CT scan, lower back (lumbar spine)
Facility: Medicine Lodge Memorial Hospital
Billing Code: 72131 (CPT)
- CPT Billing Code: 72131
- Insurance Median: $601
- Cash Discount Price: $633
- vs. Medicare Baseline: 5.63x 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 563% of the Medicare baseline (a markup of 463%). 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 |
|---|---|---|
| Tricare | $507 | 475% |
| Humana | $576 | 539% |
| Aetna | $586 - $633 | 549% |
| UnitedHealthcare | $601 | 563% |
| Hpk-All Plans | $601 | 563% |
| Medicaid / KanCare | $633 | 593% |
Consumer Guidance & Cost Commentary
For a CT scan of the lower back at Medicine Lodge Memorial Hospital, the cash price is $633, which matches the facility's gross charge and the highest negotiated rate among payers. While the median negotiated rate across six payers is $601, patients with high-deductible plans may find paying cash directly more cost-effective if their insurance allows a rate higher than the cash price. It is important to note that this facility is a Critical Access Hospital in Medicine Lodge, Kansas, and while specific state or county average data was not provided in the report, the cash price aligns exactly with the Medicare amount of $106.81 when adjusted for the facility's specific billing context, suggesting a transparent pricing structure where the cash rate reflects the full cost rather than a discounted list price.
To ensure you are receiving the most accurate billing information, always request an itemized bill before paying, as summary bills often obscure individual charges and potential errors. If you choose to use insurance, be aware that while the facility is in-network for carriers like Tricare, Humana, Aetna, UnitedHealthcare, Hpk-All Plans, and Medicaid/KanCare, the negotiated rates vary slightly, with Aetna showing a range from $586 to $633 depending on the specific plan. Additionally, ask the billing department about prompt-pay discounts, which can reduce the final amount if you settle the bill upfront, and verify your deductible status to avoid unexpected out-of-pocket costs.