CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Carle Richland Memorial Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $756
Cash Discount Price: $2,520
vs. Medicare Baseline: 7.08x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Carle Richland Memorial Hospital is $756. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,520. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 7.08x the Medicare baseline. Located in 800 East Locust Street, Olney, IL.

Cash / Self-Pay

$2,520

Average discount available for prompt cash payment at this facility.

Insurance Median

$756

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: $2,520 (2359%)

Insurance Median: $756 (708%)

Cash: $2,520 (2359% of Medicare)

Ins. Median: $756 (708% 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 708% of the Medicare baseline (a markup of 608%). 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	$529 - $2,102	495%
Blue Cross Blue Shield	$529 - $1,764	495%
Humana	$529	495%
Meridian	$529	495%
Molina	$529 - $756	495%
UnitedHealthcare	$529 - $1,925	495%
Wellcare	$529	495%
Cigna	$600	562%
Healthlink	$1,638 - $1,764	1534%
Multiplan/Phcs	$2,142 - $2,192	2005%

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 $2,520.
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 Carle Richland 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.