CT scan, lower back (lumbar spine)
Facility: Kansas Medical Center Llc
Billing Code: 72131 (CPT)
- CPT Billing Code: 72131
- Insurance Median: $96
- Cash Discount Price: $642
- 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 |
|---|---|---|
| Medicaid / KanCare | $60 | 56% |
| Indian Health | $87 | 81% |
| Tricare | $87 | 81% |
| Medadv_Wellcare | $96 | 90% |
| Blue Cross Blue Shield | $96 - $437 | 90% |
| Ambetter / Centene | $96 | 90% |
| Humana | $96 | 90% |
| Three_Rivers | $193 | 181% |
| Aetna | $450 | 421% |
| Wppa | $525 | 492% |
| United | $580 | 543% |
Consumer Guidance & Cost Commentary
For a CT scan of the lower back at Kansas Medical Center Llc, the cash median price is $642, which is lower than the facility's gross charge of $1,070. While the facility's negotiated rates with major payers like Blue Cross Blue Shield and Aetna range from $96 to $450, these amounts are often higher than the cash price due to administrative costs and contract structures. Patients with high-deductible plans may find it financially beneficial to pay the cash median of $642 directly, as this avoids the multi-layered administrative fees embedded in insurance negotiated rates. It is important to verify your specific plan's deductible status before scheduling, as paying out-of-pocket can sometimes result in immediate savings compared to waiting for insurance reimbursement.
To ensure you are not overcharged, you should request a full itemized bill before finalizing payment, as summary bills often obscure individual line items and potential errors. If you receive a balance bill from an out-of-network provider, even at an in-network facility, you have the right to dispute the amount under the No Surprises Act, which bans balance billing for emergency and non-emergency services. Additionally, ask the billing department about prompt-pay discounts, which can reduce the total cost by 20% to 50% if paid upfront, bypassing the costly claims processing cycle. Always compare the final allowed amount to the Medicare benchmark of $106.81 for this procedure, as commercial rates are frequently marked up significantly above this federal baseline.