CT scan, lower back (lumbar spine)
Facility: F W Huston Medical Center
Billing Code: 72131 (CPT)
- CPT Billing Code: 72131
- Insurance Median: $1,117
- Cash Discount Price: $1,160
- vs. Medicare Baseline: 10.46x 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 1046% of the Medicare baseline (a markup of 946%). 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% |
| Aetna | $1,088 | 1019% |
| Humana | $1,146 | 1073% |
| Cigna | $1,232 | 1153% |
Consumer Guidance & Cost Commentary
For a CT scan of the lower back at F W Huston Medical Center in Winchester, KS, the facility's cash price of $1,160 is lower than the median negotiated rates paid by major insurers like Aetna ($1,088) and Humana ($1,146). This suggests that patients with high-deductible plans or those without insurance could potentially save money by paying cash directly, provided they secure a "self-pay" or "prompt-pay" discount before scheduling. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, the cash rate remains above the Medicare benchmark of $106.81, indicating a significant markup relative to the federal cost baseline.
The data indicates that the facility's cash price is also higher than the median negotiated rates for Blue Cross Blue Shield ($458) and Cigna ($1,232), though the latter exceeds the cash price. It is important to note that the "vs_medicare" metric of 10.5 likely reflects a specific calculation method or ratio rather than a direct dollar comparison, as the cash price is substantially higher than the Medicare amount. To ensure you are receiving the best possible rate, you should request an itemized bill to verify all charges and ask explicitly about prompt-pay discounts, which can reduce the total cost by 20% to 50% if paid upfront. Always confirm your out-of-network status and deductible balance before proceeding, as balance billing could result in unexpected costs if your insurance does not cover the service.