CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Mercy Hospital Carthage

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $917
Cash Discount Price: $1,086
vs. Medicare Baseline: 8.59x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Mercy Hospital Carthage is $917. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,086. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 8.59x the Medicare baseline. Located in 3125 Dr Russell Smith Way, Carthage, MO.

Cash / Self-Pay

$1,086

Average discount available for prompt cash payment at this facility.

Insurance Median

$917

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: $1,086 (1017%)

Insurance Median: $917 (859%)

Cash: $1,086 (1017% of Medicare)

Ins. Median: $917 (859% 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 859% of the Medicare baseline (a markup of 759%). 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
Blue Cross Blue Shield	$60 - $467	56%
Medicaid / KanCare	$60 - $917	56%
Aetna	$95 - $1,487	89%
Humana	$95 - $501	89%
Medicare (plans)	$100 - $494	94%
UnitedHealthcare	$140 - $1,454	131%
Cherokee Nation Health Serv Contracted [320066]	$459	430%
Cigna	$459 - $1,504	430%
Cross Timbers Hospice [20098]	$459	430%
Dept Of Veteran Affairs Contracted [320106]	$459	430%
Elara Caring Aspire Hospice [20433]	$459	430%
Globalhealth Contracted [320145]	$459	430%
Halo Hcr Inc Hospice Contracted [320432]	$459	430%
Halo Hcr Inc Hospice [20432]	$459	430%
Indian Health Service Contracted [320198]	$459	430%
Kindful Hospice Contracted [320434]	$459	430%
Kindful Hospice [20434]	$459	430%
Medical Associates Health Contracted [320444]	$459	430%
Mercy Hospice Okc [20252]	$459	430%
Mercy Mgd Behavioral Health Contracted [320259]	$459	430%
Pace Of The Ozarks Contracted [320518]	$459	430%
Provider Partners Health Plans Contracted [320450]	$459	430%
Qual Choice Contracted [320325]	$459	430%
Tricare	$461	432%
Point C Contracted [320238]	$585 - $1,504	548%
Health Systems Inc Contracted [320174]	$719	673%
Insurance System Inc Contracted [320465]	$719	673%
Administrative Payor Contracted [320005]	$752	704%
Centivo Contracted [320505]	$769	720%
Healthscope Contracted [320182]	$871	815%
Ambetter / Centene	$917	859%
Home State Health Plan Contracted [320187]	$917	859%
Novasys Contracted [320285]	$917	859%
Benefit Management Contracted [320052]	$1,003 - $1,454	939%
United Medical Resources Contracted [320454]	$1,031 - $1,504	965%
Auxiant Contracted [320462]	$1,086 - $1,420	1017%
Healthlink Contracted [320179]	$1,086 - $1,554	1017%
Preferred Health Plan Contracted [320522]	$1,086	1017%
Workers Comp [20426]	$1,337 - $1,671	1252%
90 Degree Benefits Contracted [320436]	$1,420	1329%
Aither Health Contracted [320449]	$1,420	1329%
Ebms Contracted [320493]	$1,420	1329%
Edison Health Solutions Contracted [320502]	$1,420	1329%
Imagine 360 Contracted [320494]	$1,420	1329%
Mercy Benefit Admin Contracted [320251]	$1,420 - $1,504	1329%
Reflect Health Contracted [320492]	$1,420	1329%
Show-Me Health Administrators Contracted [320483]	$1,420	1329%
Yuzu Health Contracted [320521]	$1,420	1329%
Medica Contracted [320239]	$1,447	1355%
Evolutions Health Care Contracted [320124]	$1,454	1361%
First Health Contracted [320128]	$1,454	1361%
Multiplan Contracted [320270]	$1,454	1361%
Private Health Care Systems Contracted [320320]	$1,454	1361%
American Healthcare Alliance Contracted [320020]	$1,504	1408%
Ppo Plus Contracted [320310]	$1,504	1408%
Usa Managed Care Org Contracted [320429]	$1,504	1408%

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 $1,086.
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 Carthage 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.