CT scan, lower back (lumbar spine)
Facility: Kansas City Orthopaedic Institute
Billing Code: 72131 (CPT)
- CPT Billing Code: 72131
- Insurance Median: $254
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 2.38x 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 238% of the Medicare baseline (a markup of 138%). 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 | $98 | 92% |
| Aetna | $98 | 92% |
| Cigna | $100 | 94% |
| Blue Cross Blue Shield | $254 | 238% |
Consumer Guidance & Cost Commentary
For the CPT code 72131, representing a CT scan of the lower back at Kansas City Orthopaedic Institute in Leawood, KS, the facility's negotiated rates are $98 to $254 depending on the insurance carrier. These rates are significantly higher than the Medicare benchmark of $106.81, which serves as the objective baseline for healthcare costs. While the facility is an Acute Care Hospital with a physician-owned structure, the variation in negotiated amounts reflects different contract dynamics between payers like UnitedHealthcare, Aetna, Cigna, and Blue Cross Blue Shield. It is important to note that commercial negotiated rates often include administrative overhead and do not represent the lowest possible price, as they are frequently inflated compared to cash prices.
Patients should be aware that paying cash or utilizing a prompt-pay discount may result in lower out-of-pocket costs than using insurance, particularly if the patient has a high deductible or if the negotiated rate exceeds the cash price. Although the data does not list a specific cash median, facilities often offer self-pay or prompt-pay discounts ranging from 20% to 50% for upfront payment, bypassing the administrative costs associated with claims processing. Before scheduling, it is advisable to request a waiver of insurance submission to ensure the facility applies these cash rates rather than submitting a claim that could lead to balance billing. Additionally, since the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, patients should verify that all ancillary services, such as lab work or imaging, are covered under the same negotiated framework to avoid unexpected charges.