CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Hermann Area District Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $852
Cash Discount Price: $1,161
vs. Medicare Baseline: 7.98x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Hermann Area District Hospital is $852. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,161. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 7.98x the Medicare baseline. Located in 509 W 18Th St, Hermann, MO.

Cash / Self-Pay

$1,161

Average discount available for prompt cash payment at this facility.

Insurance Median

$852

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: $1,161 (1087%)

Insurance Median: $852 (798%)

Cash: $1,161 (1087% of Medicare)

Ins. Median: $852 (798% 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 798% of the Medicare baseline (a markup of 698%). 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
Healthy Blue Mcaid - All Plans	$139	130%
Ambetter / Centene	$145 - $1,363	136%
Blue Cross Blue Shield	$150 - $1,576	140%
UnitedHealthcare	$150 - $813	140%
Healthlink Hmo	$515	482%
Care Partners Mcaid- All Plans	$562	526%
Healthlink Ppo - All Other Plans	$618	579%
Tricare	$766	717%
Choicecare Mcr Adv- All Plans	$813	761%
American Hlth Mcr Adv- All Plans	$852	798%
Humana	$852	798%
Aetna	$869 - $1,839	814%
Wellcare Mcr Adv - All Plans	$869	814%
Cigna	$1,055	988%
Harmony Hp Mcaid- All Plans	$1,123	1051%
Healthcare Usa Mcaid- All Plans	$1,258	1178%
Multiplan/Phcs - All Plans	$1,452	1359%
Coventry - All Plans	$1,645	1540%
Comp Results - All Plans	$1,742	1631%
Three Rivers - All Plans	$1,742	1631%

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 $1,161.
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 Hermann Area District Hospital 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.