CMS Price Transparency Data

CT scan, chest (no contrast)

Facility: Sarah D Culbertson Memorial Hospital

Billing Code: 71250 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 71250
Insurance Median: $1,125
Cash Discount Price: $2,155
vs. Medicare Baseline: 10.53x Medicare

The contracted insurance negotiated median rate for a CT scan, chest (no contrast) at Sarah D Culbertson Memorial Hospital is $1,125. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,155. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 10.53x the Medicare baseline. Located in 238 South Congress Street, Rushville, IL.

Cash / Self-Pay

$2,155

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,125

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: $2,155 (2018%)

Insurance Median: $1,125 (1053%)

Cash: $2,155 (2018% of Medicare)

Ins. Median: $1,125 (1053% 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 1053% of the Medicare baseline (a markup of 953%). 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	$29 - $2,308	27%
Blue Cross Blue Shield	$29 - $2,513	27%
Meridian Hp Mcaid-All Plans	$29 - $348	27%
Molina Healthcare Mcaid	$29 - $348	27%
Molina Mmai-All Other Plans	$49 - $1,103	46%
UnitedHealthcare	$49 - $2,308	46%
Cigna	$59 - $1,895	55%
Multiplan/Phcs-All Plans	$148 - $2,308	139%
Corvel-All Plans	$348	326%
Health Dynamics-All Plans	$412 - $2,308	386%
Preferred Medical Claims Solution-All Plans	$464 - $2,308	434%
Three Rivers Provider Network-All Plans	$464 - $2,308	434%
Healthlink-All Plans	$500	468%
Humana	$1,029 - $1,103	963%
Beech Street-All Plans	$2,155 - $2,308	2018%
Encompass-All Plans	$2,155 - $2,308	2018%
Hfn Epo	$2,155 - $2,308	2018%
Hfn Ppo Ip/Op Only-All Other Plans	$2,155 - $2,308	2018%
Wexford Ip/Op Only-All Plans	$2,155 - $2,308	2018%
Healthsmart-All Plans	$2,274 - $2,436	2129%

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 $2,155.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 71250.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Sarah D Culbertson Memorial Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 71250.
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.