CT scan, lower back (lumbar spine)
Facility: St Luke Hospital & Living Center
Billing Code: 72131 (CPT)
- CPT Billing Code: 72131
- Insurance Median: $820
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 7.68x 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 768% of the Medicare baseline (a markup of 668%). 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 |
|---|---|---|
| Va Ccn | $820 | 768% |
| Bluestem Pace | $820 | 768% |
| UnitedHealthcare | $820 | 768% |
| Kansas Department Of Health And Environment | $820 | 768% |
| Blue Cross Blue Shield | $820 | 768% |
| Humana | $820 | 768% |
| Ambetter / Centene | $828 | 775% |
Consumer Guidance & Cost Commentary
For the CPT code 72131, representing a CT scan of the lower back at St Luke Hospital & Living Center in Marion, Kansas, the facility's negotiated rate is $820. This amount is consistent across all seven payers listed, including UnitedHealthcare, Humana, and Blue Cross Blue Shield. While the facility is a Critical Access Hospital owned by a government authority, the data does not provide specific cash or median paid figures for this service. However, the Medicare benchmark for this procedure is $106.81, indicating that the negotiated rate represents a significant markup above the federal baseline. Patients should be aware that while commercial rates are often higher than cash prices, the lack of available cash data here means the negotiated rate is the primary benchmark for in-network coverage.
Because this service is covered by multiple insurers with identical negotiated amounts, patients should verify their specific plan's deductible status before scheduling to avoid unexpected out-of-pocket costs. Although the data does not list a cash price, patients with high-deductible plans or those seeking to minimize administrative fees should inquire directly with the hospital about "self-pay" or "prompt-pay" discounts, which can sometimes reduce costs by 20% to 50%. It is also important to understand that if a patient receives care from an out-of-network provider at this facility, the No Surprises Act may protect them from balance billing for emergency services, though they should still request an itemized bill to ensure no unbundled charges or services not rendered are included.