CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Carle Health Pekin Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $1,336
Cash Discount Price: $5,345
vs. Medicare Baseline: 12.51x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Carle Health Pekin Hospital is $1,336. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $5,345. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 12.51x the Medicare baseline. Located in 600 South 13Th Street, Pekin, IL.

Cash / Self-Pay

$5,345

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,336

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: $5,345 (5004%)

Insurance Median: $1,336 (1251%)

Cash: $5,345 (5004% of Medicare)

Ins. Median: $1,336 (1251% 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 1251% of the Medicare baseline (a markup of 1151%). 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	$50 - $1,336	47%
Blue Cross Blue Shield	$112 - $2,111	105%
Humana	$112 - $136	105%
Molina	$112 - $1,604	105%
UnitedHealthcare	$112 - $336	105%
Wellcare	$112	105%
Meridian	$130	122%
Cigna	$1,050	983%
Healthlink	$2,390 - $2,657	2238%
Multiplan/Phcs	$2,672	2502%

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 $5,345.
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 Carle Health Pekin 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.