CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Cincinnati Children's Hospital Medical Center

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 72131
  • Insurance Median: $202
  • Cash Discount Price: $626
  • vs. Medicare Baseline: 1.89x Medicare
The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Cincinnati Children's Hospital Medical Center is $202. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $626. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.89x the Medicare baseline. Located in 3333 Burnet Avenue, Cincinnati, OH.
Cash / Self-Pay
$626

Average discount available for prompt cash payment at this facility.

Insurance Median
$202

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: $626 (586%)
Insurance Median: $202 (189%)
Cash: $626 (586% of Medicare)
Ins. Median: $202 (189% 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.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash 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 $31 - $2,174 29%
Mhs_In $32 - $127 30%
Caresource_In $33 - $134 31%
Aetna $37 - $2,101 35%
Humana $39 - $553 37%
Passport_Ky $39 - $575 37%
United_Health_Care_Ky $39 - $584 37%
Wellcare_Ky $39 - $582 37%
Caresource_Oh $68 - $274 64%
Amerihealth_Caritas_Oh $70 - $296 66%
Molina_Oh $71 - $302 66%
Buckeye_Oh $74 - $315 69%
United_Health_Care_Oh $81 - $289 76%
Caresource_Oh_Insurance $116 - $1,062 109%
Medical_Mutual_Of_Ohio_Insurance $130 - $2,101 122%
Parkview_Signature_Care_Insurance $148 - $1,725 139%
Point_Comfort_Insurance $157 - $1,438 147%
Margaret_Mary_Health_Insurance $160 - $1,725 150%
United_Health_Care_Insurance $184 - $1,982 172%
Beechstreet_Insurance $195 - $2,168 183%
Cigna $195 - $2,101 183%
Health_Ohio_Network_Insurance $220 - $2,101 206%
Custom_Design_Benefits_Insurance $230 - $2,101 215%
Health_Smart_Preferred_Insurance $230 - $2,101 215%
Medical_Benefit_Administrators_Insurance $230 - $2,101 215%
Ohio_Health_Choice_Insurance $230 - $2,101 215%
Private_Health_Care_Systems_Insurance $232 - $2,124 217%
First_Health_Group_Insurance $237 - $2,168 222%
Health_Link_Insurance $237 - $2,168 222%
Evolutions_Health_Care_Systems $242 - $2,212 227%
Galaxy_Health_Insurance $242 - $2,212 227%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 3333 Burnet Avenue, Cincinnati, OH 45229
  • CMS Rating: No CMS Rating
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Childrens