CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Mc Donough District Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $402
Cash Discount Price: $722
vs. Medicare Baseline: 3.76x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Mc Donough District Hospital is $402. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $722. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 3.76x the Medicare baseline. Located in 525 East Grant Street, Macomb, IL.

Cash / Self-Pay

$722

Average discount available for prompt cash payment at this facility.

Insurance Median

$402

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: $722 (676%)

Insurance Median: $402 (376%)

Cash: $722 (676% of Medicare)

Ins. Median: $402 (376% 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 376% of the Medicare baseline (a markup of 276%). 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
Health Alliance	$27 - $1,719	25%
Hfn	$42 - $1,739	39%
UnitedHealthcare	$42 - $1,739	39%
Aetna	$45 - $1,932	42%
Humana	$45 - $1,739	42%
Medicaid / KanCare	$45 - $1,932	42%
Medicare (plans)	$45 - $119	42%
Meridian	$45 - $119	42%
Molina	$45 - $1,932	42%
Mutual Medical	$45 - $1,932	42%
Veteran Affairs	$45 - $119	42%
Tricare	$111	104%
Blue Cross Blue Shield	$134 - $1,932	125%
Springfield Health	$388 - $1,584	363%
Consociate	$402 - $1,642	376%
Trilogy	$402 - $1,642	376%
Blue Choice	$426 - $1,739	399%
Current Health	$426 - $1,739	399%
Healthlink	$426 - $1,816	399%
Preferred Plan	$449 - $1,835	420%

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 $722.
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 Mc Donough 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.