CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Clay County Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $159
Cash Discount Price: $3,096
vs. Medicare Baseline: 1.49x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Clay County Hospital is $159. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,096. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.49x the Medicare baseline. Located in 911 Stacy Burk Dr, Flora, IL.

Cash / Self-Pay

$3,096

Average discount available for prompt cash payment at this facility.

Insurance Median

$159

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: $3,096 (2899%)

Insurance Median: $159 (149%)

Cash: $3,096 (2899% of Medicare)

Ins. Median: $159 (149% 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.

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	$44 - $2,446	41%
Blue Cross Blue Shield	$44 - $2,272	41%
Meridian	$44 - $836	41%
Molina	$44	41%
Ambetter / Centene	$47 - $836	44%
Medica(Wellfirst)	$47 - $1,920	44%
UnitedHealthcare	$47 - $2,477	44%
Wellcare	$47 - $836	44%
Healthlink	$205 - $2,477	192%
Cigna	$253 - $2,477	237%
Usa Mco	$300 - $2,941	281%

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 $3,096.
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 Clay County 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.