CT scan, lower back (lumbar spine)
Facility: Nmc Health
Billing Code: 72131 (CPT)
- CPT Billing Code: 72131
- Insurance Median: $910
- Cash Discount Price: $1,107
- vs. Medicare Baseline: 8.52x 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 852% of the Medicare baseline (a markup of 752%). 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 |
|---|---|---|
| Bluestem Pace | $101 | 95% |
| Leading Age | $162 | 152% |
| Medicaid / KanCare | $162 | 152% |
| Aetna | $408 | 382% |
| Blue Cross Blue Shield | $480 | 449% |
| Wppa | $870 | 815% |
| Occunet | $949 | 888% |
| Medincrease Health Plan | $1,028 | 962% |
| Samaritan Ministries International | $1,028 | 962% |
| Prime Health Services | $1,186 | 1110% |
| UnitedHealthcare | $1,423 | 1332% |
| Cigna | $1,502 | 1406% |
Consumer Guidance & Cost Commentary
For the CPT code 72131 (CT scan, lower back), Nmc Health in Newton, KS, lists a gross charge of $1,581.00, which is significantly higher than the facility's cash median of $1,107.00. When compared to the Medicare benchmark of $106.81, the gross charge represents a markup of 8.5 times the federal baseline, illustrating how commercial chargemasters can inflate costs far beyond the true cost of care. While the facility offers a median negotiated rate of $910.00 for in-network payers, this amount still exceeds the cash price, suggesting that patients with high-deductible plans might save money by paying cash directly, provided they verify "self-pay" or "prompt-pay" discounts with the hospital before scheduling.
The data shows a wide range of negotiated rates across 12 different payers, with the lowest at $101.00 for Bluestem Pace and the highest at $1,502.00 for Cigna, highlighting that in-network status does not guarantee the lowest possible price. Since the facility is a voluntary non-profit acute care hospital in Newton (ZIP 67114), patients should be aware that balance billing is generally prohibited for emergency services under the No Surprises Act, though unexpected charges can still occur if ancillary services like labs are out-of-network. To ensure accuracy, consumers should request a full itemized billing audit rather than accepting a summary bill, as over 80% of hospital bills contain errors such as double-billing or unbundled codes that can be corrected through a formal written dispute.