CT scan, lower back (lumbar spine)
Facility: Kearny County Hospital
Billing Code: 72131 (CPT)
- CPT Billing Code: 72131
- Insurance Median: $1,505
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 14.09x 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 1409% of the Medicare baseline (a markup of 1309%). 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 |
|---|---|---|
| Humana | $586 | 549% |
| Blue Cross Blue Shield | $1,505 | 1409% |
| Wps Gha - Mac J5 Part A | $1,505 | 1409% |
| UnitedHealthcare | $1,505 | 1409% |
| Aetna | $1,505 | 1409% |
| Community Care Health Plan Of | $1,505 | 1409% |
Consumer Guidance & Cost Commentary
For the CPT code 72131 (CT scan, lower back), the negotiated rate for in-network insurance at Kearny County Hospital is $1,505, which matches the maximum allowed amount across all six payers listed, including Humana, Blue Cross Blue Shield, and UnitedHealthcare. This rate is significantly higher than the state of Kansas average, as indicated by a 14.1% variance versus the Medicare benchmark. While commercial insurance contracts often result in higher costs due to administrative overhead and claim processing fees, patients with high-deductible plans may find it financially advantageous to pay the cash price directly, as the facility's cash rate is not listed in the data but is typically lower than the negotiated insurance amount. It is important to note that commercial rates can sometimes exceed the true cost of care, making direct payment a viable option if the patient's out-of-pocket costs under insurance would exceed the cash price.
Patients should be aware that while the No Surprises Act protects against balance billing for emergency care and non-emergency services from out-of-network providers at in-network facilities, unexpected charges can still occur if ancillary services like emergency physicians or labs are out-of-network. To avoid these surprises, consumers should request a full itemized bill before paying, as summary bills often obscure individual line items and potential errors such as unbundled codes or services not rendered. Additionally, since this facility is a Critical Access Hospital owned by the local government, patients should proactively ask about "self-pay" or "prompt-pay" discounts, which can reduce the total cost by 20% to 50% if paid upfront. Disputing any unexpected charges should be done in writing to ensure proper review