CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: UW Health

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $746
Cash Discount Price: $519
vs. Medicare Baseline: 6.98x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at UW Health is $746. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $519. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 6.98x the Medicare baseline. Located in 1401 East State Street, Rockford, IL.

Cash / Self-Pay

$519

Average discount available for prompt cash payment at this facility.

Insurance Median

$746

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: $519 (486%)

Insurance Median: $746 (698%)

Cash: $519 (486% of Medicare)

Ins. Median: $746 (698% 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 698% of the Medicare baseline (a markup of 598%). 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
Aetna	$107 - $1,506	100%
Blue Cross Blue Shield	$107 - $927	100%
Humana	$107	100%
Medicare (plans)	$107 - $117	100%
Mychoice Wi Medical Adv	$107	100%
UnitedHealthcare	$107 - $1,604	100%
Quartz Fully Insured	$724	678%
Ecoh	$1,058 - $1,642	991%
Hfn	$1,058 - $1,642	991%
Alliance Premier Network	$1,139	1066%
Quartz Aso	$1,139	1066%
The Alliance	$1,466	1373%
Wps Ppo	$1,613	1510%
Cigna	$1,665	1559%
Beloit Healt System	$1,883	1763%
Mercycare	$1,948	1824%
First Health/Coventry	$2,051	1920%
Health Payment Systems	$2,434	2279%
Healthsmart	$2,434	2279%
Sheboygan Employers Health Network	$2,597	2431%
Multiplan	$2,902	2717%

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 $519.
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 UW Health 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.