CT scan, lower back (lumbar spine)
Facility: Stanton County Hospital
Billing Code: 72131 (CPT)
- CPT Billing Code: 72131
- Insurance Median: $1,672
- Cash Discount Price: $1,759
- vs. Medicare Baseline: 15.65x 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 1565% of the Medicare baseline (a markup of 1465%). 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 - $1,672 | 427% |
| Healthy Blue Mcr Adv - All Other Plans | $1,724 | 1614% |
| Healthy Blue Mcaid | $1,759 | 1647% |
Consumer Guidance & Cost Commentary
For a CT scan of the lower back at Stanton County Hospital, the cash price is $1,759, which matches the facility's gross charge. This rate is significantly higher than the state average, as indicated by the 15.7% variance compared to Medicare benchmarks. While commercial insurance plans like Blue Cross Blue Shield have negotiated rates ranging from $456 to $1,672, these amounts often exceed the cash price, meaning patients with high-deductible plans might save money by paying out-of-pocket and seeking prompt-pay discounts. It is important to note that while the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, patients should still verify their specific plan details and ask the hospital directly about self-pay or prompt-pay reductions before scheduling.
The facility's negotiated rates vary by payer, with Healthy Blue Mcaid charging the full $1,759 and Blue Cross Blue Shield offering a range up to $1,672. Because commercial rates can sometimes be inflated by administrative costs and contract dynamics, the cash price serves as a useful baseline for comparison. To ensure you are not overcharged, request a full itemized bill that breaks down every CPT code and charge, as summary bills often hide unbundled services or errors. If you receive a bill that seems inconsistent with the negotiated or cash rates, you have the right to dispute it in writing with the billing supervisor rather than accepting a verbal settlement, ensuring you only pay the accurate amount owed.