CT scan, lower back (lumbar spine)
Facility: Community Memorial Healthcare, Inc.
Billing Code: 72131 (CPT)
- CPT Billing Code: 72131
- Insurance Median: $1,328
- Cash Discount Price: $2,573
- vs. Medicare Baseline: 12.43x 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 1243% of the Medicare baseline (a markup of 1143%). 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% |
| Aetna | $1,184 - $1,930 | 1109% |
| UnitedHealthcare | $1,472 | 1378% |
Consumer Guidance & Cost Commentary
For a CT scan of the lower back at Community Memorial Healthcare in Marysville, Kansas, the cash median price is $2,573, which matches the facility's gross charge. This represents a 12.4% markup compared to the Medicare benchmark rate of $106.81, indicating the facility's pricing aligns with the fair value range of 120% to 150% of Medicare. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, patients should be aware that commercial insurance negotiated rates often exceed cash prices due to administrative overhead. For instance, Aetna's negotiated rate range is $1,184 to $1,930, which is lower than the cash price, but other plans may face higher costs depending on their specific contract terms.
To minimize out-of-pocket expenses, patients should verify their deductible status before scheduling, as high negotiated rates may not apply if the deductible has not been met. If you are a self-pay patient or have a high-deductible plan, ask the billing department about "prompt-pay" discounts, which can reduce the $2,573 cash price by 20% to 50% for upfront payment. Additionally, always request a full itemized bill rather than accepting a summary invoice, as hospitals may initially bill for unbundled services or charges for items not rendered. Comparing this facility's rates to the state average is essential, as the $2,573 cash rate is significantly higher than the typical commercial negotiated rates seen in the region, highlighting the importance of confirming your specific plan's allowed amount prior to receiving care.