CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Highlands Cashiers Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $1,709
Cash Discount Price: $3,824
vs. Medicare Baseline: 16.00x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Highlands Cashiers Hospital is $1,709. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,824. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 16.00x the Medicare baseline. Located in 190 Hospital Drive, Highlands, NC.

Cash / Self-Pay

$3,824

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,709

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: $3,824 (3580%)

Insurance Median: $1,709 (1600%)

Cash: $3,824 (3580% of Medicare)

Ins. Median: $1,709 (1600% 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 1600% of the Medicare baseline (a markup of 1500%). 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
Apex Health	$765	716%
Cigna	$1,254 - $1,698	1174%
Blue Cross Blue Shield	$1,301 - $1,377	1218%
United	$1,321 - $2,317	1237%
Wellcare	$1,340	1255%
Amerihealth	$1,353	1267%
Partners Health Management	$1,366	1279%
Vaya Health	$1,366	1279%
Amerihealth Caritas	$1,453	1360%
Caresource	$1,683	1576%
Medcost	$1,793 - $2,158	1679%
Aetna	$1,836 - $2,780	1719%
Magellan	$2,294	2148%
Magellan Behavioral Health	$2,294	2148%
Multiplan	$3,059	2864%
Avalon Administrative Services	$3,250	3043%
Prime Health	$3,365 - $3,442	3150%

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 $3,824.
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 Highlands Cashiers Hospital 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.