CT scan, lower back (lumbar spine)
Facility: Lmh
Billing Code: 72131 (CPT)
- CPT Billing Code: 72131
- Insurance Median: $105
- Cash Discount Price: $905
- vs. Medicare Baseline: 0.98x 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 |
|---|---|---|
| Cigna | $39 - $2,419 | 37% |
| Humana | $39 - $105 | 37% |
| Medicare (plans) | $39 - $105 | 37% |
| UnitedHealthcare | $39 - $2,404 | 37% |
| Blue Cross Blue Shield | $46 - $2,343 | 43% |
| Haskell Indian Health Services | $46 - $105 | 43% |
| Allwell | $47 - $107 | 44% |
| Ambetter / Centene | $47 - $163 | 44% |
| Aetna | $1,835 - $3,005 | 1718% |
| Non Contracted | $2,897 | 2712% |
| First Health | $3,367 | 3152% |
Consumer Guidance & Cost Commentary
For this CT scan of the lower back at Lmh in Lawrence, KS, the facility's cash price of $905.00 is significantly lower than the gross charge of $3,621.00. While the facility is government-owned and located in a rural area, the cash rate remains a substantial portion of the gross, though it is notably higher than the median negotiated rate of $105.00 seen across payers like Humana and Medicare. Because commercial insurance contracts often include administrative overheads that inflate the baseline price by 20% to 40%, patients with high-deductible plans may find the cash price more affordable if their insurance negotiated rate exceeds $905.00. It is important to verify your specific plan's allowed amount before scheduling, as assuming in-network status guarantees the lowest price can lead to unexpected costs if the contract ceiling is higher than the cash option.
Patients should be aware that while the No Surprises Act protects against balance billing for emergency care and non-emergency services from out-of-network providers at in-network facilities, it does not eliminate all potential billing complexities. If you receive a bill that appears to be a balance bill, you should not pay it immediately out of fear of credit damage; instead, request a formal itemized billing audit to identify errors, double-billing, or unbundled codes, as over 80% of hospital bills contain mistakes. Additionally, since the facility offers a cash price of $905.00, you should explicitly ask for "self-pay" or "prompt-pay" discounts before check-in, as hospitals often provide fee reductions of 20% to 50% for upfront payment