CT scan, lower back (lumbar spine)
Facility: Stormont Vail Hospital
Billing Code: 72131 (CPT)
- CPT Billing Code: 72131
- Insurance Median: $96
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 0.90x 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 |
|---|---|---|
| UnitedHealthcare | $61 - $93 | 57% |
| Ambetter / Centene | $61 - $93 | 57% |
| Blue Cross Blue Shield | $62 - $613 | 58% |
| Humana | $96 - $98 | 90% |
| Aetna | $96 - $98 | 90% |
Consumer Guidance & Cost Commentary
For this CT scan of the lumbar spine at Stormont Vail Hospital in Topeka, KS, the facility's negotiated rates range from $61 to $98 depending on your specific insurance plan, with UnitedHealthcare and Ambetter / Centene showing the lowest range at $61 to $93. These commercial rates are significantly higher than the Medicare benchmark of $106.81, which serves as the federal baseline for hospital costs. While commercial insurance contracts often include administrative overhead that inflates prices, the facility's cash median is not available in this dataset. However, patients with high-deductible plans should be aware that paying cash upfront can sometimes result in lower out-of-pocket costs if the negotiated insurance rate exceeds the cash price, making it essential to verify "self-pay" or "prompt-pay" discounts directly with the hospital before scheduling.
When evaluating this service, it is important to compare rates against the local cost baseline rather than the hospital's gross chargemaster list, which can be misleadingly high. The Medicare rate of $106.81 represents the scientifically validated cost of care, and commercial negotiated rates typically average between 200% and 300% of this benchmark, whereas fair pricing is generally defined as 120% to 150%. Although the data does not provide specific county or state average comparisons for this procedure, the No Surprises Act protects patients from balance billing for out-of-network services at this in-network facility. To ensure you receive the most accurate pricing, request a full itemized bill to review every code and unit cost, and consider disputing any errors in writing to avoid unnecessary medical debt.