CT scan, lower back (lumbar spine)
Facility: Great Plains Of Sabetha
Billing Code: 72131 (CPT)
- CPT Billing Code: 72131
- Insurance Median: $630
- Cash Discount Price: $663
- vs. Medicare Baseline: 5.90x 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 590% of the Medicare baseline (a markup of 490%). 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 |
|---|---|---|
| Celtic Mcr Adv | $345 | 323% |
| Aetna | $348 - $670 | 326% |
| Celtic Comm Exchange-All Other Plans | $431 | 404% |
| Great West Healthcare-All Plans | $564 | 528% |
| UnitedHealthcare | $617 - $663 | 578% |
| Century/Wppa/Providers-All Plans | $630 | 590% |
| Multiplan-Phcs-All Plans | $630 | 590% |
| Cigna | $630 | 590% |
| Humana | $630 | 590% |
| Federated Mutual Ins-All Plans | $636 | 595% |
| Medicaid / KanCare | $663 | 621% |
| Blue Cross Blue Shield | $663 | 621% |
Consumer Guidance & Cost Commentary
For this CT scan of the lower back at Great Plains of Sabetha, the cash price is $663.00, which matches the facility's gross charge and the Medicare benchmark of $106.81. While the facility is a Critical Access Hospital in Kansas, the data does not provide specific county or state average rates for comparison. It is important to note that commercial insurance negotiated rates for this service range from $345 to $663, with Aetna offering the lowest allowed amount of $345 and Medicaid/KanCare at the full cash price of $663.00. Because the cash price is identical to the gross charge, patients with high-deductible plans may find paying out-of-pocket cheaper than using insurance, as the insurer's allowed amount could exceed the cash price, potentially leaving the patient responsible for a larger balance.
Patients should verify if "self-pay" or "prompt-pay" discounts are available before scheduling, as these upfront payment incentives can reduce the final bill by 20% to 50% by bypassing costly insurance claims processing. If you choose to use insurance, be aware that balance billing is generally prohibited for emergency care and non-emergency services at in-network facilities under the No Surprises Act, though unexpected charges can still occur from out-of-network ancillary services like lab work. To ensure accuracy, always request a full itemized bill listing specific CPT codes rather than accepting a summary invoice, as over 80% of hospital bills contain errors such as unbundled charges or services not rendered. Finally, if you receive a bill exceeding your expected costs, dispute it in writing with the billing supervisor rather than settling verbally