CMS Price Transparency Data

CT scan, chest (no contrast)

Facility: Memorial Hospital and Health Care Center

Billing Code: 71250 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 71250
Insurance Median: $123
Cash Discount Price: $90
vs. Medicare Baseline: 1.15x Medicare

The contracted insurance negotiated median rate for a CT scan, chest (no contrast) at Memorial Hospital and Health Care Center is $123. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $90. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.15x the Medicare baseline. Located in 800 W 9Th St, Jasper, IN.

Cash / Self-Pay

$90

Average discount available for prompt cash payment at this facility.

Insurance Median

$123

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: $90 (84%)

Insurance Median: $123 (115%)

Cash: $90 (84% of Medicare)

Ins. Median: $123 (115% 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
Blue Cross Blue Shield	$37 - $243	35%
Aetna	$47 - $438	44%
Caresource In Marketplace	$47 - $153	44%
Humana	$47 - $123	44%
Tricare	$47 - $123	44%
Mdwise	$48 - $125	45%
Mhs Hoosier Care Connect	$48 - $125	45%
Chamber Care	$49	46%
Immergrun	$57 - $147	53%
UnitedHealthcare	$57 - $368	53%
Ambetter / Centene	$62 - $159	58%
Onecare	$62 - $159	58%
Siho	$62 - $159	58%
Noncontracted	$76 - $196	71%
Patoka Valley	$87 - $403	81%
Encore	$89 - $410	83%
Encore Elite +	$89 - $410	83%
Cigna	$167 - $438	156%
Sagamore	$167 - $438	156%

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 $90.
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 Memorial Hospital and Health Care Center 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.