CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Highland District Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $510
Cash Discount Price: $1,226
vs. Medicare Baseline: 4.77x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Highland District Hospital is $510. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,226. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 4.77x the Medicare baseline. Located in 1275 North High Street, Hillsboro, OH.

Cash / Self-Pay

$1,226

Average discount available for prompt cash payment at this facility.

Insurance Median

$510

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: $1,226 (1148%)

Insurance Median: $510 (477%)

Cash: $1,226 (1148% of Medicare)

Ins. Median: $510 (477% 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 477% of the Medicare baseline (a markup of 377%). 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
Highland_County_Sheriff_Dept	$113	106%
Medicaid / KanCare	$113 - $119	106%
Blue Cross Blue Shield	$117 - $1,164	110%
Humana	$117 - $1,357	110%
Medicare (plans)	$490 - $505	459%
UnitedHealthcare	$490	459%
Aetna	$500 - $1,244	468%
Medigold	$515	482%
Immergrun_Amish	$1,226	1148%
Medben	$1,226	1148%
Central_Benefits_Commercial	$1,379	1291%
Cigna	$1,379	1291%
Medical_Mutual_Commercial	$1,394	1305%
Uhc_	$1,409	1319%

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 $1,226.
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 Highland District 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.