
| Medicaid / KanCare | $2,033 | 1903% |
| Optima Health | $2,033 | 1903% |