CT scan, lower back (lumbar spine)
Facility: Kansas Spine & Specialty Hospital, Llc
Billing Code: 72131 (CPT)
- CPT Billing Code: 72131
- Insurance Median: $96
- Cash Discount Price: $1,041
- vs. Medicare Baseline: 0.90x 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 |
|---|---|---|
| Humana | $94 | 88% |
| UnitedHealthcare | $96 - $116 | 90% |
| Providrs Care Network | $96 | 90% |
| Blue Cross Blue Shield | $96 - $462 | 90% |
| Aetna | $96 - $120 | 90% |
| United Mine Workers Of America | $96 | 90% |
| Lantern Specialty Care | $153 | 143% |
Consumer Guidance & Cost Commentary
For a CT scan of the lower back at Kansas Spine & Specialty Hospital, the cash median price is $1,041, which is lower than the facility's gross charge of $1,602. While insurance plans like UnitedHealthcare and Blue Cross Blue Shield have negotiated rates ranging from $94 to $462, these amounts often exceed the cash price, meaning patients with high-deductible plans might save money by paying out-of-pocket. To secure the best rate, patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront fee reductions can bypass the administrative costs and inflated negotiated rates associated with insurance billing.
It is important to understand that commercial insurance rates are not always the lowest available; in this case, the cash price is significantly lower than the highest negotiated rates found among payers like Blue Cross Blue Shield. Additionally, while the Medicare benchmark for this service is $106.81, commercial rates often run 10 to 15 times higher due to administrative markups and contract structures. Consumers should avoid accepting summary bills and instead request a detailed, itemized statement to ensure no errors exist, and they should be aware that federal protections like the No Surprises Act may prevent balance billing for out-of-network services at in-network facilities.