CT scan, lower back (lumbar spine)
Facility: Ashland Health Center
Billing Code: 72131 (CPT)
- CPT Billing Code: 72131
- Insurance Median: $667
- Cash Discount Price: $534
- vs. Medicare Baseline: 6.24x 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 624% of the Medicare baseline (a markup of 524%). 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 | $223 | 209% |
| Compalliance-All Plans | $534 | 500% |
| Health Partners Of Kansas-All Plans | $567 | 531% |
| Multiplan-All Plans | $654 | 612% |
| Aetna | $667 | 624% |
| Healthy Blue Mcr Adv - All Other Plans | $667 | 624% |
| Health Choice-All Plans | $667 | 624% |
| Medicaid / KanCare | $667 | 624% |
| UnitedHealthcare | $667 | 624% |
| Medica Mcare - All Plans | $667 | 624% |
| Medicare (plans) | $667 | 624% |
| Providers Care (Wppa)-All Plans | $1,000 | 936% |
Consumer Guidance & Cost Commentary
For this CT scan of the lower back at Ashland Health Center in Ashland, KS, the facility's negotiated rates range from $223 to $667 depending on your specific insurance plan. While the facility's cash price is $534, many commercial payers have negotiated rates that exceed this amount, with some plans paying up to the full gross charge of $667. This pricing structure highlights the importance of understanding your plan's status; if you have a high-deductible plan, paying the cash price of $534 upfront could save you money compared to your insurance's negotiated rate, which may be higher due to administrative costs and contract dynamics. Patients should always verify their specific "self-pay" or "prompt-pay" discounts with the hospital before scheduling, as these upfront payment incentives can significantly reduce the final bill.
It is important to note that this facility is a Critical Access Hospital, and its pricing is benchmarked against Medicare, which serves as a reliable baseline for fair market value. The Medicare amount for this procedure is $106.81, and the facility's negotiated rates are notably higher than this federal rate, reflecting the standard markup in commercial healthcare. While the data does not provide explicit county or state average comparisons for this specific code, the wide variance in payer rates—from $223 for Blue Cross Blue Shield to $1000 for Providers Care—underscores the necessity of checking your individual plan details. If you receive a bill that appears to include balance billing for out-of-network services at an in-network facility, you may be entitled to protections under the No Surprises Act, and you should request a formal itemized audit to ensure all charges are accurate and