CT scan, lower back (lumbar spine)
Facility: Lincoln County Hospital
Billing Code: 72131 (CPT)
- CPT Billing Code: 72131
- Insurance Median: $480
- Cash Discount Price: $1,193
- vs. Medicare Baseline: 4.49x 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 449% of the Medicare baseline (a markup of 349%). 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 | $480 | 449% |
Consumer Guidance & Cost Commentary
For this CT scan of the lower back at Lincoln County Hospital in Lincoln, KS, the facility's cash price of $1,193 is lower than the negotiated rate of $480 paid by Blue Cross Blue Shield, which is the only payer listed for this service. While the hospital is a Critical Access Hospital owned by the local government, patients with high-deductible plans might find paying the cash price directly more affordable than using insurance, as the insurer's negotiated rate exceeds the cash amount. It is important to note that commercial rates often include administrative overhead and contract dynamics that can make them higher than the direct cash price, even for in-network services.
The Medicare benchmark for this procedure is $106.81, which serves as a baseline for evaluating the facility's pricing markup. The cash price of $1,193 represents a significant increase over the Medicare rate, reflecting the costs of facility operations and physician services beyond the federal baseline. Patients should be aware that balance billing is generally prohibited for emergency care and non-emergency services at in-network facilities under the No Surprises Act, though unexpected charges can still occur if ancillary services are out-of-network. To minimize costs, consumers should request a prompt-pay discount or self-pay rate before scheduling, as these upfront payments can bypass the administrative fees associated with insurance claims processing.