CT scan, lower back (lumbar spine)
Facility: Hamilton County Hospital
Billing Code: 72131 (CPT)
- CPT Billing Code: 72131
- Insurance Median: $1,328
- Cash Discount Price: $1,475
- vs. Medicare Baseline: 12.43x 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 1243% of the Medicare baseline (a markup of 1143%). 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 | $215 - $480 | 201% |
| First Health Coventry - All Plans | $1,254 | 1174% |
| Cigna | $1,401 | 1312% |
| UnitedHealthcare | $1,401 | 1312% |
| Va Ccn - All Plans | $1,475 | 1381% |
| Aetna | $2,508 | 2348% |
Consumer Guidance & Cost Commentary
For this CT scan of the lumbar spine at Hamilton County Hospital in Syracuse, KS, the cash price is $1,475, which matches the facility's median negotiated rate. While the hospital is a government-owned Critical Access Hospital, patients should be aware that commercial insurance rates can sometimes exceed cash prices due to administrative overhead and contract structures. In this specific case, the cash price is identical to the median negotiated amount of $1,401 reported for this service, meaning there is no financial advantage to paying out-of-pocket compared to the standard insurance allowed amount. However, patients with high-deductible plans should still verify their specific plan details, as some policies may cover the full $1,475 cash rate if the deductible has not been met, effectively making the cash price the total out-of-pocket cost.
When evaluating the cost of this procedure, it is important to look beyond the hospital's list price and compare it to federal benchmarks. The Medicare amount for this code is $106.81, and the facility's cash rate represents a 12.4% markup relative to this federal baseline. This aligns with the industry standard where fair pricing is typically defined between 120% and 150% of the Medicare rate, whereas commercial negotiated rates often average 200% to 300% of Medicare. Additionally, while the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, patients should still request an itemized bill to ensure no unbundled charges or services not rendered are included. If you choose to pay directly, ask the billing department about prompt-pay discounts, which can reduce the total cost by