CT scan, lower back (lumbar spine)
Facility: Decatur Health
Billing Code: 72131 (CPT)
- CPT Billing Code: 72131
- Insurance Median: $852
- Cash Discount Price: $1,005
- vs. Medicare Baseline: 7.98x 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 798% of the Medicare baseline (a markup of 698%). 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 | $589 | 551% |
| Wppa/Providrs Care- All Plans | $670 | 627% |
| UnitedHealthcare | $681 - $852 | 638% |
| Humana | $688 | 644% |
| Midlands Choice- All Plans | $1,005 | 941% |
| Aetna | $1,005 - $1,116 | 941% |
| Medicaid / KanCare | $1,128 | 1056% |
Consumer Guidance & Cost Commentary
For a CT scan of the lower back at Decatur Health in Oberlin, Kansas, the cash price is $1,005, which is significantly lower than the facility's negotiated rates with major insurers like UnitedHealthcare (ranging from $681 to $852) and Aetna (ranging from $1,005 to $1,116). This price difference highlights a common billing dynamic where commercial insurance contracts often exceed cash-pay rates due to administrative overhead and contract structures. If you have a high-deductible plan, paying the cash price of $1,005 upfront may be more cost-effective than your insurance negotiating a rate that could still leave you responsible for significant out-of-pocket costs after your deductible is met.
When comparing this service to federal benchmarks, the Medicare rate for this procedure is $106.81, meaning the cash price represents a markup of approximately 800% over the government baseline. While commercial negotiated rates typically average 200% to 300% of Medicare, this specific cash price remains substantially higher than the Medicare amount, illustrating how facility pricing can vary widely even when compared to the federal standard. To ensure you are receiving the best possible rate, we recommend requesting a prompt-pay discount or self-pay classification before scheduling, as these upfront payment incentives can further reduce the total cost. Always verify your specific plan's deductible status and allowed amounts with the billing department prior to receiving care to avoid unexpected financial exposure.