CT scan, lower back (lumbar spine)
Facility: Mercy Specialty Hospital Southeast Kansas
Billing Code: 72131 (CPT)
- CPT Billing Code: 72131
- Insurance Median: $409
- Cash Discount Price: $1,134
- vs. Medicare Baseline: 3.83x 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 383% of the Medicare baseline (a markup of 283%). 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 |
|---|---|---|
| Medicaid / KanCare | $60 - $215 | 56% |
| Blue Cross Blue Shield | $60 - $490 | 56% |
| Provider Partners Health Plans Contracted [320450] | $76 | 71% |
| UnitedHealthcare | $91 - $1,613 | 85% |
| Humana | $95 - $104 | 89% |
| Aetna | $95 - $104 | 89% |
| Cross Timbers Hospice [20098] | $102 | 95% |
| Pace Of The Ozarks Contracted [320518] | $102 | 95% |
| Mercy Hospice Okc [20252] | $102 | 95% |
| Medicare (plans) | $102 | 95% |
| Mercy Mgd Behavioral Health Contracted [320259] | $102 | 95% |
| Tricare | $102 | 95% |
| Globalhealth Contracted [320145] | $102 | 95% |
| Cherokee Nation Health Serv Contracted [320066] | $102 | 95% |
| Kindful Hospice Contracted [320434] | $102 | 95% |
| Qual Choice Contracted [320325] | $102 | 95% |
| Kindful Hospice [20434] | $102 | 95% |
| Cigna | $102 - $467 | 95% |
| Medical Associates Health Contracted [320444] | $102 | 95% |
| Halo Hcr Inc Hospice Contracted [320432] | $102 | 95% |
| Halo Hcr Inc Hospice [20432] | $102 | 95% |
| Elara Caring Aspire Hospice [20433] | $102 | 95% |
| Centivo Contracted [320505] | $104 | 97% |
| First Health Contracted [320128] | $104 | 97% |
| Dept Of Veteran Affairs Contracted [320106] | $104 | 97% |
| United Medical Resources Contracted [320454] | $114 - $409 | 107% |
| Providrs Care Network Contracted [320484] | $197 | 184% |
| Benefit Management Contracted [320052] | $409 | 383% |
| Health Systems Inc Contracted [320174] | $409 | 383% |
| Insurance System Inc Contracted [320465] | $409 | 383% |
| Healthscope Contracted [320182] | $409 - $1,308 | 383% |
| Point C Contracted [320238] | $409 - $1,308 | 383% |
| Medica Contracted [320239] | $734 | 687% |
| Show-Me Health Administrators Contracted [320483] | $1,080 | 1011% |
| Mercy Benefit Admin Contracted [320251] | $1,080 - $1,221 | 1011% |
| Yuzu Health Contracted [320521] | $1,221 | 1143% |
| American Healthcare Alliance Contracted [320020] | $1,221 | 1143% |
| Auxiant Contracted [320462] | $1,221 - $1,308 | 1143% |
| Reflect Health Contracted [320492] | $1,221 | 1143% |
| Imagine 360 Contracted [320494] | $1,221 | 1143% |
| Aither Health Contracted [320449] | $1,221 | 1143% |
| Ebms Contracted [320493] | $1,221 | 1143% |
| Edison Health Solutions Contracted [320502] | $1,221 | 1143% |
| Healthlink Contracted [320179] | $1,308 | 1225% |
| Preferred Health Plan Contracted [320522] | $1,308 | 1225% |
| Federal Medical Center Contracted [320127] | $1,308 | 1225% |
| Compcare Of The Ozarks Contracted [320437] | $1,378 | 1290% |
| Workers Comp [20426] | $1,395 | 1306% |
| Private Health Care Systems Contracted [320320] | $1,613 | 1510% |
| Multiplan Contracted [320270] | $1,657 | 1551% |
| Multiplan [20270] | $1,657 | 1551% |
Consumer Guidance & Cost Commentary
For the CT scan of the lower back (lumbar spine) at Mercy Specialty Hospital Southeast Kansas, the facility's cash price is $1,134, which is significantly lower than the highest negotiated rates found among 51 payers, such as UnitedHealthcare's maximum of $1,613. While the facility's gross charge is $1,744, patients with high-deductible plans may find paying cash upfront more cost-effective than relying on insurance, as many commercial payers negotiate rates that exceed the cash price. The facility offers a prompt-pay discount for upfront payment, which can reduce the bill by 20% to 50%, bypassing the administrative costs and collection fees typically associated with insurance billing cycles. To secure this discount, patients should request a self-pay classification and a waiver of insurance submission before scheduling their appointment to ensure the hospital processes the claim as a direct cash transaction rather than submitting it to an insurer.
The facility's negotiated rates vary widely depending on the payer, ranging from a low of $60 for Medicaid/KanCare plans to a high of $1,657 for Multiplan, with a median negotiated amount of $409. This median is notably lower than the gross charge but still higher than the cash price, illustrating that in-network coverage does not always guarantee the lowest possible cost. Additionally, the facility's cash rate of $1,134 is higher than the Medicare benchmark of $106.81, indicating a markup typical of commercial pricing structures where rates often average 200% to 300% of the Medicare base. Patients should be aware that balance billing is generally prohibited for emergency services at in