CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Phelps Memorial Health Center

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $2,261
Cash Discount Price: $2,543
vs. Medicare Baseline: 21.17x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Phelps Memorial Health Center is $2,261. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,543. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 21.17x the Medicare baseline. Located in 1215 Tibbals St, Holdrege, NE.

Cash / Self-Pay

$2,543

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,261

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: $2,543 (2381%)

Insurance Median: $2,261 (2117%)

Cash: $2,543 (2381% of Medicare)

Ins. Median: $2,261 (2117% 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 2117% of the Medicare baseline (a markup of 2017%). 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
UnitedHealthcare	$1,159 - $2,741	1085%
Aetna	$1,215 - $2,606	1138%
Blue Cross Blue Shield	$1,215 - $2,685	1138%
Good Samaritan Mcr Adv - All Plans	$1,215	1138%
Medica Mcr Adv	$1,215	1138%
Va Ccn - All Plans	$1,215	1138%
Wellcare Mcr Adv - All Plans	$1,215	1138%
Molina Mcaid - All Plans	$1,243	1164%
Three Rivers - All Plans	$1,458	1365%
6 Degrees Hlth - All Plans	$2,261	2117%
Partners Hlth Alliance - All Plans	$2,261	2117%
Cpi Benefit Group-All Plans	$2,543	2381%
Providrs Care/Wppa - All Plans	$2,543	2381%
Provider Network Of American - All Plans	$2,628	2460%
Medica-All Other Plans	$2,656	2487%
Chi Health Partners - All Plans	$2,685	2514%
Midwest Ntwrk Alliance - All Plans	$2,685	2514%
First Health - All Plans	$2,688	2517%
Ambetter / Centene	$3,159	2958%

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 $2,543.
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 Phelps Memorial Health Center 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.