CT scan, lower back (lumbar spine)
Facility: Nemaha Valley Community Hospital
Billing Code: 72131 (CPT)
- CPT Billing Code: 72131
- Insurance Median: $869
- Cash Discount Price: $1,558
- vs. Medicare Baseline: 8.14x 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 814% of the Medicare baseline (a markup of 714%). 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% |
| Humana | $762 | 713% |
| Va Ccn - All Plans | $762 | 713% |
| Aetna | $769 - $1,471 | 720% |
| Celtic Comm Exch - All Plans | $838 | 785% |
| Partners Direct Health - All Plans | $900 | 843% |
| Multiplan - All Plans | $1,558 | 1459% |
| Midlands Choice - All Plans | $1,644 | 1539% |
| Health Partners - All Plans | $1,644 | 1539% |
Consumer Guidance & Cost Commentary
For a CT scan of the lower back at Nemaha Valley Community Hospital in Seneca, Kansas, the cash price is $1,558, which aligns exactly with the median negotiated rate for most major payers. While the facility's gross charge is $1,731, the actual amount billed to insurance plans ranges from $480 for Blue Cross Blue Shield to $1,644 for Midlands Choice and Health Partners. It is important to note that commercial negotiated rates often exceed cash prices due to administrative overhead and contract structures; however, patients with high-deductible plans may find paying the cash price of $1,558 more cost-effective than relying on insurance, which could result in higher out-of-pocket costs if deductibles are not yet met.
To understand the true cost of this service, it is best to compare rates against the Medicare benchmark rather than the hospital's inflated list price. The Medicare amount for this procedure is $106.81, which serves as a scientifically validated baseline for healthcare delivery costs. Commercial rates typically average between 200% and 300% of this Medicare rate, whereas fair pricing is generally defined as 120% to 150%. Given that the cash price of $1,558 represents approximately 14.6 times the Medicare rate, patients should verify if their specific insurance plan allows for a lower negotiated amount or if requesting a prompt-pay discount could further reduce the final bill. Always request a self-pay classification before check-in to ensure you receive the lowest possible rate and avoid automatic claims submission that might void cash discounts.