CT scan, lower back (lumbar spine)
Facility: Wamego Health Center
Billing Code: 72131 (CPT)
- CPT Billing Code: 72131
- Insurance Median: $81
- Cash Discount Price: $1,204
- vs. Medicare Baseline: 0.76x 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 |
|---|---|---|
| UnitedHealthcare | $39 - $91 | 37% |
| Medicaid / KanCare | $40 - $140 | 37% |
| Aetna | $40 - $94 | 37% |
| Providrs Care | $64 - $178 | 60% |
| Tricare | $174 | 163% |
| Blue Cross Blue Shield | $631 - $664 | 591% |
Consumer Guidance & Cost Commentary
For a CT scan of the lower back at Wamego Health Center, the cash median price is $1,204.00, which is significantly lower than the facility's negotiated rates with major payers like Blue Cross Blue Shield ($631–$664) and Medicaid/KanCare ($40–$140). While the facility's negotiated rates are higher than the cash price, this dynamic often benefits patients with high-deductible plans who may not yet have met their out-of-pocket limits; in such cases, paying the cash median directly can result in immediate savings compared to the insurance negotiated ceiling. To maximize these savings, patients should explicitly request "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can reduce the final bill by 20% to 50% by bypassing costly administrative processing fees.
This service is priced at 0.8 times the Medicare amount of $106.81, indicating a substantial markup relative to the federal government's cost-based benchmark. It is important to note that comparing rates to the hospital's gross charge list is misleading, as commercial rates often average 200% to 300% of Medicare, whereas fair pricing typically aligns closer to 120% to 150%. If you receive a summary bill, do not accept it as final; instead, request a full itemized audit to identify unbundled codes or services not rendered, as over 80% of hospital bills contain errors that can be corrected through a formal written dispute. Additionally, under the No Surprises Act, you are protected from balance billing for out-of-network services at in-network