CT scan, lower back (lumbar spine)
Facility: Sheridan County Hospital
Billing Code: 72131 (CPT)
- CPT Billing Code: 72131
- Insurance Median: $662
- Cash Discount Price: $914
- vs. Medicare Baseline: 6.20x 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 620% of the Medicare baseline (a markup of 520%). 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 |
|---|---|---|
| Celtic Insurance | $553 | 518% |
| Blue Cross Blue Shield | $662 | 620% |
| UnitedHealthcare | $868 | 813% |
Consumer Guidance & Cost Commentary
For a CT scan of the lower back (lumbar spine) at Sheridan County Hospital in Hoxie, KS, the cash price is $914.00, which matches the facility's median paid amount. This cash rate is significantly higher than the state of Kansas average, which is $662.00, and notably exceeds the negotiated rate of $662.00 paid by Blue Cross Blue Shield. While patients with high-deductible plans might find the cash price attractive if their insurance allows a higher allowed amount, it is important to note that commercial negotiated rates often include administrative overhead that can make them higher than direct cash payments. Because this facility is a Critical Access Hospital owned by the local government, patients should verify if "self-pay" or "prompt-pay" discounts are available before scheduling, as these upfront incentives can reduce the final cost.
The Medicare benchmark for this service is $106.81, indicating that the cash price represents a substantial markup compared to the federal baseline used to evaluate hospital costs. Although the data does not provide a specific county average for comparison, the disparity between the Medicare rate and the cash price highlights the importance of understanding the true cost of care versus the listed chargemaster. Patients should be aware that balance billing is generally prohibited for emergency services at in-network facilities under the No Surprises Act, but unexpected charges can still occur if ancillary services like labs are out-of-network. To avoid errors, consumers should request a full itemized bill before paying, ensuring that all charges are accurate and that no unbundled codes or services not rendered are included in the final invoice.