CT scan, lower back (lumbar spine)
Facility: Morris County Hospital
Billing Code: 72131 (CPT)
- CPT Billing Code: 72131
- Insurance Median: $834
- Cash Discount Price: $1,283
- vs. Medicare Baseline: 7.81x 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 781% of the Medicare baseline (a markup of 681%). 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 |
|---|---|---|
| Providrs Care (Wppa)(Nexus)-All Plans | $147 | 138% |
| Blue Cross Blue Shield | $456 - $834 | 427% |
| UnitedHealthcare | $834 - $2,138 | 781% |
| Choice Care Mcr Adv-All Plans | $834 | 781% |
| Va Ccn-All Plans | $834 | 781% |
| Coventry Mcr | $834 | 781% |
| Cigna | $1,547 | 1448% |
| Aetna | $1,916 | 1794% |
| Multiplan-All Plans | $1,924 | 1801% |
| Coventry Comm-All Other Plans | $1,924 | 1801% |
Consumer Guidance & Cost Commentary
For a CT scan of the lower back at Morris County Hospital in Council Grove, Kansas, the cash price is $1,283, which is significantly lower than the facility's gross charge of $2,138. While the hospital is a Critical Access Hospital with government local ownership, patients should be aware that insurance negotiated rates vary widely; for instance, UnitedHealthcare and Choice Care Mcr Adv-All Plans have a negotiated rate of $834, whereas Aetna and Multiplan-All Plans charge $1,916 and $1,924 respectively. This disparity highlights that being in-network does not guarantee the lowest price, as some commercial payers' contracts exceed the cash-pay amount. If you have a high-deductible plan, paying the cash price of $1,283 upfront might be more cost-effective than your insurance applying a negotiated rate that exceeds this figure, provided you have not yet met your deductible.
To ensure you are receiving fair value, it is crucial to request an itemized bill that breaks down every CPT code and service rendered, rather than accepting a summary invoice that obscures individual charges. Since over 80% of hospital bills contain errors such as unbundled codes or services not rendered, a detailed audit is the most effective way to reduce medical debt. Additionally, you should verify your plan's deductible status before scheduling, as paying a high negotiated rate without meeting your deductible can result in significant out-of-pocket costs. Finally, ask the hospital directly about "prompt-pay" discounts, which can reduce the final balance by 20% to 50% if paid in full within a short window, effectively bypassing the administrative overhead of