CT scan, lower back (lumbar spine)
Facility: Amberwell Atchison Association
Billing Code: 72131 (CPT)
- CPT Billing Code: 72131
- Insurance Median: $678
- Cash Discount Price: $1,325
- vs. Medicare Baseline: 6.35x 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 635% of the Medicare baseline (a markup of 535%). 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 |
|---|---|---|
| UnitedHealthcare | $437 - $2,377 | 409% |
| Va Ccn - All Plans | $437 | 409% |
| Superior Select Mcr Adv - All Plans | $437 | 409% |
| Humana | $437 - $581 | 409% |
| Triwest - All Plans | $437 | 409% |
| Blue Cross Blue Shield | $456 - $480 | 427% |
| Ambetter / Centene | $678 | 635% |
| Aetna | $729 | 683% |
| Cigna | $729 | 683% |
| Oscar - All Plans | $994 | 931% |
| Centrus Health Direct - All Plans | $994 | 931% |
| Multiplan - All Plans | $1,034 | 968% |
| Wppa Providrs Care - All Plans | $1,192 | 1116% |
Consumer Guidance & Cost Commentary
For the CT scan of the lower back (lumbar spine) at Amberwell Atchison Association, the cash price is $1,325.00, which matches the facility's cash median. This cash rate is significantly higher than the state average for this procedure, as indicated by the 6.3% variance compared to Medicare benchmarks. While commercial insurance plans like UnitedHealthcare and Humana negotiate rates ranging from $437 to $581, these amounts often exceed the cash price for patients with high-deductible plans. In such cases, paying cash upfront can be more cost-effective than relying on insurance, provided the patient qualifies for the facility's prompt-pay discount, which typically reduces the bill by 20% to 50% when paid in full within 30 days.
Patients should verify their specific plan details before scheduling, as negotiated rates vary widely among the 13 payers listed, with some plans paying up to $1,192 while others pay as low as $437. It is important to note that even though the facility is an in-network Critical Access Hospital in Atchison, KS, balance billing could still occur if ancillary services like emergency physicians or lab tests are out-of-network, though the No Surprises Act protects patients from such surprise bills for emergency care. To ensure the lowest possible cost, consumers are advised to request a self-pay classification and a formal itemized audit of the bill before payment, rather than accepting summary invoices or paying immediately upon receipt of a claim.