CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Pinckneyville Community Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $582
Cash Discount Price: $1,760
vs. Medicare Baseline: 5.45x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Pinckneyville Community Hospital is $582. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,760. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 5.45x the Medicare baseline. Located in 5383 State Route 154, Pinckneyville, IL.

Cash / Self-Pay

$1,760

Average discount available for prompt cash payment at this facility.

Insurance Median

$582

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: $1,760 (1648%)

Insurance Median: $582 (545%)

Cash: $1,760 (1648% of Medicare)

Ins. Median: $582 (545% 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 545% of the Medicare baseline (a markup of 445%). 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	$47 - $2,898	44%
Humana	$47 - $1,191	44%
Umwa Mcr Adv - All Plans	$47 - $1,191	44%
UnitedHealthcare	$47 - $2,640	44%
Wellcare Mcr Adv - All Plans	$47 - $1,191	44%
Cigna	$56 - $2,656	52%
Blue Cross Blue Shield	$109 - $2,318	102%
Healthlink Hmo	$186 - $2,528	174%
Healthlink Ppo - All Other Plans	$186 - $2,656	174%
Phcs Savility	$255 - $2,737	239%
Multiplan - All Plans	$270 - $2,898	253%
Phcs - All Other Plans	$270 - $2,640	253%
Ambetter / Centene	$319 - $582	299%
Medicaid / KanCare	$319 - $582	299%
Healthlink Work Comp	$2,656	2487%

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 $1,760.
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 Pinckneyville Community 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.