CT scan, lower back (lumbar spine)
Facility: Regional Medical Center
Billing Code: 72131 (CPT)
- CPT Billing Code: 72131
- Insurance Median: $870
- Cash Discount Price: $1,441
- vs. Medicare Baseline: 8.15x 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 815% of the Medicare baseline (a markup of 715%). 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 |
|---|---|---|
| Medical Associates Health Plan - Tri | $870 | 815% |
Consumer Guidance & Cost Commentary
Based on the provided data, there are no state or county average figures available for comparison, so the most meaningful benchmark is the Medicare rate. The gross charge for this CT scan of the lumbar spine is $1,802, which is significantly higher than the Medicare benchmark of $106.81. While the facility is a Critical Access Hospital in Manchester, Iowa, with a government-local ownership structure and a rating of 4 stars, the pricing reflects the standard chargemaster list rather than a discounted negotiated amount.
The actual financial impact for patients depends heavily on their specific insurance coverage. The facility's median negotiated rate is $870, paid by Medical Associates Health Plan - Tri, which is still nearly eight times higher than the Medicare amount. However, the cash median price is $1,441, which is notably higher than both the negotiated and paid rates. Because the cash price exceeds the insurer's allowed amount, patients with high-deductible plans might find themselves paying more out-of-pocket if they pay cash directly. To minimize costs, patients should inquire about "self-pay" or "prompt-pay" discounts before scheduling and request a waiver of insurance submission to avoid automatic claims processing that could void any potential cash savings.