CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Major Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $1,481
Cash Discount Price: $613
vs. Medicare Baseline: 13.87x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Major Hospital is $1,481. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $613. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 13.87x the Medicare baseline. Located in 2451 Intelliplex Dr, Shelbyville, IN.

Cash / Self-Pay

$613

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,481

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: $613 (574%)

Insurance Median: $1,481 (1387%)

Cash: $613 (574% of Medicare)

Ins. Median: $1,481 (1387% 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 1387% of the Medicare baseline (a markup of 1287%). 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	$98 - $988	92%
Caresource Mrktplce -All Plans	$210	197%
Ambetter / Centene	$221	207%
Sho Direct-All Plans	$1,074 - $1,106	1006%
UnitedHealthcare	$1,234 - $1,307	1155%
Phcs - All Plans	$1,481 - $1,525	1387%
Aetna	$1,637 - $1,686	1533%
Siho-All Plans	$1,696 - $1,746	1588%
Humana	$1,757 - $1,809	1645%
First Health - All Plans	$1,832 - $1,887	1715%
Cigna	$1,930 - $1,987	1807%

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 $613.
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 Major 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.