CT scan, lower back (lumbar spine)
Facility: Centura St. Catherine-Dodge City
Billing Code: 72131 (CPT)
- CPT Billing Code: 72131
- Insurance Median: $1,195
- Cash Discount Price: $727
- vs. Medicare Baseline: 11.19x 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 1119% of the Medicare baseline (a markup of 1019%). 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 |
|---|---|---|
| Medicare (plans) | $74 | 69% |
| Blue Cross Blue Shield | $74 - $565 | 69% |
| Aetna | $74 - $1,453 | 69% |
| Humana | $74 | 69% |
| Kansas Health | $74 | 69% |
| Cigna | $74 | 69% |
| Kaiser | $74 | 69% |
| Centura Employee Plan | $337 | 316% |
| UnitedHealthcare | $1,195 | 1119% |
| Wpaa | $1,272 | 1191% |
| Christian Health Aid | $1,453 | 1360% |
| Multiplan | $1,453 - $1,635 | 1360% |
| Health Partners Of Kansas | $1,635 | 1531% |
Consumer Guidance & Cost Commentary
For this CT scan of the lower back at Centura St. Catherine-Dodge City, the facility's cash median price is $727.00, which is significantly lower than the state average of $1,195.00. While many commercial payers negotiate rates ranging from $74 to $1,635, these amounts often exceed the cash price due to administrative costs and contract structures. If you have a high-deductible plan, paying the cash price upfront may result in lower out-of-pocket costs compared to your insurance's negotiated rate, provided you have not yet met your deductible. It is important to verify your specific plan's allowed amount before scheduling, as some in-network rates can be substantially higher than the facility's self-pay pricing.
The facility's Medicare benchmark rate is $106.81, which serves as a baseline for evaluating pricing fairness; commercial negotiated rates typically average 200% to 300% of this figure, though fair pricing is often defined as 120% to 150%. Patients should be aware of balance billing risks if receiving out-of-network services, though the No Surprises Act protects against surprise bills for emergency care and non-emergency services at in-network facilities. To minimize costs, consider requesting a prompt-pay discount, which can reduce the bill by 20% to 50% if paid in full within 30 days, effectively bypassing the administrative overhead of insurance claims. Always demand an itemized bill before paying to ensure no unbundled codes or services not rendered are included, and do not sign away your rights to dispute out-of-network charges without reviewing the terms carefully.