CT scan, lower back (lumbar spine)
Facility: University Of Kansas Health System - St Francis Campus
Billing Code: 72131 (CPT)
- CPT Billing Code: 72131
- Insurance Median: $913
- Cash Discount Price: $668
- vs. Medicare Baseline: 8.55x 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 855% of the Medicare baseline (a markup of 755%). 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 |
|---|---|---|
| Oncology Patient Assistance Programs [2295] | $913 | 855% |
| Hooray Health [8000] | $913 | 855% |
| Web Tpa [2115] | $913 | 855% |
| Aetna | $913 | 855% |
| Blue Cross Blue Shield | $913 | 855% |
| Lucent Health [6000] | $913 | 855% |
| Healthcare Highways [2210] | $913 | 855% |
| Black Lung [6055] | $913 | 855% |
| Department Of Corrections [1340] | $1,113 | 1042% |
| Cigna | $1,287 | 1205% |
| American Postal Workers Union [1070] | $1,287 | 1205% |
| Healthpartners [1500] | $1,287 | 1205% |
| National Association Of Letter Carriers [1695] | $1,287 | 1205% |
| Humana | $1,313 | 1229% |
| Multiplan [1680] | $1,730 | 1620% |
| Administrative Concepts [1005] | $1,730 | 1620% |
| American Healthcare [1055] | $1,730 | 1620% |
| First Health [1375] | $1,730 | 1620% |
| Coventry Healthcare [1320] | $1,825 | 1709% |
| Ks Disability Determination [6090] | $2,226 | 2084% |
Consumer Guidance & Cost Commentary
For the CT scan of the lower back (lumbar spine) at the University Of Kansas Health System - St Francis Campus, the facility's negotiated rate is $913, while the cash price is $668. This cash rate is significantly lower than the facility's gross charge of $2,226 and represents a substantial discount compared to the state average. Patients with high-deductible plans or those without insurance may find paying the cash price of $668 more cost-effective than relying on insurance, which typically results in a higher allowed amount of $2,226. To minimize out-of-pocket costs, individuals should contact the hospital directly to inquire about self-pay or prompt-pay discounts, which can further reduce the final bill before any insurance processing occurs.
The facility's pricing structure highlights the difference between commercial negotiated rates and federal benchmarks. The Medicare amount for this service is $106.81, which serves as a baseline for evaluating fair pricing; commercial negotiated rates often exceed this by a significant margin due to administrative costs and contract dynamics. While the facility's negotiated rate of $913 is lower than the gross charge, it remains higher than the cash price, illustrating how insurance billing processes can inflate costs for patients who do not utilize their coverage. Consumers are advised to request an itemized bill to verify all charges and avoid balance billing, as federal protections like the No Surprises Act may prevent unexpected out-of-network charges for emergency or non-emergency services at in-network facilities.