CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Mercy Hospital Logan County

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $1,649
Cash Discount Price: $1,826
vs. Medicare Baseline: 15.44x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Mercy Hospital Logan County is $1,649. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,826. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 15.44x the Medicare baseline. Located in 200 S Academy Rd, Guthrie, OK.

Cash / Self-Pay

$1,826

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,649

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: $1,826 (1710%)

Insurance Median: $1,649 (1544%)

Cash: $1,826 (1710% of Medicare)

Ins. Median: $1,649 (1544% 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 1544% of the Medicare baseline (a markup of 1444%). 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
Aetna	$95 - $1,649	89%
Humana	$95 - $717	89%
Medicaid / KanCare	$95 - $843	89%
Health Choice Contracted [320166]	$239	224%
Tricare	$697	653%
Blue Cross Blue Shield	$717 - $1,348	671%
Cherokee Nation Health Serv Contracted [320066]	$717	671%
Cross Timbers Hospice [20098]	$717	671%
Dept Of Veteran Affairs Contracted [320106]	$717	671%
Elara Caring Aspire Hospice Contracted [320433]	$717	671%
Elara Caring Aspire Hospice [20433]	$717	671%
Halo Hcr Inc Hospice Contracted [320432]	$717	671%
Halo Hcr Inc Hospice [20432]	$717	671%
Independent Health [20197]	$717	671%
Indian Health Service Contracted [320198]	$717	671%
Kindful Hospice Contracted [320434]	$717	671%
Kindful Hospice [20434]	$717	671%
Medical Associates Health [20444]	$717	671%
Medicare (plans)	$717 - $1,404	671%
Mercy Hospice Okc [20252]	$717	671%
Provider Partners Health Plans Contracted [320450]	$717	671%
Qual Choice Contracted [320325]	$717	671%
Tribute Health Plan Mcr Contracted [320338]	$717	671%
UnitedHealthcare	$717 - $1,966	671%
Globalhealth Contracted [320145]	$731	684%
Cigna	$739 - $2,388	692%
Ambetter / Centene	$843	789%
Home State Health Plan Contracted [320187]	$843	789%
Novasys Contracted [320285]	$843	789%
Webtpa Contracted [320417]	$1,180	1105%
Community Care Contracted [320080]	$1,374	1286%
Medica Contracted [320239]	$1,404	1314%
Aither Health Contracted [320449]	$1,685 - $2,388	1578%
Auxiant Contracted [320462]	$1,685 - $2,388	1578%
Federal Medical Center Contracted [320127]	$1,685	1578%
Healthlink Contracted [320179]	$1,685 - $2,388	1578%
Healthscope Contracted [320182]	$1,685	1578%
Mercy Benefit Admin Contracted [320251]	$1,685 - $2,388	1578%
Point C Contracted [320238]	$1,685	1578%
Preferred Health Plan Contracted [320522]	$1,685	1578%
Quik Trip Contracted [320447]	$1,685	1578%
Show-Me Health Administrators Contracted [320483]	$1,685	1578%
United Medical Resources Contracted [320454]	$1,685 - $1,966	1578%
Osma Health Contracted [320292]	$1,966	1841%
United Behavioral Health Contracted [320390]	$1,966	1841%
Benefit Management Contracted [320052]	$2,107 - $2,528	1973%
Globalhealth Contracted [320144]	$2,107	1973%
Healthcare Highways Plus Contracted [320175]	$2,107	1973%
Private Health Care Systems Contracted [320320]	$2,107 - $2,247	1973%
First Health Contracted [320128]	$2,197	2057%
Multiplan Contracted [320270]	$2,247 - $2,528	2104%
Ebms Contracted [320493]	$2,388	2236%
Imagine 360 Contracted [320494]	$2,388	2236%
Preferred Community Choice Contracted [320311]	$2,388	2236%
Reflect Health Contracted [320492]	$2,388	2236%
Yuzu Health Contracted [320521]	$2,388	2236%

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 $1,826.
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 Logan County 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.