CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Sanford Wheaton Medical Center

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $1,954
Cash Discount Price: $1,872
vs. Medicare Baseline: 18.29x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Sanford Wheaton Medical Center is $1,954. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,872. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 18.29x the Medicare baseline. Located in 401 12Th Street North, Wheaton, MN.

Cash / Self-Pay

$1,872

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,954

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: $1,872 (1753%)

Insurance Median: $1,954 (1829%)

Cash: $1,872 (1753% of Medicare)

Ins. Median: $1,954 (1829% 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 1829% of the Medicare baseline (a markup of 1729%). 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
Ucare	$112 - $2,056	105%
Blue Cross Blue Shield	$353 - $1,611	330%
Sanford Health Plan Align	$1,179	1104%
Aetna	$1,278 - $2,033	1197%
Health Partners	$1,278 - $1,895	1197%
Medicare (plans)	$1,278	1197%
UnitedHealthcare	$1,278 - $1,954	1197%
Security Health Plan	$1,287	1205%
Primewest	$1,302 - $1,416	1219%
Sanford Health Plan	$1,847 - $2,173	1729%
Medica	$2,057 - $2,214	1926%
First Choice Health Network	$2,106	1972%
Healthez	$2,106	1972%
Multiplan	$2,106	1972%

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 $1,872.
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 Sanford Wheaton Medical 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.