CT scan, lower back (lumbar spine)
Facility: Memorial Hospital
Billing Code: 72131 (CPT)
- CPT Billing Code: 72131
- Insurance Median: $1,486
- Cash Discount Price: $2,703
- vs. Medicare Baseline: 13.91x 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 1391% of the Medicare baseline (a markup of 1291%). 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 | $484 | 453% |
| Tricare | $1,351 | 1265% |
| Humana | $1,351 | 1265% |
| Medicare (plans) | $1,365 | 1278% |
| Ambetter / Centene | $1,486 | 1391% |
| Coventry - All Other Plans | $2,432 | 2277% |
| Health Partners Of Kansas - All Plans | $2,567 | 2403% |
| Preferred Healthcare-All Plans | $2,567 | 2403% |
| Wppa/Providers Care-All Plans | $3,784 | 3543% |
Consumer Guidance & Cost Commentary
For this CT scan of the lower back at Memorial Hospital in Abilene, KS, the cash price is $2,703.00, which matches the facility's median paid amount. While the facility is a Critical Access Hospital owned by a Government Hospital District, the negotiated rates for in-network payers like Blue Cross Blue Shield and Tricare range from $484 to $1,486. It is important to note that for patients with high-deductible plans, paying cash upfront can sometimes be more cost-effective than using insurance, as the insurance negotiated rate ($1,486) exceeds the cash price in this specific dataset. Patients should always verify if "self-pay" or "prompt-pay" discounts are available before scheduling, as these upfront payment incentives can significantly reduce the final bill by bypassing administrative processing fees.
The data indicates a significant variance in pricing depending on the payer, with the lowest negotiated rate being $484 and the highest reaching $3,784. When comparing the facility's cash rate to the Medicare benchmark of $106.81, the commercial cash price represents a 13.9% markup relative to the federal baseline, highlighting the substantial difference between government-set costs and private sector pricing. Since over 80% of hospital bills contain errors, consumers should request a full itemized CPT-coded statement rather than accepting a summary bill, which may obscure unbundled charges or services not rendered. If a patient receives a balance bill from an out-of-network provider at this in-network facility, they should dispute the charge with their insurer under the No Surprises Act to avoid unexpected costs.