CMS Price Transparency Data

X-ray, lower back

Facility: Adena Pike Medical Center

Billing Code: 72110 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72110
Insurance Median: $458
Cash Discount Price: $304
vs. Medicare Baseline: 4.29x Medicare

The contracted insurance negotiated median rate for a X-ray, lower back at Adena Pike Medical Center is $458. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $304. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 4.29x the Medicare baseline. Located in 100 Dawn Lane, Waverly, OH.

Cash / Self-Pay

$304

Average discount available for prompt cash payment at this facility.

Insurance Median

$458

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: $304 (285%)

Insurance Median: $458 (429%)

Cash: $304 (285% of Medicare)

Ins. Median: $458 (429% 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 429% of the Medicare baseline (a markup of 329%). 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
Aetna	$146 - $495	137%
Blue Cross Blue Shield	$146 - $525	137%
Buckeye Community Health Plan	$146	137%
Humana	$146 - $578	137%
Medical Mutual Of Ohio	$146 - $387	137%
Medigold	$146	137%
Molina	$146	137%
Care Source	$149	140%
Gateway Health	$201	188%
Molina Marketplace	$239	224%
Care Source Just4Me	$263	246%
Sidecar Health	$401	375%
Ohio Ppo Connect	$426	399%
The Health Plan	$426	399%
Cigna	$440	412%
Medical Mutual Of Ohio Supermed	$458	429%
First Health	$477	447%
Ohio Health Choice	$484	453%
UnitedHealthcare	$523	490%
Integrated Health Plan	$572	536%
Healthsmart	$578	541%
Multiplan/Private Healthcare Systems	$578	541%
Three Rivers Network	$578	541%

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 $304.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 72110.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Adena Pike Medical Center is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 72110.
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.