CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Ohiohealth Morrow County Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $1,033
Cash Discount Price: $1,781
vs. Medicare Baseline: 9.67x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Ohiohealth Morrow County Hospital is $1,033. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,781. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 9.67x the Medicare baseline. Located in 651 West Marion Road, Mount Gilead, OH.

Cash / Self-Pay

$1,781

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,033

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: $1,781 (1667%)

Insurance Median: $1,033 (967%)

Cash: $1,781 (1667% of Medicare)

Ins. Median: $1,033 (967% 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 967% of the Medicare baseline (a markup of 867%). 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
Medicaid / KanCare	$226 - $230	212%
UnitedHealthcare	$226 - $2,244	212%
Blue Cross Blue Shield	$228 - $2,115	213%
Amerihealth Caritas - All Plans	$232	217%
Humana	$232 - $2,548	217%
Molina Exchange - All Other Plans	$372	348%
Medicare (plans)	$1,014 - $1,034	949%
Aetna	$1,033 - $2,356	967%
Caresource Marketplace - All Other Plans	$1,267	1186%
Medical Mutual Of Ohio Marketplace	$2,055	1924%
Ohiohealthy Network - All Other Plans	$2,055	1924%
Ohiohealthy Preferred	$2,055	1924%
Medical Mutual Of Ohio Comm - All Other Plans	$2,219	2078%
Medical Mutual Of Ohio - Admin Serv	$2,329	2181%
Phcs - All Plans	$2,521	2360%
Cigna	$2,576	2412%
Multiplan - All Plans	$2,603	2437%
Healthstar Comm - All Plans	$2,630	2462%
Beech Street - All Plans	$2,658	2489%

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 $1,781.
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 Ohiohealth Morrow County 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.