CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Mercy Hospital Lebanon

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $1,683
Cash Discount Price: $1,459
vs. Medicare Baseline: 15.76x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Mercy Hospital Lebanon is $1,683. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,459. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 15.76x the Medicare baseline. Located in 100 Hospital Drive, Lebanon, MO.

Cash / Self-Pay

$1,459

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,683

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: $1,459 (1366%)

Insurance Median: $1,683 (1576%)

Cash: $1,459 (1366% of Medicare)

Ins. Median: $1,683 (1576% 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 1576% of the Medicare baseline (a markup of 1476%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance 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
Medicaid / KanCare	$60 - $300	56%
Medicare (plans)	$97 - $103	91%
Aetna	$101 - $1,546	95%
Blue Cross Blue Shield	$101 - $1,149	95%
Champva [20065]	$101	95%
Cherokee Nation Health Serv Contracted [320066]	$101	95%
Cigna	$101 - $1,661	95%
Cross Timbers Hospice [20098]	$101	95%
Dept Of Veteran Affairs Contracted [320106]	$101	95%
Elara Caring Aspire Hospice [20433]	$101	95%
Globalhealth Contracted [320145]	$101	95%
Halo Hcr Inc Hospice Contracted [320432]	$101	95%
Halo Hcr Inc Hospice [20432]	$101	95%
Humana	$101 - $1,907	95%
Kindful Hospice Contracted [320434]	$101	95%
Kindful Hospice [20434]	$101	95%
Mercy Hospice Okc [20252]	$101	95%
Mercy Mgd Behavioral Health Contracted [320259]	$101	95%
Pace Of The Ozarks Contracted [320518]	$101	95%
Provider Partners Health Plans Contracted [320450]	$101	95%
Qual Choice Contracted [320325]	$101	95%
Tricare	$101	95%
UnitedHealthcare	$101 - $2,132	95%
Healthscope Contracted [320182]	$129	121%
Centivo Contracted [320505]	$170	159%
Ambetter / Centene	$300	281%
Home State Health Plan Contracted [320187]	$300	281%
Novasys Contracted [320285]	$300	281%
Medica Contracted [320239]	$836	783%
Medica [20239]	$836	783%
Administrative Payor Contracted [320005]	$1,010	946%
Healthlink Contracted [320179]	$1,459 - $1,907	1366%
Preferred Health Plan Contracted [320522]	$1,459	1366%
90 Degree Benefits Contracted [320436]	$1,683	1576%
Mercy Benefit Admin Contracted [320251]	$1,683 - $1,795	1576%
Show-Me Health Administrators Contracted [320483]	$1,683	1576%
United Medical Resources Contracted [320454]	$1,683 - $1,795	1576%
Aither Health Contracted [320449]	$1,795	1681%
Auxiant Contracted [320462]	$1,795	1681%
Benefit Management Contracted [320052]	$1,795	1681%
Ebms Contracted [320493]	$1,795	1681%
Edison Health Solutions Contracted [320502]	$1,795	1681%
Evolutions Health Care Contracted [320124]	$1,795	1681%
First Health Contracted [320128]	$1,795	1681%
Health Systems Inc Contracted [320174]	$1,795	1681%
Imagine 360 Contracted [320494]	$1,795	1681%
Insurance System Inc Contracted [320465]	$1,795	1681%
Point C Contracted [320238]	$1,795 - $2,132	1681%
Point C [20238]	$1,795	1681%
Reflect Health Contracted [320492]	$1,795	1681%
Workers Comp [20426]	$1,795 - $1,907	1681%
Yuzu Health Contracted [320521]	$1,795	1681%
American Healthcare Alliance Contracted [320020]	$1,907	1785%
Usa Managed Care Org Contracted [320429]	$1,975	1849%
Multiplan Contracted [320270]	$2,132	1996%
Private Health Care Systems Contracted [320320]	$2,132	1996%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $1,459.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 72131.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Mercy Hospital Lebanon is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 72131.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.