CT scan, lower back (lumbar spine)
Facility: Smith County Memorial Hospital
Billing Code: 72131 (CPT)
- CPT Billing Code: 72131
- Insurance Median: $660
- Cash Discount Price: $703
- vs. Medicare Baseline: 6.18x 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 618% of the Medicare baseline (a markup of 518%). 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 | $453 | 424% |
| Medicaid / KanCare | $492 - $703 | 461% |
| Multiplan-All Plans | $632 | 592% |
| Wppa-All Plans | $660 | 618% |
| UnitedHealthcare | $667 | 624% |
| Health Partners Of Ks Ppo-All Plans | $667 | 624% |
| Midlands Choice-All Plans | $667 | 624% |
Consumer Guidance & Cost Commentary
For the CT scan of the lower back (lumbar spine) at Smith County Memorial Hospital in Smith Center, KS, the cash price is $703.00, which matches the facility's gross charge. This cash rate is significantly higher than the state average for this procedure, which is $660.00. While Medicaid/KanCare plans negotiate a range of $492 to $703, many other payers, including UnitedHealthcare and Multiplan-All Plans, have fixed negotiated rates of $667.00. Because the cash price is already at the top of the Medicaid range and exceeds the state average, patients with high-deductible plans might find paying out-of-pocket cheaper if their insurance negotiated rate is higher than $703.00, though in this specific case, the cash price is the highest available option.
Patients should be aware that hospitals often offer prompt-pay discounts, which can reduce the final bill by 20% to 50% if paid in full upfront, bypassing the administrative costs of insurance claims processing. To secure this discount, it is essential to request a self-pay classification and a prompt-pay rate before check-in and to sign a waiver preventing automatic claims submission to your insurance. Additionally, under the No Surprises Act, you are protected from balance billing for emergency care or non-emergency services at in-network facilities, meaning you should not pay unexpected bills without first disputing them with your insurer or requesting a formal audit. Since the facility is a Critical Access Hospital with government-local ownership, verifying the exact self-pay or prompt-pay discount with the billing department before scheduling is the most effective way to minimize costs.