CT scan, lower back (lumbar spine)
Facility: Girard Medical Center
Billing Code: 72131 (CPT)
- CPT Billing Code: 72131
- Insurance Median: $852
- Cash Discount Price: $1,460
- vs. Medicare Baseline: 7.98x 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 798% of the Medicare baseline (a markup of 698%). 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 - $852 | 449% |
| Kansas Superior Select-All Plans | $852 | 798% |
| Medicare (plans) | $852 | 798% |
| Humana | $852 | 798% |
| UnitedHealthcare | $852 - $2,311 | 798% |
| Aetna | $852 - $4,258 | 798% |
| Ambetter / Centene | $852 | 798% |
| Multiplan-All Plans | $2,251 | 2107% |
| Uhhis-All Plans | $2,311 | 2164% |
Consumer Guidance & Cost Commentary
For the CT scan of the lower back (lumbar spine) at Girard Medical Center in Girard, KS, the facility's cash median price is $1,460, while the negotiated rate paid by most commercial payers is $852. It is important to note that for patients with high-deductible plans, paying cash directly can sometimes be cheaper than using insurance if the insurance negotiated rate exceeds the cash price, though in this specific case, the cash rate is higher. Medicare serves as the objective baseline for pricing, with a benchmark rate of $106.81 for this procedure; commercial rates are significantly higher than this federal standard, reflecting the markup inherent in private insurance contracts.
While the facility is a Critical Access Hospital owned by a Government Hospital District, the data shows a wide variation in allowed amounts across different insurers, ranging from $480 to $4,258. Patients should be aware that negotiated rates often include administrative costs for claims processing and contract management, which can inflate the baseline price. To potentially lower costs, individuals should ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can bypass costly insurance billing cycles. Additionally, since over 80% of hospital bills contain errors, patients are encouraged to request a detailed, itemized bill to verify that all charges are accurate and to dispute any unbundled codes or services not rendered.