CMS Price Transparency Data
CT scan, lower back (lumbar spine)
Facility: Mercy Hospital Lincoln
Billing Code: 72131 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 72131
- Insurance Median: $252
- Cash Discount Price: $808
- vs. Medicare Baseline: 2.36x Medicare
The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Mercy Hospital Lincoln is $252. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $808. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 2.36x the Medicare baseline. Located in 1000 East Cherry Street, Troy, MO.
Cash / Self-Pay
$808
Average discount available for prompt cash payment at this facility.
Insurance Median
$252
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: $808 (756%)
Insurance Median: $252 (236%)
Cash: $808 (756% of Medicare)
Ins. Median: $252 (236% 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 236% of the Medicare baseline (a markup of 136%). 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 |
|---|---|---|
| Medicaid / KanCare | $19 - $1,005 | 18% |
| Aetna | $45 - $1,434 | 42% |
| Medicare (plans) | $64 - $2,189 | 60% |
| Tricare | $64 - $468 | 60% |
| UnitedHealthcare | $65 - $1,445 | 61% |
| American Health Advantage Of Mo Mcr [10473] | $70 - $515 | 66% |
| Blue Cross Blue Shield | $70 - $1,686 | 66% |
| Cherokee Nation Health Serv Contracted [320066] | $70 - $515 | 66% |
| Cross Timbers Hospice [20098] | $70 - $515 | 66% |
| Dept Of Veteran Affairs Contracted [320106] | $70 - $515 | 66% |
| Elara Caring Aspire Hospice Contracted [320433] | $70 - $515 | 66% |
| Elara Caring Aspire Hospice [20433] | $70 - $515 | 66% |
| Globalhealth Contracted [320145] | $70 - $515 | 66% |
| Halo Hcr Inc Hospice Contracted [320432] | $70 - $515 | 66% |
| Halo Hcr Inc Hospice [20432] | $70 - $515 | 66% |
| Humana | $70 - $1,970 | 66% |
| Indian Health Service Contracted [320198] | $70 - $515 | 66% |
| Kindful Hospice Contracted [320434] | $70 - $515 | 66% |
| Kindful Hospice [20434] | $70 - $515 | 66% |
| Mercy Hospice Okc [20252] | $70 - $515 | 66% |
| Pace Of The Ozarks Contracted [320518] | $70 - $515 | 66% |
| Provider Partners Health Plans Contracted [320450] | $70 - $512 | 66% |
| Qual Choice Contracted [320325] | $70 - $515 | 66% |
| Cigna | $75 - $1,817 | 70% |
| Centivo Contracted [320505] | $108 - $795 | 101% |
| Medica Contracted [320239] | $125 - $919 | 117% |
| Ambetter / Centene | $136 - $1,005 | 127% |
| Home State Health Plan Contracted [320187] | $136 - $1,005 | 127% |
| Novasys Contracted [320285] | $136 - $1,005 | 127% |
| Hope Trust Contracted [320488] | $147 - $1,084 | 138% |
| Health Choices Contracted [320448] | $178 - $1,313 | 167% |
| Health Choices [20448] | $178 - $1,313 | 167% |
| Medical Associates Health Contracted [320444] | $178 - $1,313 | 167% |
| First Health Contracted [320128] | $195 - $1,434 | 183% |
| United Medical Resources Contracted [320454] | $196 - $1,445 | 184% |
| Mercy Mgd Behavioral Health Contracted [320259] | $223 | 209% |
| Multiplan Contracted [320270] | $223 - $1,642 | 209% |
| Private Health Care Systems Contracted [320320] | $223 | 209% |
| Workers Comp [20426] | $223 - $1,751 | 209% |
| Healthlink Contracted [320179] | $241 - $1,948 | 226% |
| Aither Health Contracted [320449] | $252 - $1,861 | 236% |
| Aither Health [20449] | $252 - $1,861 | 236% |
| Auxiant Contracted [320462] | $252 - $1,861 | 236% |
| Ebms Contracted [320493] | $252 - $1,861 | 236% |
| Edison Health Solutions Contracted [320502] | $252 - $1,861 | 236% |
| Federal Medical Center Contracted [320127] | $252 - $1,861 | 236% |
| Imagine 360 Contracted [320494] | $252 - $1,861 | 236% |
| Insurance System Inc Contracted [320465] | $252 - $1,861 | 236% |
| Mercy Benefit Admin Contracted [320251] | $252 - $1,861 | 236% |
| Mercy Benefit Admin [20251] | $252 - $1,861 | 236% |
| Point C Contracted [320238] | $252 - $1,861 | 236% |
| Preferred Health Plan Contracted [320522] | $252 - $1,861 | 236% |
| Reflect Health Contracted [320492] | $252 - $1,861 | 236% |
| Show-Me Health Administrators Contracted [320483] | $252 - $1,861 | 236% |
| Tri State Healthcare Coalition Contracted [320379] | $252 - $1,861 | 236% |
| Yuzu Health Contracted [320521] | $252 - $1,861 | 236% |