CMS Price Transparency Data
CT scan, lower back (lumbar spine)
Facility: Mercy Health Saint Mary's
Billing Code: 72131 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 72131
- Insurance Median: $1,078
- Cash Discount Price: $960
- vs. Medicare Baseline: 10.09x Medicare
The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Mercy Health Saint Mary's is $1,078. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $960. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 10.09x the Medicare baseline. Located in 200 Jefferson Avenue Se, Grand Rapids, MI.
Cash / Self-Pay
$960
Average discount available for prompt cash payment at this facility.
Insurance Median
$1,078
Median negotiated contract rate across all mapped commercial carriers.
Medicare Reference Rate
$106.81
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Medicare Reference Baseline: $106.81 (100%)
Cash / Self-Pay: $960 (899%)
Insurance Median: $1,078 (1009%)
Cash: $960 (899% of Medicare)
Ins. Median: $1,078 (1009% of 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 1009% of the Medicare baseline (a markup of 909%). 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.
Input your details and click calculate to compare out-of-pocket costs.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Blue Cross Blue Shield | $58 - $135 | 54% |
| Medicaid / KanCare | $58 - $60 | 54% |
| Access Health | $73 | 68% |
| Aetna | $102 - $104 | 95% |
| Blue Care Network Advantage | $102 | 95% |
| Medicare (plans) | $102 | 95% |
| Align Senior Care | $104 | 97% |
| Correctional Recovery | $104 | 97% |
| Geha | $104 - $1,123 | 97% |
| Hospice Faith | $104 | 97% |
| Hospice Of Holland | $104 | 97% |
| Medical Mutual | $104 | 97% |
| Meritain | $104 | 97% |
| Preferred One | $104 | 97% |
| UnitedHealthcare | $107 - $1,477 | 100% |
| Longevity Ipa Of Michigan Llc Health Plan Isnp | $117 | 110% |
| Oscar | $133 | 125% |
| Bcn Domestic | $135 | 126% |
| Blue Benefit Administrators Of Massachusetts | $135 | 126% |
| Blue Care Network | $135 | 126% |
| Blue Distinction Transplant | $135 | 126% |
| Blue Shield - Ca | $135 | 126% |
| Blue Shield - Id (Regence) | $135 | 126% |
| Blue Shield - Ny Highmark Northeastern | $135 | 126% |
| Blue Shield - Ny Highmark Western | $135 | 126% |
| Blue Shield - Pa (Highmark) | $135 | 126% |
| Blue Shield - Wa (Regence) | $135 | 126% |
| Health Choices | $135 - $1,124 | 126% |
| Kaiser Domestic | $135 | 126% |
| Molina Marketplace | $135 | 126% |
| Vitalcore | $161 | 151% |
| Wellpath | $161 | 151% |
| U Of M Health Plan | $288 - $1,124 | 270% |
| Priority Health | $630 - $643 | 590% |
| Wc Accident Fund | $807 | 756% |
| Wc Advantage | $807 | 756% |
| Wc Aig | $807 | 756% |
| Wc Allied | $807 | 756% |
| Wc Amerisure | $807 | 756% |
| Wc Amtrust | $807 | 756% |
| Wc Asu Risk Mgt | $807 | 756% |
| Wc Berkley Admin | $807 | 756% |
| Wc Broadspire | $807 | 756% |
| Wc Bunch & Associates | $807 | 756% |
| Wc Ccmsi | $807 | 756% |
| Wc Emc Insurance Company | $807 | 756% |
| Wc Esis | $807 | 756% |
| Wc Fcci | $807 | 756% |
| Wc Federated | $807 | 756% |
| Wc Gallagher Bassett | $807 | 756% |
| Wc Genex Care For Ohio | $807 | 756% |
| Wc Guard Insurance Company | $807 | 756% |
| Wc Hartford | $807 | 756% |
| Wc Liberty Mutual | $807 | 756% |
| Wc Meijers | $807 | 756% |
| Wc Michigan | $807 | 756% |
| Wc Mitchell Frankenmuth | $807 | 756% |
| Wc Pma | $807 | 756% |
| Wc Sedgwick | $807 | 756% |
| Wc Sentry | $807 | 756% |
| Wc Travelers | $807 | 756% |
| Wc Tristar | $807 | 756% |
| Wc Walmart | $807 | 756% |
| Wc Zurich | $807 | 756% |
| Nomi Health | $827 | 774% |
| Acs Benefit Services | $849 | 795% |
| Allied Benefit Systems | $849 | 795% |
| Claimchoice Adminstrators | $849 | 795% |
| Consociate | $849 | 795% |
| Cypress Benefit Administrators | $849 | 795% |
| Forest County Potawatomi | $849 | 795% |
| Health Smart | $849 | 795% |
| Healthgram | $849 | 795% |
| Healthscope | $849 | 795% |
| Secureone Preferred United Plans | $849 | 795% |
| Sisco Benefits | $849 | 795% |
| The Health Plan | $849 | 795% |
| Trustmark Small Business Benefits | $849 | 795% |
| Unified Group Services | $849 | 795% |
| Webtpa | $849 | 795% |
| Asr Health Benefits | $940 | 880% |
| Hap | $940 - $1,145 | 880% |
| Varipro | $960 | 899% |
| Caresource | $965 | 903% |
| 1199 National Benefit Fund | $1,078 | 1009% |
| Allied National Global Care | $1,078 | 1009% |
| Asrm - Reliance Standard Life Insurance | $1,078 | 1009% |
| Christian Care Ministry | $1,078 | 1009% |
| Cigna | $1,078 | 1009% |
| Dean Health | $1,078 | 1009% |
| Fallon Health | $1,078 | 1009% |
| Family Life Insurance Company | $1,078 | 1009% |
| Ghc Scw | $1,078 | 1009% |
| Group Pension Administrators | $1,078 | 1009% |
| International Benefit Administrators | $1,078 | 1009% |
| Lifetime Benefit Solutions | $1,078 | 1009% |
| Manhattan Life | $1,078 | 1009% |
| Medi Share | $1,078 | 1009% |
| Multiplan | $1,078 | 1009% |
| Mvp | $1,078 | 1009% |
| Pai | $1,078 | 1009% |
| Pan-American Life | $1,078 | 1009% |
| Paramount Hmo | $1,078 | 1009% |
| Phcs | $1,078 | 1009% |
| Trinity Health Share | $1,078 | 1009% |
| Acclaim | $1,124 | 1052% |
| Administrative Concepts | $1,124 | 1052% |
| Allegeant | $1,124 | 1052% |
| Ameriben | $1,124 | 1052% |
| American Family | $1,124 | 1052% |
| American Healthcare Alliance | $1,124 | 1052% |
| American Republic | $1,124 | 1052% |
| Amerihealth | $1,124 | 1052% |
| Aultcare | $1,124 | 1052% |
| Automated Benefit Services | $1,124 | 1052% |
| Auxiant | $1,124 | 1052% |
| Benefit Administrative Systems,Llc | $1,124 | 1052% |
| Boon Chapman | $1,124 | 1052% |
| Cam Administrative Services | $1,124 | 1052% |
| Christian Brother Services | $1,124 | 1052% |
| Christian Brothers Holy Cross | $1,124 | 1052% |
| Comprehensive Benefits | $1,124 | 1052% |
| Continental Life Insurance | $1,124 | 1052% |
| Custom Benefit Administrators | $1,124 | 1052% |
| Employee Benefit Concepts | $1,124 | 1052% |
| Employee Benefit Management | $1,124 | 1052% |
| Enterprise Group Planning | $1,124 | 1052% |
| Freedom Life Insurance Company | $1,124 | 1052% |
| Group Administrators | $1,124 | 1052% |
| Group Marketing Services | $1,124 | 1052% |
| Guardian | $1,124 | 1052% |
| Health America | $1,124 | 1052% |
| Healthez | $1,124 | 1052% |
| Humana | $1,124 - $1,477 | 1052% |
| Insight | $1,124 | 1052% |
| Intercare | $1,124 | 1052% |
| Jfp Benefit Management | $1,124 | 1052% |
| Jp Farley Corporation | $1,124 | 1052% |
| Key Benefit Administrator | $1,124 | 1052% |
| Liberty Union Life Assurance Co | $1,124 | 1052% |
| Lucent Health | $1,124 | 1052% |
| Luminare Health | $1,124 | 1052% |
| Luminare Health (Detroit) | $1,124 | 1052% |
| Medben | $1,124 | 1052% |
| Medcost | $1,124 | 1052% |
| Mutual Health Services | $1,124 | 1052% |
| Mutual Of Omaha | $1,124 | 1052% |
| Ncas | $1,124 | 1052% |
| Nippon Life Ins | $1,124 | 1052% |
| Nova | $1,124 | 1052% |
| Painters Union Insurance Fund | $1,124 | 1052% |
| Physicians Mutual | $1,124 | 1052% |
| Plumbers Local 98 Insurance Fund | $1,124 | 1052% |
| Prairie States | $1,124 | 1052% |
| Primary Physician Care | $1,124 | 1052% |
| Professional Benefit Administrators | $1,124 | 1052% |
| The Loomis Company | $1,124 | 1052% |
| Unicare | $1,124 | 1052% |
| Us Health And Life | $1,124 | 1052% |
| Valenz | $1,124 | 1052% |
| Western & Southern Financial Group | $1,124 | 1052% |
| Wps | $1,124 | 1052% |
| Coventry | $1,170 | 1095% |
| First Health | $1,170 | 1095% |
| Cmh Allegan County | $1,477 | 1383% |
| Cmh Ausable Valley | $1,477 | 1383% |
| Cmh Barry County | $1,477 | 1383% |
| Cmh Berrien County | $1,477 | 1383% |
| Cmh Cass County | $1,477 | 1383% |
| Cmh Clinton-Eaton-Ingham County | $1,477 | 1383% |
| Cmh Kalamazoo | $1,477 | 1383% |
| Cmh Kent County | $1,477 | 1383% |
| Cmh Lenawee County | $1,477 | 1383% |
| Cmh Misc | $1,477 | 1383% |
| Cmh Monroe County | $1,477 | 1383% |
| Cmh Montcalm County | $1,477 | 1383% |
| Cmh Muskegon County | $1,477 | 1383% |
| Cmh Newaygo County | $1,477 | 1383% |
| Cmh North Country | $1,477 | 1383% |
| Cmh Northern Lakes County | $1,477 | 1383% |
| Cmh Ottawa County | $1,477 | 1383% |
| Cmh Van Buren County | $1,477 | 1383% |
| Cmh West Mi County | $1,477 | 1383% |
| Magellan Behavioral Health | $1,477 | 1383% |