CT scan, lower back (lumbar spine)
Facility: Phillips County Hospital
Billing Code: 72131 (CPT)
- CPT Billing Code: 72131
- Insurance Median: $572
- Cash Discount Price: $537
- vs. Medicare Baseline: 5.36x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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 536% of the Medicare baseline (a markup of 436%). 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.
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 | $480 - $512 | 449% |
| UnitedHealthcare | $506 - $632 | 474% |
| Medicaid / KanCare | $632 | 592% |
| Health Partners-All Plans | $632 | 592% |
Consumer Guidance & Cost Commentary
For a CT scan of the lower back at Phillips County Hospital, the cash median price is $537.00, which is lower than the negotiated rates paid by major insurers like UnitedHealthcare ($506–$632) and Blue Cross Blue Shield ($480–$512). While Medicaid and Health Partners-All Plans pay the full gross charge of $632.00, patients with high-deductible plans may find paying cash directly more cost-effective, as the cash price avoids the administrative markup inherent in insurance billing cycles. It is important to note that while the facility is a Critical Access Hospital in Phillipsburg, KS, with government-local ownership, the cash rate remains the most transparent baseline for comparison against commercial payer contracts.
To ensure you receive the most accurate billing, always request a full itemized bill before paying, as summary invoices can obscure errors or unbundled charges. If you receive a balance bill for out-of-network services, remember that the No Surprises Act protects you from paying the difference between the provider's chargemaster and your insurance allowed amount for emergency care and non-emergency services at in-network facilities. Additionally, since the facility offers a prompt-pay discount for upfront payments, you should explicitly ask for a self-pay classification and a prompt-pay rate at registration to avoid automatic claims submission, which can void any potential cash savings.