CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Warner Hospital and Health Services

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $2,546
Cash Discount Price: $3,264
vs. Medicare Baseline: 23.84x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Warner Hospital and Health Services is $2,546. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,264. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 23.84x the Medicare baseline. Located in 422 W White St, Clinton, IL.

Cash / Self-Pay

$3,264

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,546

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: $3,264 (3056%)

Insurance Median: $2,546 (2384%)

Cash: $3,264 (3056% of Medicare)

Ins. Median: $2,546 (2384% 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 2384% of the Medicare baseline (a markup of 2284%). 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	$405 - $2,774	379%
Blue Cross Blue Shield	$405 - $3,199	379%
Harmony Hp Mcaid-All Plans	$405	379%
Medicaid / KanCare	$405	379%
Meridian Hp-All Plans	$405	379%
Molina-All Other Plans	$405	379%
Health Alliance Med Adv	$1,338	1253%
Humana	$1,338 - $2,774	1253%
Molina Mcr/Mcd Dual	$1,338	1253%
UnitedHealthcare	$1,338 - $2,774	1253%
Wellcare Mcr Adv-All Plans	$1,338	1253%
Healthlink Hmo	$2,546	2384%
City Of Clinton (Employees Serv)-All Plans	$2,611	2445%
Cigna	$2,709	2536%
Caterpillar-All Plans	$2,774	2597%
Multiplan Phcs-All Plans	$2,774	2597%
Health Alliance-All Other Plans	$2,872	2689%
Healthlink Ppo/Work Comp-All Other Plans	$2,872	2689%
Consociate Care Ppo-All Plans	$2,938	2751%
Hfn Ppo/Epo-All Plans	$2,938	2751%
Three Rivers-All Plans	$3,101	2903%

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 $3,264.
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 Warner Hospital and Health Services 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.