CT scan, lower back (lumbar spine)
Facility: Scott County Hospital
Billing Code: 72131 (CPT)
- CPT Billing Code: 72131
- Insurance Median: $1,200
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 11.23x 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 1123% of the Medicare baseline (a markup of 1023%). 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 |
|---|---|---|
| UnitedHealthcare | $60 - $1,380 | 56% |
| Blue Cross Blue Shield | $480 | 449% |
| Humana | $610 | 571% |
| Wppa | $872 - $1,200 | 816% |
| Aetna | $1,308 | 1225% |
Consumer Guidance & Cost Commentary
For the CPT code 72131 (CT scan, lower back), Scott County Hospital in Scott City, KS, has a gross charge of $1,453.00. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, the negotiated rates vary significantly among payers, ranging from $480 with Blue Cross Blue Shield to $1,308 with Aetna. It is important to note that the cash median and median paid values are not available for this specific code. However, patients should be aware that cash-pay options can sometimes be more cost-effective than insurance negotiated rates, particularly for those with high-deductible plans where the insurer's allowed amount might exceed the cash price. Additionally, patients should inquire directly with the hospital about "self-pay" or "prompt-pay" discounts, which can offer immediate fee reductions for upfront payment.
When evaluating costs, it is crucial to compare rates against objective benchmarks rather than the hospital's inflated chargemaster list. In this case, the Medicare amount for this procedure is $106.81, which serves as a scientifically validated baseline for the true cost of delivery. Commercial negotiated rates often average between 200% and 300% of the Medicare rate, though fair pricing is typically defined as 120% to 150%. Since the data does not provide specific county or state average comparisons for this code, patients should rely on the Medicare benchmark to assess if the facility's pricing is reasonable. Furthermore, if a patient receives care from an out-of-network provider or encounters unexpected ancillary services, they may face balance billing for the difference between the provider's full charge and