CT scan, lower back (lumbar spine)
Facility: Ellinwood District Hospital
Billing Code: 72131 (CPT)
- CPT Billing Code: 72131
- Insurance Median: $413
- Cash Discount Price: $502
- vs. Medicare Baseline: 3.87x 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 387% of the Medicare baseline (a markup of 287%). 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 |
|---|---|---|
| Aetna | $413 | 387% |
| UnitedHealthcare | $413 | 387% |
| Cigna | $413 | 387% |
| Humana | $413 | 387% |
| Blue Cross Blue Shield | $413 | 387% |
Consumer Guidance & Cost Commentary
For this CT scan of the lower back at Ellinwood District Hospital in Ellinwood, KS, the facility's negotiated rate is $413, which matches the lowest and highest amounts reported across all five commercial payers, including Aetna, UnitedHealthcare, Cigna, Humana, and Blue Cross Blue Shield. This negotiated rate is significantly higher than the cash price of $502.00, meaning patients with high-deductible plans might save money by paying cash directly, provided they can secure a self-pay or prompt-pay discount before scheduling. While the facility is a Critical Access Hospital owned by a government hospital district, the data shows no specific county or state average for this procedure to compare against, so the $413 negotiated rate represents the specific contract terms for this location.
The Medicare benchmark for this service is $106.81, indicating that the commercial negotiated rate of $413.00 is 3.9 times the Medicare amount. This substantial markup reflects the administrative costs and contract dynamics inherent in commercial insurance billing, where rates often exceed the true cost of care by a significant margin. To ensure you are receiving the best possible price, it is crucial to verify your deductible status before using insurance, as paying out-of-pocket could result in a lower total cost if the insurance allowed amount exceeds the cash price. Additionally, patients should request a waiver of insurance submission at registration to avoid automatic claims processing and ask explicitly about prompt-pay discounts, which can reduce the final bill by 20% to 50% if paid in full upfront.