CT scan, lower back (lumbar spine)
Facility: Rooks County Health Center
Billing Code: 72131 (CPT)
- CPT Billing Code: 72131
- Insurance Median: $1,370
- Cash Discount Price: $1,142
- vs. Medicare Baseline: 12.83x 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 1283% of the Medicare baseline (a markup of 1183%). 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 | $480 | 449% |
| Veterans Admin - All Plans | $716 | 670% |
| Tricare | $716 | 670% |
| Celtic Mcr Adv | $716 | 670% |
| Celtic Comm - All Other Plans | $787 | 737% |
| Preferred Benefits Admin | $1,370 | 1283% |
| Aetna | $1,370 | 1283% |
| UnitedHealthcare | $1,370 | 1283% |
| Preferred Hlthcare - All Other Plans | $1,447 | 1355% |
| Health Partners - All Plans | $1,447 | 1355% |
| Healthy Blue Mcaid - All Plans | $1,523 | 1426% |
Consumer Guidance & Cost Commentary
For the CPT code 72131 (CT scan, lower back), the facility's gross charge is $1,523.00, which is significantly higher than the Medicare benchmark of $106.81. While the facility's cash median price is $1,142.00 and the median negotiated rate across payers is $1,370.00, patients should be aware that insurance plans often pay amounts closer to the negotiated rate, which can exceed the cash price. For instance, several major payers like Preferred Benefits Admin, Aetna, and UnitedHealthcare have a single allowed amount of $1,370.00, which is higher than the cash rate. This dynamic suggests that for patients with high-deductible plans, paying the cash price of $1,142.00 upfront might result in lower out-of-pocket costs compared to the insurance negotiated rate, provided the patient's plan does not cover the full amount.
To maximize savings, patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can reduce the final bill by 20% to 50%. It is crucial to request a waiver of insurance submission to prevent the facility from submitting a claim that would void the cash discount agreement. Additionally, if a patient receives a balance bill after insurance payment, they should verify the legality of the charge under the No Surprises Act, particularly if the facility is in-network but specific ancillary services were out-of-network. Given that the facility is a Critical Access Hospital in Plainville, KS, and operates under a government hospital district, patients should