CT scan, lower back (lumbar spine)
Facility: Ellsworth County Medical Center
Billing Code: 72131 (CPT)
- CPT Billing Code: 72131
- Insurance Median: $851
- Cash Discount Price: $945
- vs. Medicare Baseline: 7.97x 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 797% of the Medicare baseline (a markup of 697%). 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 | $430 - $453 | 403% |
| Triwest -All Plans | $444 | 416% |
| Healthy Blue Mcr Adv | $444 | 416% |
| Humana | $444 - $898 | 416% |
| Va Ccn-All Plans | $444 | 416% |
| UnitedHealthcare | $614 - $945 | 575% |
| First Health - All Plans | $850 | 796% |
| Aetna | $850 | 796% |
| Cigna | $898 | 841% |
| Medicaid / KanCare | $945 | 885% |
| Coventry Mcaid-All Plans | $945 | 885% |
| Healthy Blue Mcaid- All Other Plans | $945 | 885% |
| Providers Care-Wppa-All Plans | $1,418 | 1328% |
Consumer Guidance & Cost Commentary
For a CT scan of the lower back at Ellsworth County Medical Center, the cash price is $945, which matches the facility's gross charge and the Medicaid rate. This cash price is significantly higher than the state average for this procedure, which is $732. While commercial insurance plans like Humana and UnitedHealthcare have negotiated rates ranging from $444 to $945, these amounts often exceed the cash price due to administrative costs and contract structures. Patients with high-deductible plans should consider paying the cash price directly, as it may be cheaper than the insurance negotiated rate, provided they can afford the upfront cost. It is also important to ask the hospital about self-pay or prompt-pay discounts before scheduling, as paying in full upfront can sometimes reduce the final bill by 20% to 50%.
The facility's negotiated rates vary widely among payers, with the lowest allowed amount being $430 for Blue Cross Blue Shield and the highest at $1,418 for Providers Care-Wppa-All Plans. These rates are calculated based on specific payer contracts and do not reflect the true cost of care; instead, they include administrative overhead and risk adjustments. To ensure you are not overcharged, always request an itemized bill that lists every CPT code and service rendered, as summary bills often hide errors or unbundled charges. If you receive a balance bill from an out-of-network provider, you may be protected under the No Surprises Act, which bans balance billing for emergency care and non-emergency services at in-network facilities. Disputing any unexpected charges in writing can help resolve billing errors and prevent surprise costs.