CT scan, lower back (lumbar spine)
Facility: Holton Community Hospital
Billing Code: 72131 (CPT)
- CPT Billing Code: 72131
- Insurance Median: $1,249
- Cash Discount Price: $1,129
- vs. Medicare Baseline: 11.69x 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 1169% of the Medicare baseline (a markup of 1069%). 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 | $453 | 424% |
| Aetna | $798 - $1,505 | 747% |
| UnitedHealthcare | $798 - $1,505 | 747% |
| Humana | $806 | 755% |
| Kansas Superior Select - All Plans | $814 | 762% |
| Preferred Health Fn Select - All Other Plans | $1,249 | 1169% |
| Preferred Health Professionals | $1,249 | 1169% |
| Preferred Health Freedom | $1,249 | 1169% |
| Wppa Providers - All Plans | $1,430 | 1339% |
| Medicaid / KanCare | $1,505 | 1409% |
Consumer Guidance & Cost Commentary
For a CT scan of the lower back at Holton Community Hospital, the gross charge is $1,505. While the facility's cash median price of $1,129 is lower than the gross charge, it is important to note that many in-network insurance plans negotiate rates that exceed this cash amount; for instance, Aetna and UnitedHealthcare have negotiated rates ranging from $798 to $1,505. This dynamic suggests that patients with high-deductible plans might find paying the cash price directly more cost-effective than relying on insurance, provided they have not yet met their deductible. To maximize savings, patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront fee reductions can bypass the administrative costs associated with insurance billing cycles.
The facility's pricing is benchmarked against federal standards, with the Medicare rate for this procedure set at $106.81. Commercial negotiated rates often average between 200% and 300% of this Medicare baseline, though fair pricing is typically defined as 120% to 150%. In this case, the median negotiated rate of $1,249 represents a significant markup over the Medicare amount. Consumers should be aware that balance billing—where a patient is billed for the difference between the provider's full charge and the insurance allowed amount—is generally prohibited for emergency care and non-emergency services at in-network facilities under the No Surprises Act. If a patient receives a surprise bill, they should dispute it in writing with the insurer rather than paying immediately to avoid potential credit damage.