CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Rush Memorial Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $331
Cash Discount Price: $545
vs. Medicare Baseline: 3.10x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Rush Memorial Hospital is $331. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $545. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 3.10x the Medicare baseline. Located in 1300 N Main St, Rushville, IN.

Cash / Self-Pay

$545

Average discount available for prompt cash payment at this facility.

Insurance Median

$331

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: $545 (510%)

Insurance Median: $331 (310%)

Cash: $545 (510% of Medicare)

Ins. Median: $331 (310% 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 310% of the Medicare baseline (a markup of 210%). 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
UnitedHealthcare	$39 - $877	37%
Humana	$44 - $1,008	41%
Aetna	$45 - $1,008	42%
Caresource Mcr Adv	$45 - $340	42%
Blue Cross Blue Shield	$46 - $803	43%
Today'S Option Mcr Adv-All Plans	$46 - $350	43%
Viant Beech St Mcr Adv	$46 - $350	43%
My True Advantage - All Plans	$47 - $340	44%
Consumers Life Ins-All Plans	$48 - $986	45%
Caresource Marketplace-All Other Plans	$60 - $544	56%
Multiplan-All Plans	$61 - $1,019	57%
Encore Health Services-All Plans	$76 - $1,074	71%
Siho-All Plans	$76 - $1,008	71%
Phcs-All Plans	$100 - $877	94%
Cigna	$178 - $877	167%
Health Net	$178 - $323	167%
Coventry/First Health-All Plans	$249 - $986	233%
Sagamore-All Plans	$1,008	944%
Community Health Alliance-All Plans	$1,030	964%

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 $545.
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 Rush 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.