CT scan, lower back (lumbar spine)
Facility: Kansas Heart Hospital
Billing Code: 72131 (CPT)
- CPT Billing Code: 72131
- Insurance Median: $1,665
- Cash Discount Price: $1,166
- vs. Medicare Baseline: 15.59x 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 1559% of the Medicare baseline (a markup of 1459%). 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 |
|---|---|---|
| Tricare | $87 | 81% |
| Medicaid / KanCare | $96 - $1,850 | 90% |
| Humana | $96 | 90% |
| UnitedHealthcare | $96 - $1,850 | 90% |
| Celtic Mcr Adv | $96 | 90% |
| Blue Cross Blue Shield | $462 - $1,850 | 433% |
| Wppa - All Plans | $541 | 507% |
| Multiplan - All Plans | $1,665 | 1559% |
| Aetna | $1,804 - $1,850 | 1689% |
| Soonerselect Mcaid - All Plans | $1,850 | 1732% |
| Celtic Mcaid - All Other Plans | $1,850 | 1732% |
Consumer Guidance & Cost Commentary
For a CT scan of the lower back at Kansas Heart Hospital in Wichita, the cash price is $1,166, which is lower than the facility's gross charge of $1,850. While the hospital's negotiated rates with major payers like Medicaid/KanCare and UnitedHealthcare range from $96 to $1,850, the cash price offers a potential savings for patients with high-deductible plans who may not meet their out-of-pocket limits. It is important to note that commercial negotiated rates often include administrative overhead and can exceed the cash price; therefore, patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling to ensure they are receiving the most favorable rate available.
When evaluating costs, it is more accurate to compare prices against the Medicare benchmark rather than the hospital's full list price. For this procedure, the Medicare amount is $106.81, and the facility's cash rate of $1,166 represents a 15.6% increase over the Medicare rate, which aligns with typical commercial pricing structures. Since over 80% of hospital bills contain errors, patients should request a detailed, itemized statement to verify that all charges are accurate and that no services were unbundled or duplicated. If a balance bill arises from an out-of-network provider, patients should not pay immediately but should instead dispute the bill with their insurer to invoke federal protections under the No Surprises Act.