CT scan, lower back (lumbar spine)
Facility: Clay County Medical Center
Billing Code: 72131 (CPT)
- CPT Billing Code: 72131
- Insurance Median: $99
- Cash Discount Price: $1,074
- vs. Medicare Baseline: 0.93x 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.
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 |
|---|---|---|
| Multiplan- All Plans | $47 - $1,941 | 44% |
| UnitedHealthcare | $69 - $1,941 | 65% |
| Health Partners - All Plans | $75 - $1,941 | 70% |
| Aetna | $97 - $1,900 | 91% |
| Wppa/Providrs Care- All Plans | $97 - $1,900 | 91% |
Consumer Guidance & Cost Commentary
For a CT scan of the lower back at Clay County Medical Center in Clay Center, KS, the cash price is $1,074.00, which matches the facility's median negotiated rate and the Medicare benchmark of $106.81. While the facility is a Critical Access Hospital with government local ownership, the data indicates that commercial payers like UnitedHealthcare and Multiplan have negotiated rates ranging from $69 to $1,941, significantly higher than the cash price. Patients with high-deductible plans may find it financially advantageous to pay the cash price of $1,074.00 directly, as this amount is lower than the maximum negotiated rates some insurers might apply. To secure the best possible price, it is essential to ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can further reduce the final bill by bypassing costly insurance claims processing.
The facility's pricing structure relies on a negotiated rate ceiling that varies by payer, with the lowest negotiated amount being $47 and the highest reaching $1,941 across five different payers. Because the cash price of $1,074.00 is already equal to the median negotiated rate, patients should verify their specific plan's allowed amount to ensure they are not being charged above the contractually agreed-upon limit. If a patient receives an out-of-network bill for ancillary services, they should request an itemized billing audit to identify errors or unbundled codes, as over 80% of hospital bills contain mistakes that can be corrected. Finally, remember that the No Surprises Act protects patients from balance billing for emergency care or