CMS Price Transparency Data
CT scan, lower back (lumbar spine)
Facility: Mercy Hospital Ardmore, Inc
Billing Code: 72131 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 72131
- Insurance Median: $1,006
- Cash Discount Price: $1,557
- vs. Medicare Baseline: 9.42x Medicare
The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Mercy Hospital Ardmore, Inc is $1,006. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,557. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 9.42x the Medicare baseline. Located in 1011 14Th Ave Nw, Ardmore, OK.
Cash / Self-Pay
$1,557
Average discount available for prompt cash payment at this facility.
Insurance Median
$1,006
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: $1,557 (1458%)
Insurance Median: $1,006 (942%)
Cash: $1,557 (1458% of Medicare)
Ins. Median: $1,006 (942% 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 942% of the Medicare baseline (a markup of 842%). 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.
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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 - $1,524 | 89% |
| Humana | $95 - $1,653 | 89% |
| Medicaid / KanCare | $95 - $146 | 89% |
| Blue Cross Blue Shield | $106 | 99% |
| Cherokee Nation Health Serv Contracted [320066] | $106 | 99% |
| Cross Timbers Hospice [20098] | $106 | 99% |
| Dept Of Veteran Affairs Contracted [320106] | $106 | 99% |
| Elara Caring Aspire Hospice Contracted [320433] | $106 | 99% |
| Elara Caring Aspire Hospice [20433] | $106 | 99% |
| Halo Hcr Inc Hospice Contracted [320432] | $106 | 99% |
| Halo Hcr Inc Hospice [20432] | $106 | 99% |
| Independent Health [20197] | $106 | 99% |
| Indian Health Service Contracted [320198] | $106 | 99% |
| Kindful Hospice Contracted [320434] | $106 | 99% |
| Kindful Hospice [20434] | $106 | 99% |
| Medical Associates Health [20444] | $106 | 99% |
| Medicare (plans) | $106 - $2,396 | 99% |
| Mercy Hospice Okc [20252] | $106 | 99% |
| Provider Partners Health Plans Contracted [320450] | $106 | 99% |
| Qual Choice Contracted [320325] | $106 | 99% |
| Tribute Health Plan Mcr Contracted [320338] | $106 | 99% |
| Tricare | $106 | 99% |
| Globalhealth Contracted [320145] | $108 | 101% |
| UnitedHealthcare | $108 - $851 | 101% |
| Cigna | $110 - $512 | 103% |
| Administrative Payor Contracted [320005] | $137 | 128% |
| Ambetter / Centene | $146 | 137% |
| Home State Health Plan Contracted [320187] | $146 | 137% |
| Novasys Contracted [320285] | $146 | 137% |
| Community Care Contracted [320080] | $162 - $1,677 | 152% |
| Workers Comp [20426] | $183 | 171% |
| Health Choice Contracted [320166] | $239 | 224% |
| Healthsmart Preferred Care Contracted [320184] | $239 - $1,557 | 224% |
| Kempton Contracted [320214] | $239 | 224% |
| Medica Contracted [320239] | $439 - $2,396 | 411% |
| Globalhealth Contracted [320144] | $470 | 440% |
| United Medical Resources Contracted [320454] | $851 - $1,557 | 797% |
| Healthcare Highways Plus Contracted [320175] | $934 - $1,438 | 874% |
| Webtpa Contracted [320417] | $1,006 | 942% |
| Osma Health Contracted [320292] | $1,078 | 1009% |
| Aither Health Contracted [320449] | $1,438 | 1346% |
| Auxiant Contracted [320462] | $1,438 - $1,557 | 1346% |
| Benefit Management Contracted [320052] | $1,438 - $1,557 | 1346% |
| Ebms Contracted [320493] | $1,438 | 1346% |
| Healthlink Contracted [320179] | $1,438 - $1,557 | 1346% |
| Imagine 360 Contracted [320494] | $1,438 | 1346% |
| Mercy Benefit Admin Contracted [320251] | $1,438 - $1,557 | 1346% |
| Quik Trip Contracted [320447] | $1,438 | 1346% |
| Reflect Health Contracted [320492] | $1,438 | 1346% |
| Show-Me Health Administrators Contracted [320483] | $1,438 | 1346% |
| Yuzu Health Contracted [320521] | $1,438 | 1346% |
| Federal Medical Center Contracted [320127] | $1,557 | 1458% |
| Healthscope Contracted [320182] | $1,557 | 1458% |
| Healthsmart Accel Contracted [320183] | $1,557 | 1458% |
| Point C Contracted [320238] | $1,557 | 1458% |
| Preferred Health Plan Contracted [320522] | $1,557 | 1458% |
| Tri State Healthcare Coalition Contracted [320379] | $1,557 | 1458% |
| First Health Contracted [320128] | $1,593 | 1491% |
| Private Health Care Systems Contracted [320320] | $1,797 - $1,917 | 1682% |
| Preferred Community Choice Contracted [320311] | $1,821 | 1705% |
| Multiplan Contracted [320270] | $1,917 - $2,156 | 1795% |