CT scan, lower back (lumbar spine)
Facility: Susan B Allen Memorial Hospital
Billing Code: 72131 (CPT)
- CPT Billing Code: 72131
- Insurance Median: $635
- Cash Discount Price: $741
- vs. Medicare Baseline: 5.95x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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 595% of the Medicare baseline (a markup of 495%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
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 | $350 | 328% |
| Providrs Care | $919 | 860% |
Consumer Guidance & Cost Commentary
For a CT scan of the lower back at Susan B Allen Memorial Hospital in El Dorado, KS, the cash median price is $741.00, which is significantly lower than the facility's gross charge of $1,140.00. While the facility offers a median negotiated rate of $635.00 for in-network payers like UnitedHealthcare and Providrs Care, patients with high-deductible plans may find the cash price more advantageous if their insurance allowed amount exceeds $741.00. It is important to note that commercial negotiated rates often include administrative overhead and can be higher than cash prices; therefore, patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling to ensure they are receiving the best possible fee.
This procedure's pricing is evaluated against federal benchmarks, where the Medicare amount of $106.81 serves as the objective baseline for fair pricing. The cash price of $741.00 represents a substantial markup over the Medicare rate, illustrating how commercial rates can exceed the true cost of care delivery. Because over 80% of hospital bills contain errors, patients should request a detailed, itemized CPT-coded statement rather than accepting a summary bill, which may obscure unbundled charges or services not rendered. If a balance bill arises from an out-of-network ancillary service, patients should verify the legality of the charge under the No Surprises Act and dispute the amount in writing before signing any consent waivers that could waive their rights to protection.