CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Saint Francis Hospital-Evanston

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $117
Cash Discount Price: $111
vs. Medicare Baseline: 1.10x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Saint Francis Hospital-Evanston is $117. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $111. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.10x the Medicare baseline. Located in 355 Ridge Ave, Evanston, IL.

Cash / Self-Pay

$111

Average discount available for prompt cash payment at this facility.

Insurance Median

$117

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: $111 (104%)

Insurance Median: $117 (110%)

Cash: $111 (104% of Medicare)

Ins. Median: $117 (110% 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.

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
Ravenswood Physicians Associates Ipa	$84 - $111	79%
Resurrection Physicians Provider Group Ipa	$84 - $111	79%
Blue Cross Blue Shield	$106 - $156	99%
Aetna	$111 - $1,090	104%
Celtic (Wellcare)	$111	104%
Cigna	$111 - $800	104%
Clear Spring Health Of Illinois	$111	104%
Devoted Health	$111	104%
Essential Health Partners	$111 - $128	104%
Humana	$111 - $134	104%
Illinois Physicians Alliance	$111	104%
Longevity Health Plan Of Illinois	$111	104%
Medicare (plans)	$111	104%
Self-Pay	$111	104%
Tricare	$111	104%
UnitedHealthcare	$111 - $246	104%
Molina	$115 - $167	108%
Zing Health Provider Network	$115	108%
Meridian	$117 - $141	110%
Provider Partners Health Plan (Pphp)	$117	110%
Access Community Health Network	$134	125%
Countycare	$134	125%
Medicaid / KanCare	$134	125%
Standard Eapg Logic - Contracts	$134	125%
Clifton Health Systems	$173	162%
Ambetter / Centene	$181	169%
Imagine Health Network, Inc.	$824	771%
Coventry	$1,516	1419%
Hfn Inc (Healthcare Finest Network)	$1,516	1419%
Workers Comp	$1,516	1419%

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 $111.
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 Saint Francis Hospital-Evanston 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.