CT scan, lower back (lumbar spine)
Facility: Kingman Healthcare Center
Billing Code: 72131 (CPT)
- CPT Billing Code: 72131
- Insurance Median: $107
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 1.00x 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 |
|---|---|---|
| Medicaid / KanCare | $107 | 100% |
| Healthy Blue | $107 | 100% |
| Aetna | $408 | 382% |
Consumer Guidance & Cost Commentary
For the CPT code 72131, representing a CT scan of the lower back at Kingman Healthcare Center in Kansas, the median negotiated rate is $107.00, which aligns exactly with the lowest and highest rates reported by the three in-network payers: Medicaid/KanCare, Healthy Blue, and Aetna. This facility, a Critical Access Hospital in a rural setting, does not offer a cash price for this service, as the cash median is not available in the data. While commercial negotiated rates often exceed Medicare benchmarks due to administrative overhead and contract structures, the fixed rate here suggests a standardized pricing model typical of smaller facilities. Patients should be aware that while in-network rates provide protection against balance billing under the No Surprises Act, they may not always represent the absolute lowest cost if a self-pay option were available.
When evaluating costs, it is important to compare these rates against state and county averages to understand market positioning, though specific comparative averages for this code in Kingman, KS, were not provided in the current dataset. The Medicare amount for this procedure is $106.81, meaning the negotiated rate is roughly equivalent to the federal baseline, which is significantly lower than the typical 200% to 300% markup seen in many commercial settings. If a patient has a high-deductible plan, they might consider asking the billing department about "self-pay" or "prompt-pay" discounts before scheduling, as paying upfront can sometimes bypass the administrative layers that inflate insurance rates. Always verify the exact allowed amount with the hospital prior to the visit to ensure there are no unexpected out-of-pocket costs once deductibles are met.