CT scan, lower back (lumbar spine)
Facility: Cloud County Health Center
Billing Code: 72131 (CPT)
- CPT Billing Code: 72131
- Insurance Median: $2,567
- Cash Discount Price: $1,892
- vs. Medicare Baseline: 24.03x 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 2403% of the Medicare baseline (a markup of 2303%). 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 |
|---|---|---|
| Aetna | $2,432 - $2,513 | 2277% |
| Mpi-All Plans | $2,567 | 2403% |
| Pponext-All Plans | $2,567 | 2403% |
| Health Partners - All Plans | $2,567 | 2403% |
Consumer Guidance & Cost Commentary
For the CT scan of the lower back at Cloud County Health Center in Concordia, KS, the facility's cash median price is $1,892, which is lower than the median negotiated rate of $2,567 paid by most insurers. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, the cash price remains significantly higher than the Medicare benchmark of $106.81, reflecting a markup typical of commercial billing. Patients with high-deductible plans may find paying the cash price directly more cost-effective than using insurance, as the negotiated rate often exceeds the cash amount. It is advisable to contact the hospital directly to inquire about self-pay or prompt-pay discounts, which can further reduce the final bill by bypassing administrative fees associated with insurance claims.
This specific procedure's pricing is evaluated against the broader healthcare landscape, where the gross charge of $2,703 serves as the baseline before any discounts are applied. Although the data does not provide explicit county or state average comparisons for this specific code, the significant gap between the Medicare rate and the facility's cash price highlights the importance of understanding the true cost of care. To ensure transparency, patients should request a detailed, itemized bill to verify that all charges are accurate and that no services were unbundled or double-billed. By comparing the allowed amount against the cash price and seeking out-of-network discounts if applicable, consumers can make informed decisions that minimize unexpected financial burdens.