CT scan, lower back (lumbar spine)
Facility: Wichita County Health Center
Billing Code: 72131 (CPT)
- CPT Billing Code: 72131
- Insurance Median: $1,144
- Cash Discount Price: $1,003
- vs. Medicare Baseline: 10.71x 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 1071% of the Medicare baseline (a markup of 971%). 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 |
|---|---|---|
| Medicaid / KanCare | $1,035 | 969% |
| UnitedHealthcare | $1,254 | 1174% |
Consumer Guidance & Cost Commentary
For the CPT code 72131, representing a CT scan of the lower back, Wichita County Health Center in Leoti, Kansas, has a gross charge of $1,254.00. The facility's negotiated rates for Medicaid/KanCare and UnitedHealthcare are both fixed at $1,035.00 and $1,254.00, respectively, with no variation across plans. When compared to the Medicare benchmark of $106.81, the facility's rates are significantly higher, reflecting a markup of 10.7 times the Medicare amount. This substantial difference highlights the typical administrative and contractual layers that inflate commercial rates above the federal baseline, which serves as the most objective measure of true service cost.
Patients should be aware that paying cash directly can sometimes result in lower out-of-pocket costs than using insurance, particularly if the patient's deductible has not yet been met. The cash median price for this service is $1,003.00, which is lower than the Medicaid negotiated rate of $1,035.00. To maximize savings, individuals should contact the hospital before scheduling to confirm if self-pay or prompt-pay discounts are available, as these upfront payment incentives can bypass standard insurance billing cycles. Additionally, since this is a Critical Access Hospital with government-local ownership, verifying the specific billing classification at registration is essential to ensure the patient receives the most favorable rate structure available.