CT scan, lower back (lumbar spine)
Facility: Wilson Medical Center
Billing Code: 72131 (CPT)
- CPT Billing Code: 72131
- Insurance Median: $701
- Cash Discount Price: $657
- vs. Medicare Baseline: 6.56x 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 656% of the Medicare baseline (a markup of 556%). 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 | $453 - $876 | 424% |
| Ambetter / Centene | $464 - $876 | 434% |
| Aetna | $464 - $876 | 434% |
| Humana | $464 | 434% |
| UnitedHealthcare | $464 - $815 | 434% |
| Tricare | $464 | 434% |
| Cigna | $701 | 656% |
| Health Partners-All Plans | $806 | 755% |
| Mulitplan-All Plans | $806 | 755% |
Consumer Guidance & Cost Commentary
For a CT scan of the lower back at Wilson Medical Center in Neodesha, Kansas, the billed amount is $876, but the actual cost to patients varies significantly based on payment method. The facility's cash price is $657, which is lower than the median negotiated rate of $701 paid by insurance plans. While the facility is a Critical Access Hospital owned by the local government, patients should be aware that commercial insurance rates often exceed cash prices; for instance, some in-network payers like Blue Cross Blue Shield and Aetna have negotiated rates as high as $876, which is identical to the gross charge. This means that for patients with high-deductible plans, paying the cash price of $657 directly could result in significant savings compared to the insurance allowed amount.
To minimize unexpected costs, consumers should request a prompt-pay discount before scheduling the procedure, as paying in full upfront can reduce the bill by 20% to 50%. It is also crucial to avoid balance billing by verifying that the facility is in-network, as the No Surprises Act protects patients from being billed the difference between the chargemaster and the insurance allowed amount for emergency care or non-emergency services at in-network facilities. Finally, patients should insist on an itemized billing audit rather than accepting a summary bill, since over 80% of hospital bills contain errors such as unbundled codes or charges for services not rendered, and a detailed review is the most effective way to ensure the final invoice reflects the true cost.