CT scan, lower back (lumbar spine)
Facility: Hodgeman County Health Center
Billing Code: 72131 (CPT)
- CPT Billing Code: 72131
- Insurance Median: $1,192
- Cash Discount Price: $1,354
- vs. Medicare Baseline: 11.16x 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 1116% of the Medicare baseline (a markup of 1016%). 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 | $435 - $458 | 407% |
| Medicaid / KanCare | $1,084 - $1,693 | 1015% |
| UnitedHealthcare | $1,084 - $1,608 | 1015% |
| Humana | $1,084 | 1015% |
| Triwest - All Plans | $1,084 | 1015% |
| Aetna | $1,354 | 1268% |
| First Health - All Plans | $1,524 | 1427% |
| Health Partners - All Plans | $1,608 | 1505% |
| Wppa (Provdrscare) - All Plans | $1,608 | 1505% |
Consumer Guidance & Cost Commentary
For the CT scan of the lower back (lumbar spine) at Hodgeman County Health Center in Jetmore, Kansas, the facility's cash median rate is $1,354, which is significantly lower than the gross charge of $1,693. While the facility is a Critical Access Hospital owned by the local government, patients should note that their insurance negotiated rates vary widely; for example, Blue Cross Blue Shield plans pay between $435 and $458, whereas Medicaid/KanCare plans pay between $1,084 and $1,693. Because commercial negotiated rates often exceed cash prices due to administrative overhead and contract structures, patients with high-deductible plans may find it financially advantageous to pay the cash rate directly, provided they secure a "waiver of insurance submission" to avoid balance billing.
To ensure you are receiving the most accurate pricing, it is essential to request an itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. Additionally, while the facility's cash rate is competitive, the Medicare benchmark for this procedure is only $106.81, indicating that even the lowest commercial negotiated rates represent a substantial markup compared to the federal cost baseline. Consumers should verify their specific plan's allowed amount with the hospital prior to scheduling and ask explicitly about prompt-pay discounts, which can reduce the final bill by 20% to 50% if paid in full upfront, thereby bypassing costly claims processing and administrative fees.