CT scan, lower back (lumbar spine)
Facility: Wesley Medical Center
Billing Code: 72131 (CPT)
- CPT Billing Code: 72131
- Insurance Median: $2,940
- Cash Discount Price: $16,997
- vs. Medicare Baseline: 27.53x 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 2753% of the Medicare baseline (a markup of 2653%). 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 |
|---|---|---|
| UnitedHealthcare | $60 | 56% |
| Amerigroup | $62 | 58% |
| Aetna | $62 - $6,068 | 58% |
| Medicaid / KanCare | $62 | 58% |
| First Health | $201 - $7,836 | 188% |
| Multiplan | $210 - $15,297 | 197% |
| United | $245 - $7,649 | 229% |
| Blue Cross Blue Shield | $478 | 448% |
| Health Partners Of Kansas | $2,940 - $8,498 | 2753% |
| Wppa | $2,957 | 2768% |
| Ambetter / Centene | $3,059 | 2864% |
| Medical Associates Health Plan | $3,212 | 3007% |
| Preferred Health Choices | $3,212 | 3007% |
| Spirit Aerosystems | $5,439 | 5092% |
| Triwest Healthcare Alliance | $11,048 | 10344% |
| Usa Managed Care | $14,447 | 13526% |
Consumer Guidance & Cost Commentary
For patients paying cash directly, the most important thing to know is that the cash median rate for this CT scan of the lower back at Wesley Medical Center is $16,997. While this appears high, it is worth noting that commercial insurance negotiated rates often exceed the cash price due to administrative overhead and contract structures, meaning self-pay patients with high-deductible plans may actually save money by paying the cash rate directly rather than relying on in-network insurance. Before scheduling, patients should explicitly ask the billing department about "self-pay" or "prompt-pay" discounts, which can range from 20% to 50% off the listed price when bills are paid in full upfront, effectively bypassing the costly insurance claims processing cycle.
In the broader context of pricing, the gross charge for this procedure is also $16,997, while the median negotiated rate for commercial payers is significantly lower at $2,940. However, individual insurance plans vary widely; for example, UnitedHealthcare and Amerigroup have a fixed negotiated rate of $60, while Aetna's rate spans from $62 to $6,068 depending on the specific plan. It is critical for consumers to verify their specific plan's allowed amount before assuming the in-network rate is the best price available, as some facilities charge significantly more than others for the same service. Additionally, patients should be aware of Medicare benchmarking, where the Medicare amount for this code is only $106.81, highlighting the substantial markup present in both commercial and cash rates compared to federal reimbursement standards.