CT scan, lower back (lumbar spine)
Facility: Stafford County Hospital
Billing Code: 72131 (CPT)
- CPT Billing Code: 72131
- Insurance Median: $766
- Cash Discount Price: $766
- vs. Medicare Baseline: 7.17x 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 717% of the Medicare baseline (a markup of 617%). 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 |
|---|---|---|
| Health Partners-All Plans | $728 | 682% |
| Humana | $766 | 717% |
| Medica Mcr- All Plans | $766 | 717% |
| Va Ccn-All Plans | $766 | 717% |
| UnitedHealthcare | $766 | 717% |
Consumer Guidance & Cost Commentary
For the CPT code 72131, representing a CT scan of the lower back at Stafford County Hospital, the cash price is $766.00, which matches the facility's negotiated rate with all five listed payers, including Health Partners, Humana, and UnitedHealthcare. Because the cash price equals the insurance negotiated rate, patients with high-deductible plans may find paying out-of-pocket directly cheaper than relying on insurance, as the insurer would not cover any portion of the bill. The facility, a Critical Access Hospital in Stafford, KS, does not list a specific county or state average for this procedure in the provided data, so the $766.00 cash price serves as the definitive benchmark for self-pay patients.
Given that the cash price is identical to the negotiated amount, there is no discrepancy to trigger balance billing concerns for in-network patients, and the No Surprises Act protections are less relevant for this specific transaction structure. However, patients should still verify their specific plan details to ensure the service is covered and that no unexpected ancillary charges apply. If a patient chooses to pay directly, they should explicitly ask the billing department about "self-pay" or "prompt-pay" discounts before scheduling, as these programs can sometimes offer additional reductions beyond the standard cash rate. Since the cash price is already the lowest available rate in this dataset, the primary focus should be on confirming that the patient's insurance does not impose a higher allowed amount than the cash price.