CT scan, lower back (lumbar spine)
Facility: Hospital District #6 Patterson Health Center
Billing Code: 72131 (CPT)
- CPT Billing Code: 72131
- Insurance Median: $855
- Cash Discount Price: $760
- vs. Medicare Baseline: 8.00x 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 800% of the Medicare baseline (a markup of 700%). 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 | $430 - $453 | 403% |
| UnitedHealthcare | $855 - $950 | 800% |
| Providers Care (Wppa)-All Plans | $1,662 | 1556% |
Consumer Guidance & Cost Commentary
For the CPT code 72131 (CT scan, lower back), the facility's negotiated rate of $855.00 is significantly higher than the cash price of $760.00, illustrating how insurance contracts often inflate costs through administrative overhead and multi-layered billing structures. While the gross chargemaster lists at $950.00, the actual amount paid by UnitedHealthcare aligns with the facility's negotiated ceiling, whereas cash-paying patients could save money by paying directly. Given that cash prices can sometimes be lower than insurance negotiated rates for those with high-deductible plans, it is advisable to verify your specific plan's allowed amount before scheduling to ensure you are not overpaying due to network tiering dynamics.
This service is provided by a Critical Access Hospital in Anthony, KS, where the Medicare benchmark rate of $106.81 serves as the objective baseline for evaluating pricing markups. The facility's negotiated rate of $855.00 represents a substantial markup compared to the federal government's fixed reimbursement, highlighting the difference between the true cost of care and commercial pricing. Patients should be aware that while the No Surprises Act protects against balance billing for out-of-network providers at in-network facilities, they should still request a full itemized bill to audit for errors, as over 80% of hospital bills contain discrepancies. Additionally, asking about prompt-pay discounts before check-in could further reduce the final cost if the patient chooses to pay upfront.