CT scan, lower back (lumbar spine)
Facility: Saint John Hospital
Billing Code: 72131 (CPT)
- CPT Billing Code: 72131
- Insurance Median: $103
- Cash Discount Price: $98
- vs. Medicare Baseline: 0.96x 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.
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 |
|---|---|---|
| Medicaid / KanCare | $60 | 56% |
| UnitedHealthcare | $91 - $138 | 85% |
| Celtic | $93 - $158 | 87% |
| Healthy Blue | $93 - $103 | 87% |
| Midland Care Connection | $98 | 92% |
| Tricare | $98 | 92% |
| Cigna | $98 | 92% |
| Medicare (plans) | $98 | 92% |
| Aetna | $98 - $208 | 92% |
| Kansas Superior Select | $100 | 94% |
| Employer Direct Healthcare | $138 | 129% |
| Corizon | $138 | 129% |
| Well Path | $138 | 129% |
| Centurion | $148 | 139% |
| Naphcare | $153 | 143% |
| Comp Alliance Workers Comp | $191 | 179% |
| Oha Networks | $205 | 192% |
| Worker Compensation | $212 | 198% |
| Blue Cross Blue Shield | $228 - $480 | 213% |
Consumer Guidance & Cost Commentary
For this CT scan of the lower back at Saint John Hospital in Leavenworth, KS, the cash price is $98.00, which is significantly lower than the facility's gross charge of $5,690.00. While the hospital's negotiated rates for various insurance plans range from $60 to $228, the cash price remains the lowest option available. It is important to note that for patients with high-deductible plans, paying the cash price upfront can be more cost-effective than relying on insurance, as the negotiated rates often exceed the cash amount. Patients should proactively ask the billing department about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can further reduce the final bill by bypassing administrative claim processing fees.
The facility's cash rate of $98.00 is notably lower than the median negotiated rate of $103.00 and the median paid amount of $2,845.00 reported for this procedure. When comparing to the Medicare benchmark of $106.81, the cash price is slightly lower, suggesting a fair pricing structure relative to the federal baseline. However, many commercial payers have negotiated rates that fluctuate between $60 and $228, with some plans like Medicaid/KanCare showing a low of $60. Consumers should be aware that balance billing is generally prohibited for emergency services under the No Surprises Act, but it is crucial to verify network status and request an itemized bill to ensure no unexpected charges are applied. Always confirm your deductible status and request a written audit if you receive a bill that appears to include services not rendered or unbundled