CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Adena Fayette Medical Center

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $1,013
Cash Discount Price: $764
vs. Medicare Baseline: 9.48x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Adena Fayette Medical Center is $1,013. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $764. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 9.48x the Medicare baseline. Located in 1430 Columbus Avenue, Washington Ch, OH.

Cash / Self-Pay

$764

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,013

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: $764 (715%)

Insurance Median: $1,013 (948%)

Cash: $764 (715% of Medicare)

Ins. Median: $1,013 (948% 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 948% of the Medicare baseline (a markup of 848%). 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
Blue Cross Blue Shield	$520 - $1,013	487%
Aetna	$627 - $1,250	587%
Buckeye Community Health Plan	$627	587%
Humana	$627	587%
Medical Mutual Of Ohio	$627 - $1,152	587%
Medigold	$627	587%
Molina	$627	587%
Care Source	$639	598%
Molina Marketplace	$689	645%
United Medical Resources Ohcp	$962	901%
UnitedHealthcare	$962 - $971	901%
Cigna	$1,053	986%
Ohio Ppo Connect	$1,070	1002%
The Health Plan	$1,070	1002%
Care Source Just4Me	$1,128	1056%
Medical Mutual Of Ohio Supermed	$1,152	1079%
First Health	$1,198 - $1,250	1122%
Ohio Health Choice	$1,217	1139%
Multiplan/Private Healthcare Systems	$1,452	1359%
Sidecar Health	$1,727	1617%

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 $764.
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 Adena Fayette Medical Center 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.