CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Pulaski Memorial Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $119
Cash Discount Price: $1,164
vs. Medicare Baseline: 1.11x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Pulaski Memorial Hospital is $119. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,164. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.11x the Medicare baseline. Located in 616 E 13Th St, Winamac, IN.

Cash / Self-Pay

$1,164

Average discount available for prompt cash payment at this facility.

Insurance Median

$119

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: $1,164 (1090%)

Insurance Median: $119 (111%)

Cash: $1,164 (1090% of Medicare)

Ins. Median: $119 (111% 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
Mdwise Mcaid Hcc	$44 - $98	41%
Mdwise Mcaid Hhw	$44 - $98	41%
Mdwise Mcaid Hip - All Other Plans	$44 - $988	41%
Ambetter / Centene	$45 - $988	42%
Blue Cross Blue Shield	$45 - $2,050	42%
Caresource Mcaid Hip	$45 - $988	42%
Caresource Mcare Hmo	$45 - $988	42%
Cenpatico Mcaid Hip	$45 - $988	42%
Humana	$45 - $2,562	42%
Mhs Mcaid Hip	$45 - $988	42%
Mhs Mcare Allwell	$45 - $998	42%
Multiplan - All Plans	$45 - $2,868	42%
UnitedHealthcare	$45 - $2,517	42%
Caresource Exch Hmo Hix - All Other Plans	$56 - $1,235	52%
Encore Ppo - All Other Plans	$68 - $2,709	64%
Community Health Alliance - All Plans	$88 - $2,836	82%
Cigna	$89 - $3,027	83%
Sagamore - All Other Plans	$89 - $2,409	83%
Sagamore Rose Acre	$89 - $2,374	83%
Caresource Mcaid Hhw	$98 - $119	92%
Cenpatico Mcaid Hhw - All Other Plans	$98 - $119	92%
Mhs Mcaid Hhw/Hcc	$98 - $119	92%
Encore Workers Comp	$124 - $2,868	116%
Aetna	$1,147	1074%

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 $1,164.
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 Pulaski 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.