CT scan, lower back (lumbar spine)
Facility: Rawlins County Health Center
Billing Code: 72131 (CPT)
- CPT Billing Code: 72131
- Insurance Median: $1,148
- Cash Discount Price: $1,122
- vs. Medicare Baseline: 10.75x 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 1075% of the Medicare baseline (a markup of 975%). 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 | $458 | 429% |
| UnitedHealthcare | $1,148 | 1075% |
Consumer Guidance & Cost Commentary
For a CT scan of the lower back at Rawlins County Health Center in Atwood, Kansas, the cash price is $1,122, which is lower than the facility's gross charge of $1,320. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, the cash rate is notably higher than the state average for this procedure. Patients with high-deductible plans may find this cash price more affordable than their insurance negotiated rate of $1,148, as paying out-of-pocket avoids the administrative fees and markup inherent in the insurance billing cycle. It is important to verify if your specific plan has a lower allowed amount or if you qualify for a prompt-pay discount by paying in full upfront, which can sometimes reduce the final cost further.
This service is covered by two payers, Blue Cross Blue Shield and UnitedHealthcare, with negotiated rates of $458 and $1,148 respectively. The Medicare benchmark for this code is $106.81, indicating that the cash price represents a significant markup over the federal government's cost-based reimbursement. Because the cash rate exceeds the Medicare amount by 10.7%, commercial insurance contracts often result in higher out-of-pocket costs for patients who have not met their deductibles. To ensure you are not facing unexpected balance billing, always request an itemized bill before paying, as summary invoices may hide unbundled charges or services not rendered. If you receive a surprise bill, you may be entitled to protections under the No Surprises Act, which prohibits balance billing for out-of-network providers at in-network facilities.