CT scan, lower back (lumbar spine)
Facility: Stevens County Hospital
Billing Code: 72131 (CPT)
- CPT Billing Code: 72131
- Insurance Median: $670
- Cash Discount Price: $770
- vs. Medicare Baseline: 6.27x 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 627% of the Medicare baseline (a markup of 527%). 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 |
|---|---|---|
| Humana | $285 | 267% |
| Aetna | $293 - $770 | 274% |
| Blue Cross Blue Shield | $456 - $480 | 427% |
| First Health - All Plans | $693 | 649% |
| Wppa - All Plans | $732 | 685% |
| Medicaid / KanCare | $770 | 721% |
Consumer Guidance & Cost Commentary
For the CPT code 72131 (CT scan, lower back), Stevens County Hospital in Hugoton, KS, lists a cash price of $770.00, which matches the facility's gross charge and the median paid by Medicaid/KanCare. While the facility's negotiated rates for commercial payers like Aetna and Blue Cross Blue Shield range from $293 to $770, the cash price remains the highest single figure in this dataset. It is important to note that for patients with high-deductible plans, paying the cash price of $770.00 upfront may be more cost-effective than relying on insurance, as the negotiated rates for some commercial payers can exceed this amount. Additionally, patients should inquire directly with the hospital about "self-pay" or "prompt-pay" discounts, which could reduce the final bill by 20% to 50% if paid in full within a short window.
When evaluating the value of this service, it is helpful to compare the facility's pricing against the Medicare benchmark. The Medicare amount for this procedure is $106.81, and the facility's cash price of $770.00 represents a 6.3x markup relative to this federal baseline. While commercial negotiated rates vary significantly by insurer, the cash price serves as a clear floor for out-of-pocket costs. Given that the facility is a Critical Access Hospital with government-local ownership, patients are encouraged to request an itemized billing audit to ensure no unbundled codes or services not rendered are included in the final statement, as over 80% of hospital bills contain errors.