CT scan, lower back (lumbar spine)
Facility: Graham County Hospital
Billing Code: 72131 (CPT)
- CPT Billing Code: 72131
- Insurance Median: $492
- Cash Discount Price: $635
- vs. Medicare Baseline: 4.61x 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 461% of the Medicare baseline (a markup of 361%). 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 |
|---|---|---|
| Medicaid / KanCare | $145 | 136% |
| UnitedHealthcare | $145 - $603 | 136% |
| Blue Cross Blue Shield | $453 | 424% |
| Medicare (plans) | $476 | 446% |
| Celtic Commercial-All Other Plans | $524 | 491% |
| Wppa (Providers Care)-All Plans | $603 | 565% |
Consumer Guidance & Cost Commentary
For a CT scan of the lower back at Graham County Hospital in Hill City, Kansas, the cash price is $635.00, which matches the facility's median negotiated rate of $492.00 and the cash median of $635.00. While the gross charge is $635.00, commercial payers like UnitedHealthcare and Celtic Commercial-All Other Plans have negotiated rates ranging from $145 to $603, significantly lower than the gross amount. However, patients with high-deductible plans may find paying the cash price of $635.00 more cost-effective than using insurance, as some in-network negotiated rates can exceed the cash price. It is important to verify your specific plan's allowed amount before scheduling, as assuming in-network status guarantees the lowest price can lead to higher out-of-pocket costs if your deductible has not yet been met.
This facility, a Critical Access Hospital owned by the local government, reports a Medicare amount of $106.81, which serves as a benchmark for fair pricing. The facility's cash price of $635.00 is notably higher than the Medicare rate, reflecting the standard markup between commercial and federal reimbursement. To minimize costs, patients should inquire about prompt-pay discounts, which can reduce bills by 20% to 50% if paid upfront, bypassing the administrative overhead associated with insurance claims. Additionally, since over 80% of hospital bills contain errors, requesting a detailed, itemized statement before payment is essential to identify any unbundled codes or services not rendered, ensuring you are only paying for what was actually provided.