CT scan, lower back (lumbar spine)
Facility: Kiowa District Hospital
Billing Code: 72131 (CPT)
- CPT Billing Code: 72131
- Insurance Median: $816
- Cash Discount Price: $691
- vs. Medicare Baseline: 7.64x 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 764% of the Medicare baseline (a markup of 664%). 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 |
|---|---|---|
| Healthchoice-All Plans | $224 | 210% |
| Tricare | $337 | 316% |
| Blue Cross Blue Shield | $453 | 424% |
| UnitedHealthcare | $691 - $864 | 647% |
| Health Partners Of Ks-All Plans | $760 | 712% |
| Humana | $780 | 730% |
| Multiplan-All Plans | $812 | 760% |
| Gbs Insurance - All Plans | $812 | 760% |
| Medicare (plans) | $821 | 769% |
| Aetna | $821 | 769% |
| Triwest-All Plans | $821 | 769% |
| Medicaid / KanCare | $864 | 809% |
| Providers Care (Wppa)-All Plans | $1,296 | 1213% |
| Liberty Healthshare-All Plans | $1,395 | 1306% |
Consumer Guidance & Cost Commentary
For a CT scan of the lower back at Kiowa District Hospital in Kiowa, KS, the cash price is $691, which is lower than the facility's gross charge of $864. While the hospital is a Critical Access Hospital owned by a Government Hospital District, the negotiated rates vary significantly by insurer, ranging from $224 for Healthchoice-All Plans up to $1,395 for Liberty Healthshare-All Plans. Patients with high-deductible plans might find the cash price of $691 more affordable than their specific insurance's negotiated rate, which could exceed the cash amount depending on their plan. It is important to note that while the facility's cash rate is lower than the gross charge, commercial negotiated rates often include administrative overhead and contract dynamics that can make them higher than the direct cash price.
The Medicare benchmark for this service is $106.81, which serves as a baseline for evaluating the facility's pricing markup. Commercial negotiated rates for this procedure average significantly higher than the Medicare amount, reflecting the complex cost structures of insurance contracts. For patients concerned about balance billing, the No Surprises Act provides federal protections against surprise bills for out-of-network providers at in-network facilities, though patients should still verify their network status and request a prompt-pay discount if paying out-of-pocket. To ensure accuracy, patients should request a full itemized bill rather than accepting a summary invoice, as detailed statements can reveal errors or unbundled charges that may not have been rendered.