CT scan, lower back (lumbar spine)
Facility: Cheyenne County Hospital
Billing Code: 72131 (CPT)
- CPT Billing Code: 72131
- Insurance Median: $732
- Cash Discount Price: $655
- vs. Medicare Baseline: 6.85x 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 685% of the Medicare baseline (a markup of 585%). 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 |
|---|---|---|
| UnitedHealthcare | $215 - $770 | 201% |
| Blue Cross Blue Shield | $453 | 424% |
| First Health - All Plans | $539 | 505% |
| Aetna | $554 - $732 | 519% |
| Tricare | $554 | 519% |
| Healthy Blue Mcr Adv | $554 | 519% |
| Choice Care - All Plans | $560 | 524% |
| Firstguard - All Plans | $616 | 577% |
| Wppa - All Plans | $693 | 649% |
| Cpm - All Plans | $732 | 685% |
| Preferred Hc - All Plans | $732 | 685% |
| Midlands Choice - All Plans | $747 | 699% |
| Health Partners - All Plans | $755 | 707% |
| Integrated Hp - All Plans | $755 | 707% |
| Ppo Next - All Plans | $755 | 707% |
| Unicare - All Plans | $755 | 707% |
| Healthy Blue Mcaid - All Other Plans | $770 | 721% |
| Childrens Mercy - All Plans | $770 | 721% |
| Healthwave Mcaid - All Plans | $770 | 721% |
| Providers Care-All Plans | $1,155 | 1081% |
Consumer Guidance & Cost Commentary
For CPT code 72131, a CT scan of the lower back, the gross charge at Cheyenne County Hospital in St. Francis, KS is $770.00. While the facility's cash median rate is $655.00, which is lower than the negotiated rates paid by most insurance plans, patients should be aware that commercial negotiated rates often exceed cash prices due to administrative overhead and contract structures. In this case, the median negotiated rate across payers is $732.00, and the highest negotiated rate is $1,155.00. If you have a high-deductible plan or have not yet met your deductible, paying the cash price of $655.00 upfront could result in significant savings compared to the insurance allowed amount. It is advisable to contact the hospital directly to confirm if "self-pay" or "prompt-pay" discounts are available before scheduling your appointment.
The Medicare benchmark for this procedure is $106.81, which serves as a baseline for evaluating the facility's pricing markup. The facility's cash rate of $655.00 represents a substantial increase over the Medicare amount, reflecting the costs of facility operations and physician services beyond the federal reimbursement standard. Commercial negotiated rates generally range from 200% to 300% of the Medicare rate, though fair pricing is often defined as 120% to 150%. Given that this is a Critical Access Hospital, the pricing reflects the specific cost basis for this facility type. Consumers should review their specific plan details to understand their out-of-pocket responsibilities, as the $770.00 gross