CT scan, lower back (lumbar spine)
Facility: Hiawatha Community Hospital
Billing Code: 72131 (CPT)
- CPT Billing Code: 72131
- Insurance Median: $1,032
- Cash Discount Price: $1,325
- vs. Medicare Baseline: 9.66x 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 966% of the Medicare baseline (a markup of 866%). 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 | $456 - $480 | 427% |
| UnitedHealthcare | $490 - $1,138 | 459% |
| Aetna | $490 - $1,071 | 459% |
| Humana | $495 | 463% |
| Ambetter / Centene | $588 | 551% |
| Centrus Health Direct - All Plans | $994 | 931% |
| Oscar - All Plans | $994 | 931% |
| Preferred Hlth - All Plans | $1,192 | 1116% |
| Wppa Providrs Care - All Plans | $1,259 | 1179% |
| Cigna | $1,259 | 1179% |
| Midlands Choice - All Plans | $1,285 | 1203% |
| Multiplan - All Plans | $1,285 | 1203% |
| Healthy Blue Mcaid - All Plans | $1,325 | 1241% |
Consumer Guidance & Cost Commentary
For a CT scan of the lower back at Hiawatha Community Hospital, the cash median price is $1,325, which matches the facility's gross charge. This rate is significantly higher than the state of Kansas average, where the median paid amount for this service is $994. While the facility offers a negotiated rate of $1,032 for in-network patients, this figure remains above the state average. Patients with high-deductible plans may find the cash price more advantageous if their insurance negotiated rate exceeds $1,325, as paying out-of-pocket could result in lower total costs. It is important to verify your specific plan's allowed amount before scheduling, as commercial rates vary widely among payers, ranging from $456 to $1,325 depending on the insurance carrier.
To minimize potential financial exposure, consumers should proactively request a prompt-pay discount or self-pay rate before check-in, as these upfront incentives can reduce the final bill by 20% to 50%. Additionally, if you are billed for services rendered by out-of-network providers at this in-network facility, the No Surprises Act generally protects you from balance billing for emergency care and non-emergency services. If you receive an unexpected bill, you should dispute it with your insurer rather than paying immediately, and always request a full itemized CPT-coded statement to identify any unbundled charges or services not rendered. This facility is a Critical Access Hospital in Hiawatha, KS, and while the Medicare benchmark for this procedure is $106.81, the commercial rates reflect the administrative costs and contract dynamics specific to the local market.