CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Unity Physicians Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $11,990
Cash Discount Price: Unavailable
vs. Medicare Baseline: 112.26x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Unity Physicians Hospital is $11,990. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 112.26x the Medicare baseline. Located in 4455 Edison Lakes Pkwy, Mishawaka, IN.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$11,990

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%)

Insurance Median: $11,990 (11226%)

Ins. Median: $11,990 (11226% 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 11226% of the Medicare baseline (a markup of 11126%). 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
Aarp Supplemental	$97 - $23,443	91%
Aetna	$97 - $23,443	91%
Blue Cross Blue Shield	$97 - $36,377	91%
Cigna	$97 - $23,443	91%
Department Of Va	$97 - $23,443	91%
Medicare (plans)	$97 - $23,443	91%
Mhs Healthy Indiana Plan	$97 - $23,443	91%
Railroad Retirement	$97 - $23,443	91%
UnitedHealthcare	$97 - $49,159	91%
Medicaid / KanCare	$98	92%
Mhs Hoosier Care Connect	$98	92%
Three Rivers Provider Network	$117 - $28,131	110%
Humana	$136 - $35,000	127%
Encore	$175 - $42,197	164%
Provider Network Of America	$194 - $46,886	182%
Nalc	$403 - $49,159	377%
Sagamore Health Network	$403 - $49,159	377%
Multiplan	$437	409%
Multiplan Wc	$537	503%
All Savers	$49,159	46025%
Medica	$49,159	46025%
Medica Ifb	$49,159	46025%
Oxford	$49,159	46025%

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 $X.
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 Unity Physicians 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.