CT scan, lower back (lumbar spine)
Facility: Children'S Mercy South
Billing Code: 72131 (CPT)
- CPT Billing Code: 72131
- Insurance Median: $119
- Cash Discount Price: $980
- vs. Medicare Baseline: 1.11x 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 | $41 - $2,638 | 38% |
| Healthy Blue | $43 - $273 | 40% |
| Medicaid / KanCare | $44 - $70 | 41% |
| Home State Health | $50 - $240 | 47% |
| Cigna | $53 - $2,729 | 50% |
| Wppa Providrs Care | $61 - $2,552 | 57% |
| Healthlink | $61 - $3,455 | 57% |
| Health Midwest Comprehensive Care | $64 - $2,556 | 60% |
| American Healthcare Alliance | $67 - $3,337 | 63% |
| Quiktrip | $82 - $2,556 | 77% |
| Wellfit/Centrus | $89 - $2,552 | 83% |
| Medica | $92 - $2,289 | 86% |
| Centivo | $92 - $2,552 | 86% |
| Humana | $92 - $2,611 | 86% |
| Orscheln | $93 - $2,552 | 87% |
| Nebraska Furniture Mart | $94 - $2,552 | 88% |
| Multiplan | $102 - $2,984 | 95% |
| Blue Cross Blue Shield | $102 - $2,905 | 95% |
| Aetna | $104 - $2,670 | 97% |
| Mercy Health | $115 - $2,944 | 108% |
| Coxhealth Network | $117 - $2,905 | 110% |
| Coventry Health Care Of Kansas | $132 - $2,905 | 124% |
| National Preferred Provider Network | $139 - $3,533 | 130% |
Consumer Guidance & Cost Commentary
For a CT scan of the lower back at Children's Mercy South in Overland Park, the facility's cash median price is $980.00, which is significantly lower than the negotiated rates paid by most insurance plans. While the facility's cash rate is roughly 93% of the Medicare benchmark of $1,068.10, commercial insurance contracts often result in much higher out-of-pocket costs for patients. For instance, UnitedHealthcare members face a range of $41 to $2,638, and Cigna members could see charges up to $2,729, far exceeding the cash price. This disparity highlights that paying cash upfront can sometimes be the most cost-effective option for patients with high-deductible plans, provided they secure a "self-pay" or "prompt-pay" discount before scheduling their appointment.
It is important to understand that commercial insurance rates are not fixed; they vary widely based on the specific payer and plan. In this dataset, the lowest negotiated rate observed was $41 with UnitedHealthcare, while the highest reached $3,533 with the National Preferred Provider Network. Because these rates are contractually agreed upon, they often include administrative overhead that inflates the baseline price, sometimes making them higher than the cash price despite being "in-network." Patients should avoid assuming that being in-network guarantees the lowest price and should always verify their specific plan's allowed amount before receiving care. If a patient receives a bill that exceeds the cash rate, they should request an itemized audit to ensure no errors exist, as over 80% of hospital bills contain mistakes that can be corrected.