CT scan, lower back (lumbar spine)
Facility: Aurora Medical Center
Billing Code: 72131 (CPT)
- CPT Billing Code: 72131
- Insurance Median: $1,014
- Cash Discount Price: $1,470
- vs. Medicare Baseline: 9.49x 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 949% of the Medicare baseline (a markup of 849%). 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 |
|---|---|---|
| Aurora Caregiver | $475 | 445% |
| UnitedHealthcare | $538 - $2,475 | 504% |
| Blue Cross Blue Shield | $556 - $2,499 | 521% |
| Healthpartners | $796 - $2,205 | 745% |
| Molina Exchange | $796 | 745% |
| Common Ground | $812 | 760% |
| Centivo | $820 | 768% |
| Aetna | $836 - $2,428 | 783% |
| Health Payment Systems | $875 | 819% |
| Quartz One | $900 | 843% |
| Everpointe Elite | $983 | 920% |
| Quartz Group | $1,000 | 936% |
| Hs Technology | $1,014 | 949% |
| Wisconsin Physician Service | $1,128 - $1,187 | 1056% |
| Trilogy | $1,170 | 1095% |
| Cigna | $1,700 - $2,487 | 1592% |
| Health Eos Plus | $1,764 | 1652% |
| Health Eos | $2,352 | 2202% |
Consumer Guidance & Cost Commentary
Aurora Medical Center, located at 975 Port Washington Road in Grafton, Wisconsin, reported a cash median price of $1,470 for a CT scan of the lower back (lumbar spine). While the facility's cash rate is higher than the state average of $1,014, it remains below the gross chargemaster price of $2,940. For patients with high-deductible plans, paying the cash price of $1,470 upfront may be more cost-effective than relying on insurance, as several major payers like UnitedHealthcare and Blue Cross Blue Shield have negotiated rates as high as $2,499 and $2,475 respectively, which exceed the cash amount.
The Medicare amount for this service is $106.81, and the facility's commercial median negotiated rate is $1,014, which is lower than the cash price but still higher than the Medicare benchmark. Patients should be aware that prompt-pay discounts, typically ranging from 20% to 50%, may be available if they pay in full within a short window, potentially reducing the cash liability further. It is important to request these self-pay or prompt-pay rates before scheduling and to avoid automatic claims submission by signing a waiver of insurance submission to ensure the cash discount applies.