CT scan, lower back (lumbar spine)
Facility: Greenwood County Hospital
Billing Code: 72131 (CPT)
- CPT Billing Code: 72131
- Insurance Median: $712
- Cash Discount Price: $674
- vs. Medicare Baseline: 6.67x 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 667% of the Medicare baseline (a markup of 567%). 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 |
|---|---|---|
| Triwest - All Plans | $301 | 282% |
| Tricare | $354 | 331% |
| Choicecare Mcr Adv - All Plans | $354 | 331% |
| UnitedHealthcare | $354 - $708 | 331% |
| Blue Cross Blue Shield | $430 - $453 | 403% |
| Integrated Health Plan - All Plans | $632 | 592% |
| First Health - All Other Plans | $717 | 671% |
| Beech Street - All Plans | $717 | 671% |
| First Health Ccn Network | $717 | 671% |
| Preferred Hs (Coventry) - All Plans | $759 | 711% |
| Principal Health Care Inc - All Plans | $801 | 750% |
| Amerigroup Mcaid-All Plans | $843 | 789% |
| Medicaid / KanCare | $843 | 789% |
| Providrs Care/Wppa - All Plans | $1,264 | 1183% |
Consumer Guidance & Cost Commentary
For the CPT code 72131, representing a CT scan of the lower back, Greenwood County Hospital in Eureka, KS, lists a gross charge of $843.00. The facility's cash median price is $674.00, which is lower than the state average of $708.00 and the county average of $712.00. While many commercial payers negotiate rates that exceed the cash price—such as UnitedHealthcare's range of $354 to $708 and Blue Cross Blue Shield's range of $430 to $453—patients with high-deductible plans may find the cash rate more affordable if their insurance allowed amount is higher than $674.00. It is important to note that commercial negotiated rates often include administrative overhead and do not reflect the true cost of care, which is better represented by the Medicare benchmark of $106.81.
Patients should be aware that insurance contracts can sometimes lead to balance billing if a provider is out-of-network, though the No Surprises Act protects against this for emergency and non-emergency services at in-network facilities. Even with in-network coverage, unexpected charges can occur if ancillary services like laboratory tests are billed separately. To minimize costs, consumers should request an itemized billing audit to verify that no unbundled codes or services not rendered are included, as over 80% of hospital bills contain errors. Additionally, patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as paying in full upfront can often reduce the total amount owed by bypassing the costly insurance claims process.