CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Anderson Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $1,198
Cash Discount Price: $2,027
vs. Medicare Baseline: 11.22x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Anderson Hospital is $1,198. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,027. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 11.22x the Medicare baseline. Located in 6800 State Route 162, Maryville, IL.

Cash / Self-Pay

$2,027

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,198

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: $2,027 (1898%)

Insurance Median: $1,198 (1122%)

Cash: $2,027 (1898% of Medicare)

Ins. Median: $1,198 (1122% 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 1122% of the Medicare baseline (a markup of 1022%). 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 Care Service Corporation	$99 - $1,854	93%
Tricare	$109 - $4,572	102%
Aetna	$110 - $4,767	103%
Humana	$110 - $4,767	103%
Medicare (plans)	$110 - $4,767	103%
UnitedHealthcare	$110 - $4,767	103%
Devoted Health Ppo	$112 - $4,863	105%
Essence	$112 - $5,010	105%
Clear Springs Health	$114 - $4,910	107%
Medicaid / KanCare	$134 - $304	125%
Ambetter / Centene	$162 - $7,053	152%
Blue Choice	$162 - $7,053	152%
Hopetrust	$280 - $12,160	262%
Mercy Benefit Admin	$301	282%
Mercy Aco	$308	288%
Work Comp	$796 - $26,600	745%
Healthlink	$1,198 - $1,265	1122%
Self Pay	$2,027 - $25,000	1898%
Blue Cross Blue Shield	$2,174 - $2,252	2035%
Cigna	$2,837	2656%
Multiplan/Phcs	$3,040	2846%
Beech Street Corporation	$3,648	3415%

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 $2,027.
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 Anderson 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.