CT scan, lower back (lumbar spine)
Facility: Trego County Lemke Memorial Hospital
Billing Code: 72131 (CPT)
- CPT Billing Code: 72131
- Insurance Median: $657
- Cash Discount Price: $659
- vs. Medicare Baseline: 6.15x 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 615% of the Medicare baseline (a markup of 515%). 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 |
|---|---|---|
| Humana | $380 | 356% |
| Tricare | $410 | 384% |
| Medicaid / KanCare | $480 - $775 | 449% |
| UnitedHealthcare | $480 - $775 | 449% |
| Aetna | $480 - $698 | 449% |
| Va Ccn - All Plans | $480 | 449% |
| Ambetter / Centene | $529 | 495% |
| Blue Cross Blue Shield | $657 | 615% |
| Health Partners - All Plans | $736 | 689% |
| Healthy Blue Mcaid - All Plans | $775 | 726% |
Consumer Guidance & Cost Commentary
For the CPT code 72131 (CT scan, lower back), Trego County Lemke Memorial Hospital lists a gross charge of $775.00, with a cash median of $659.00 and a median negotiated rate of $657.00. While the facility is a Critical Access Hospital in Wakeeney, KS, and is owned by the Government - Local, the data indicates that commercial insurance plans typically pay between $480 and $775 depending on the carrier. Notably, the cash price of $659.00 is lower than the median negotiated rate of $657.00 for most payers, suggesting that patients with high-deductible plans or those without insurance might save money by paying cash directly. It is important to verify "self-pay" or "prompt-pay" discounts with the hospital before scheduling, as these upfront payments can reduce the final bill by bypassing administrative claim processing fees.
When evaluating this price, it is essential to compare rates against the Medicare benchmark rather than the hospital's inflated gross charges. The Medicare amount for this procedure is $106.81, which serves as the objective baseline for fair pricing; commercial rates are often significantly higher due to administrative costs and contract dynamics. For instance, the cash median of $659.00 represents a substantial markup over the Medicare rate, reflecting the complexity of commercial billing. 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 item