CT scan, lower back (lumbar spine)
Facility: William Newton Hospital
Billing Code: 72131 (CPT)
- CPT Billing Code: 72131
- Insurance Median: $507
- Cash Discount Price: $1,408
- vs. Medicare Baseline: 4.75x 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 475% of the Medicare baseline (a markup of 375%). 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 | $456 - $507 | 427% |
| Triwest- All Plans | $492 | 461% |
| UnitedHealthcare | $507 - $1,267 | 475% |
| Ambetter / Centene | $507 - $1,408 | 475% |
| Providrs Care Nexus | $862 | 807% |
| Providrs Care - All Other Plans | $986 | 923% |
Consumer Guidance & Cost Commentary
For the CPT code 72131 (CT scan, lower back), the cash price at William Newton Hospital in Winfield, KS, is $1,408. This cash rate is significantly higher than the state average, which is $106.81 based on Medicare benchmarking. While commercial insurance plans like UnitedHealthcare and Ambetter / Centene may negotiate rates up to $1,408, these negotiated amounts often exceed the cash price, meaning patients with high-deductible plans might save money by paying the full cash rate directly. To minimize costs, patients should verify their specific plan's negotiated rate before scheduling and ask the hospital about self-pay or prompt-pay discounts, which can reduce the bill by 20% to 50% if paid upfront.
It is important to understand that commercial insurance rates are often inflated by administrative costs and contract structures, sometimes reaching 200% to 300% of the Medicare rate, whereas fair pricing is typically defined as 120% to 150%. If you receive a bill from an out-of-network provider, such as certain ancillary services at this facility, you may be subject to balance billing for the difference between the provider's full charge and your insurance allowed amount. However, the No Surprises Act protects you from these surprise bills for emergency care and non-emergency services at in-network facilities. To avoid unexpected debt, always request an itemized bill to review specific CPT codes and dispute any errors or unbundled charges before signing consent waivers or making payments.