CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Jacksonville Memorial Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $1,770
Cash Discount Price: $3,847
vs. Medicare Baseline: 16.57x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Jacksonville Memorial Hospital is $1,770. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,847. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 16.57x the Medicare baseline. Located in 1600 W Walnut St, Jacksonville, IL.

Cash / Self-Pay

$3,847

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,770

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: $3,847 (3602%)

Insurance Median: $1,770 (1657%)

Cash: $3,847 (3602% of Medicare)

Ins. Median: $1,770 (1657% 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 1657% of the Medicare baseline (a markup of 1557%). 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
Blue Cross Blue Shield	$114 - $3,847	107%
Tricare	$120 - $701	112%
Coventry	$121 - $606	113%
Health Alliance	$121 - $2,616	113%
Humana	$121 - $3,281	113%
Medicare (plans)	$121 - $606	113%
UnitedHealthcare	$127 - $2,770	119%
Medicaid / KanCare	$209	196%
Molina Healthcare	$209	196%
Corvel/Corcare	$944 - $1,239	884%
Illinois Workers Compensation	$1,013 - $1,505	948%
Healthlink	$1,050 - $3,270	983%
Commercial Workers Compensation	$1,430	1339%
Health Alliance Mh Employee Plan	$1,770	1657%
Current Health Network	$2,116 - $2,885	1981%
6 Degrees Health	$2,308	2161%
Hope Trust	$2,308	2161%
Hst	$2,308	2161%
Cigna	$2,666	2496%
Aetna	$2,689 - $3,078	2518%
Phcs/Multiplan	$3,462	3241%
Hfn	$3,655	3422%
Liability	$3,847	3602%

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 $3,847.
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 Jacksonville 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.