CT scan, lower back (lumbar spine)
Facility: Fredonia Regional Hospital
Billing Code: 72131 (CPT)
- CPT Billing Code: 72131
- Insurance Median: $611
- Cash Discount Price: $679
- vs. Medicare Baseline: 5.72x 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 572% of the Medicare baseline (a markup of 472%). 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 | $336 - $480 | 315% |
| Veterans Programs - All Plans | $346 | 324% |
| UnitedHealthcare | $346 - $611 | 324% |
| Aetna | $346 - $611 | 324% |
| Reserve National-All Plans | $611 | 572% |
| Meritain-All Plans | $611 | 572% |
| Cigna | $611 | 572% |
Consumer Guidance & Cost Commentary
For this CT scan of the lower back at Fredonia Regional Hospital in Fredonia, Kansas, the cash price is $679.00, which matches the facility's median negotiated rate. While the hospital is a Critical Access Hospital owned by the local government, patients should note that cash payment can sometimes be more cost-effective than using insurance, particularly if your plan has a high deductible or if the insurer's negotiated rate exceeds the cash price. Although the data does not provide specific county or state average comparisons for this service, it is important to remember that commercial negotiated rates often include administrative overhead that can inflate the baseline price compared to the Medicare benchmark of $106.81 for this procedure.
If you choose to pay out-of-pocket, you should explicitly ask the billing department about "self-pay" or "prompt-pay" discounts before scheduling your visit, as these upfront incentives can significantly reduce the final cost. Conversely, if you use insurance, be aware that the No Surprises Act protects you from balance billing for emergency care and non-emergency services at in-network facilities, meaning you should not pay the difference between the hospital's full charge and your insurance allowed amount without first disputing the bill in writing. To ensure you are receiving the most accurate pricing, always request a full itemized bill with specific CPT codes rather than accepting a summary invoice, as this allows you to identify any unbundled charges or services that were not actually rendered.