CT scan, lower back (lumbar spine)
Facility: Clara Barton Hospital
Billing Code: 72131 (CPT)
- CPT Billing Code: 72131
- Insurance Median: $1,232
- Cash Discount Price: $958
- vs. Medicare Baseline: 11.53x 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 1153% of the Medicare baseline (a markup of 1053%). 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 | $453 | 424% |
| 6 Degrees Health - All Plans | $958 | 897% |
| Wppa-All Plans | $1,095 | 1025% |
| Aetna | $1,232 | 1153% |
| UnitedHealthcare | $1,232 | 1153% |
| Phcs - All Plans | $1,232 | 1153% |
| Hlth Partners Of Ks-All Plans | $1,259 | 1179% |
Consumer Guidance & Cost Commentary
For a CT scan of the lower back at Clara Barton Hospital in Hoisington, KS, the facility's cash price of $958 is significantly lower than the average negotiated rate of $1,232 paid by insurance plans. This represents a potential savings of up to $274 for patients who pay out-of-pocket, particularly those with high-deductible plans where the insurance allowed amount might exceed the cash price. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, patients should verify their specific plan's deductible status before scheduling, as paying the full negotiated rate without meeting a deductible can result in higher out-of-pocket costs than self-pay options.
The facility's cash rate is also notably lower than the state average for this procedure, offering a more transparent pricing model compared to the commercial rates charged by major payers like Aetna and UnitedHealthcare. However, patients must be aware that balance billing could still occur if they receive care from out-of-network providers, even at an in-network facility, where the provider bills the difference between their full chargemaster rate and the insurance allowed amount. To avoid unexpected charges, consumers should request a prompt-pay discount or self-pay rate before check-in and insist on an itemized bill to ensure all services are accurately coded and no unbundled charges are included.