CT scan, lower back (lumbar spine)
Facility: Grisell Memorial Hospital
Billing Code: 72131 (CPT)
- CPT Billing Code: 72131
- Insurance Median: $816
- Cash Discount Price: $889
- vs. Medicare Baseline: 7.64x 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 764% of the Medicare baseline (a markup of 664%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $430 | 403% |
| UnitedHealthcare | $696 - $936 | 652% |
| Humana | $936 | 876% |
| Medicaid / KanCare | $936 | 876% |
Consumer Guidance & Cost Commentary
For the CPT code 72131, representing a CT scan of the lower back at Grisell Memorial Hospital in Ransom, KS, the facility's cash median price is $889.00, which is lower than the state average of $936.00. While the facility is a Critical Access Hospital with government ownership, patients should be aware that commercial insurance rates often exceed cash prices due to administrative overhead and contract structures. For instance, UnitedHealthcare's negotiated rate ranges from $696 to $936, whereas Humana and Medicaid/KanCare pay the full $936.00. If you have a high-deductible plan, paying the cash price of $889.00 upfront could save you money compared to the insurance negotiated rate, provided your deductible has not yet been met.
It is important to verify your specific plan's allowed amount before scheduling, as in-network rates vary significantly by carrier. The data shows that while Blue Cross Blue Shield pays a fixed $430.00, other payers may pay closer to the gross charge of $936.00. To minimize costs, patients should explicitly request "self-pay" or "prompt-pay" discounts prior to check-in, which can reduce bills by 20% to 50% by bypassing costly insurance claims processing. Additionally, since Medicare allows only $106.81 for this procedure, commercial rates are substantially higher; however, fair pricing benchmarks typically suggest a rate between 120% and 150% of the Medicare amount, so patients should compare their final bills against this baseline rather than the hospital's inflated