CMS Price Transparency Data
CT scan, lower back (lumbar spine)
Facility: Mercy Hospital Waldron
Billing Code: 72131 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 72131
- Insurance Median: $634
- Cash Discount Price: $1,450
- vs. Medicare Baseline: 5.94x Medicare
The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Mercy Hospital Waldron is $634. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,450. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 5.94x the Medicare baseline. Located in 1341 West Sixth Street, Waldron, AR.
Cash / Self-Pay
$1,450
Average discount available for prompt cash payment at this facility.
Insurance Median
$634
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: $1,450 (1358%)
Insurance Median: $634 (594%)
Cash: $1,450 (1358% of Medicare)
Ins. Median: $634 (594% 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 594% of the Medicare baseline (a markup of 494%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
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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 - $1,450 | 89% |
| Humana | $95 - $1,896 | 89% |
| Medicaid / KanCare | $95 - $870 | 89% |
| Blue Cross Blue Shield | $108 - $613 | 101% |
| Usable Contracted [320409] | $108 | 101% |
| Summit Community Care Contracted [320368] | $215 | 201% |
| United Medical Resources Contracted [320454] | $252 | 236% |
| UnitedHealthcare | $252 - $613 | 236% |
| Novasys Contracted [320285] | $306 - $870 | 286% |
| Arkansas Total Care Contracted [320039] | $488 | 457% |
| Tricare | $602 | 564% |
| American Health Advantage Of Mo Mcr [20264] | $613 | 574% |
| Cherokee Nation Health Serv Contracted [320066] | $613 | 574% |
| Cross Timbers Hospice [20098] | $613 | 574% |
| Dept Of Veteran Affairs Contracted [320106] | $613 | 574% |
| Elara Caring Aspire Hospice Contracted [320433] | $613 | 574% |
| Elara Caring Aspire Hospice [20433] | $613 | 574% |
| Globalhealth Contracted [320145] | $613 | 574% |
| Halo Hcr Inc Hospice Contracted [320432] | $613 | 574% |
| Halo Hcr Inc Hospice [20432] | $613 | 574% |
| Independent Health [20197] | $613 | 574% |
| Indian Health Service Contracted [320198] | $613 | 574% |
| Indian Health Service [20198] | $613 | 574% |
| Jordan Valley Senior Care Pace [20515] | $613 | 574% |
| Kindful Hospice Contracted [320434] | $613 | 574% |
| Kindful Hospice [20434] | $613 | 574% |
| Medical Associates Health [20444] | $613 | 574% |
| Medicare (plans) | $613 - $643 | 574% |
| Mercy Hospice Okc [20252] | $613 | 574% |
| Pace Of The Ozarks [20518] | $613 | 574% |
| Provider Partners Health Plans Contracted [320450] | $613 | 574% |
| Qual Choice Contracted [320325] | $613 | 574% |
| Spina Bifida Hlthcare Benefit [20506] | $613 | 574% |
| Valir Pace [20503] | $613 | 574% |
| Cigna | $643 - $1,896 | 602% |
| Ambetter / Centene | $870 | 815% |
| Home State Health Plan Contracted [320187] | $870 | 815% |
| Qual Choice Contracted [320324] | $921 | 862% |
| Mercy Interfacility [20513] | $993 | 930% |
| Auxiant Contracted [320462] | $1,339 - $2,008 | 1254% |
| Mercy Benefit Admin Contracted [320251] | $1,339 - $2,008 | 1254% |
| Workers Comp [20426] | $1,450 | 1358% |
| 90 Degree Benefits Contracted [320436] | $1,896 | 1775% |
| Aither Health Contracted [320449] | $1,896 | 1775% |
| Ebms Contracted [320493] | $1,896 | 1775% |
| Edison Health Solutions Contracted [320502] | $1,896 | 1775% |
| Healthlink Contracted [320179] | $1,896 - $2,008 | 1775% |
| Imagine 360 Contracted [320494] | $1,896 | 1775% |
| Multiplan Contracted [320270] | $1,896 | 1775% |
| Multiplan [20270] | $1,896 | 1775% |
| Municipal Health Plan Contracted [320271] | $1,896 | 1775% |
| Reflect Health Contracted [320492] | $1,896 | 1775% |
| Show-Me Health Administrators Contracted [320483] | $1,896 | 1775% |
| Federal Medical Center Contracted [320127] | $2,008 | 1880% |
| Healthscope Contracted [320182] | $2,008 | 1880% |
| Insurance System Inc Contracted [320465] | $2,008 | 1880% |
| Personify Health Contracted [320051] | $2,008 | 1880% |
| Point C Contracted [320238] | $2,008 | 1880% |
| Preferred Health Plan Contracted [320522] | $2,008 | 1880% |
| Tri State Healthcare Coalition Contracted [320379] | $2,008 | 1880% |