CT scan, lower back (lumbar spine)
Facility: Saint Luke'S South Hospital
Billing Code: 72131 (CPT)
- CPT Billing Code: 72131
- Insurance Median: $1,009
- Cash Discount Price: $4,109
- vs. Medicare Baseline: 9.45x 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 945% of the Medicare baseline (a markup of 845%). 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 |
|---|---|---|
| Medicaid / KanCare | $60 - $136 | 56% |
| Humana | $89 - $146 | 83% |
| Aetna | $114 - $6,506 | 107% |
| UnitedHealthcare | $114 - $1,009 | 107% |
| Cigna | $118 - $5,198 | 110% |
| Transplants-Case Rates [5750] | $158 - $6,848 | 148% |
| Blue Cross Blue Shield | $240 - $5,143 | 225% |
| Commercial-Contracted [8000] | $959 - $5,540 | 898% |
| First Health [5512] | $4,059 | 3800% |
Consumer Guidance & Cost Commentary
For a CT scan of the lower back at Saint Luke's South Hospital in Overland Park, Kansas, the facility's cash price of $4,109 is significantly higher than the state average for this procedure, which is $4,109. While the hospital offers a negotiated rate of $1,009 for in-network plans, this amount is still above the state average of $1,009. Patients with high-deductible plans should consider paying cash directly, as the cash price of $4,109 is lower than the typical negotiated rate of $1,009 for many commercial payers, potentially saving money if they have not yet met their deductible. It is crucial to contact the hospital before scheduling to confirm "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if paid in full upfront.
When using insurance, patients must be aware that commercial rates often include administrative overhead and can exceed the true cost of care. The Medicare benchmark for this service is $106.81, and the facility's cash rate is roughly 38 times higher than this federal baseline, indicating a significant markup. If a patient receives care from an out-of-network provider at this facility, they may face balance billing for the difference between the provider's full charge and the insurance allowed amount, though the No Surprises Act protects against this for emergency services and non-emergency care from out-of-network providers at in-network facilities. To avoid unexpected costs, patients should request a detailed, itemized bill to verify that all charges are accurate and that no services were unbundled or double-billed, as over