CT scan, lower back (lumbar spine)
Facility: Kiowa County Memorial Hospital
Billing Code: 72131 (CPT)
- CPT Billing Code: 72131
- Insurance Median: $801
- Cash Discount Price: $765
- vs. Medicare Baseline: 7.50x 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 750% of the Medicare baseline (a markup of 650%). 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 | $458 - $890 | 429% |
| UnitedHealthcare | $641 - $1,000 | 600% |
| Health Partners Of Ks-All Plans | $704 - $880 | 659% |
| Aetna | $712 - $890 | 667% |
| Medica Prime Mcare Cost-All Plans | $712 - $890 | 667% |
| Celtic Comml Exchange-All Other Plans | $712 - $890 | 667% |
| Humana | $712 - $890 | 667% |
| Medicaid / KanCare | $800 - $1,000 | 749% |
| Providrs Care/Wppa-All Plans | $1,200 - $1,500 | 1123% |
Consumer Guidance & Cost Commentary
For a CT scan of the lower back (lumbar spine) at Kiowa County Memorial Hospital in Greensburg, KS, the cash price is $765, which is lower than the facility's gross charge of $900. While the hospital is a Critical Access Hospital owned by the local government, patients should note that commercial insurance negotiated rates often exceed cash prices due to administrative overhead and contract structures. In this case, the median negotiated rate is $801, and the lowest allowed amount from an insurer is $458, meaning some patients with high-deductible plans might save money by paying the cash price directly. It is advisable to contact the hospital before scheduling to confirm if "self-pay" or "prompt-pay" discounts are available, as these upfront payment incentives can further reduce the final bill.
This service is benchmarked against Medicare, which sets a fixed reimbursement rate of $106.81 for this procedure. The cash price of $765 represents a significant markup over the Medicare rate, illustrating how commercial pricing can differ substantially from federal cost baselines. Although specific county or state average data was not provided in the report, patients should be aware that balance billing is generally prohibited for emergency care and non-emergency services at in-network facilities under the No Surprises Act. If a patient receives a bill exceeding their insurance allowed amount, they should request an itemized audit to identify errors or unbundled codes, as over 80% of hospital bills contain mistakes that can be corrected through formal written disputes.