CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Hamilton Memorial Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $1,448
Cash Discount Price: $1,680
vs. Medicare Baseline: 13.56x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Hamilton Memorial Hospital is $1,448. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,680. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 13.56x the Medicare baseline. Located in 611 S Marshall Avenue, McLeansboro, IL.

Cash / Self-Pay

$1,680

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,448

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: $1,680 (1573%)

Insurance Median: $1,448 (1356%)

Cash: $1,680 (1573% of Medicare)

Ins. Median: $1,448 (1356% 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 1356% of the Medicare baseline (a markup of 1256%). 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	$123 - $1,778	115%
Blue Cross Blue Shield	$123 - $1,798	115%
Health Alliance	$123 - $1,581	115%
Medicare (plans)	$123 - $790	115%
UnitedHealthcare	$123 - $1,415	115%
Wellcare	$123 - $790	115%
Medicaid / KanCare	$735 - $790	688%
Healthlink	$787 - $910	737%
Alliance Coal	$790	740%
Humana	$790	740%
Healthscope	$1,383	1295%
Wellfirst (Ssmhic)	$1,383	1295%
Hope Trust	$1,482	1388%
Cigna	$1,551	1452%
Hfn, Inc	$1,581 - $1,778	1480%
Multiplan	$1,680	1573%
Siho	$1,778	1665%
Three Rivers Provider	$1,778	1665%
Healthsmart	$1,877	1757%
Stratose	$1,877	1757%

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 $1,680.
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 Hamilton Memorial 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.