CT scan, lower back (lumbar spine)
Facility: Menorah Medical Center
Billing Code: 72131 (CPT)
- CPT Billing Code: 72131
- Insurance Median: $486
- Cash Discount Price: $11,003
- vs. Medicare Baseline: 4.55x 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 455% of the Medicare baseline (a markup of 355%). 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 |
|---|---|---|
| United | $60 - $4,951 | 56% |
| Amerigroup | $60 | 56% |
| Healthyblue | $61 | 57% |
| Aetna | $62 - $5,612 | 58% |
| Medicaid / KanCare | $62 | 58% |
| Unicare | $62 | 58% |
| Home State Health Plan | $95 | 89% |
| Cigna | $122 - $8,803 | 114% |
| Multiplan | $169 - $8,142 | 158% |
| Corvel Corporation | $201 - $7,152 | 188% |
| Oha Network | $210 - $5,502 | 197% |
| Blue Cross Blue Shield | $323 - $4,951 | 302% |
| Humana | $363 - $468 | 340% |
| Ambetter / Centene | $2,047 | 1916% |
| Nhc Advantage | $2,091 | 1958% |
| Wppa Providrs Care Network | $2,201 | 2061% |
| Universal Healthcare | $3,851 | 3605% |
| Coventry | $4,423 | 4141% |
| Coventry Kc Mo | $4,511 | 4223% |
| College Park Family Care Center | $4,731 | 4429% |
| Triwest Health Alliance | $8,252 | 7726% |
| Focus Healthcare Mgmt, Inc | $8,252 | 7726% |
| Cco, Inc. | $8,252 | 7726% |
Consumer Guidance & Cost Commentary
For a CT scan of the lower back at Menorah Medical Center in Overland Park, Kansas, the cash price is $11,003. This amount is significantly higher than the state average for this procedure, which is $106.81, and also exceeds the negotiated rates paid by most commercial insurance plans. While many payers have negotiated rates ranging from $60 to $4,951, patients with high-deductible plans might find that paying the cash price directly is more cost-effective than using insurance, especially if the insurer's allowed amount exceeds the cash rate. It is important to note that the facility's cash price is also higher than the median negotiated rate of $486.00, suggesting that commercial contracts may offer substantial savings for those with active coverage.
Patients should verify their specific plan details before scheduling, as assuming that being in-network guarantees the lowest possible price is a common pitfall; some in-network facilities charge far more than others for the same service. Additionally, if you choose to pay out-of-pocket, ask the billing department about "self-pay" or "prompt-pay" discounts, which can reduce the total cost by 20% to 50% if settled upfront. Since over 80% of hospital bills contain errors, do not accept a summary bill as final; instead, request a detailed, itemized statement to identify any unbundled codes or services not rendered. Finally, remember that the Medicare benchmark of $106.81 represents the federal government's calculated cost baseline, providing a clear reference point to evaluate whether the facility's pricing structure is reasonable compared to the true cost of care.